Perimenopause In The Counselling Room - The Menopause-Informed Therapist Series

For Counsellors & Mental Health Workers

She's in her mid-forties. She's been coming to see you for a few months, working through what she describes as burnout. She's exhausted, irritable, not sleeping well, struggling to concentrate at work. She cries sometimes and can't really explain why.

You're doing good work together. But there's something that keeps nagging — the picture doesn't quite add up. The stress is real, but it doesn't fully explain the symptom profile. The interventions that should be helping aren't moving the needle the way you'd expect.

Here's a question worth sitting with: could perimenopause be part of what's happening?

Not instead of everything else — alongside it.

Here's what most of us weren't taught

Perimenopause - the transition phase leading into menopause - can begin up to ten years before a woman's final period. For many women, it starts in their early-to-mid forties. Sometimes earlier.

And it doesn't announce itself with hot flushes and night sweats (though those come too, for many). It often starts quietly. With mood changes. Sleep disruption. A kind of low-grade anxiety that feels new and hard to explain. Brain fog. A sense of "I don't feel like myself anymore" that's difficult to pin down.

Sound familiar?

The problem is, these symptoms overlap significantly with depression, anxiety, burnout, and ADHD. Which means they land in our clinic rooms - and in GP appointments, and in psychiatry sessions - and get treated as purely psychological without anyone asking: where are you in your cycle? When did you last have a period? Has anyone mentioned perimenopause?

Research suggests only around one in ten women receives adequate menopause-related healthcare. That gap doesn't start with menopause specialists — it starts much earlier, in the everyday clinical encounters where women are first trying to make sense of what's happening to them.

We are those encounters.

This isn't about becoming a menopause specialist

It's about adding a lens. Asking a question you might not have thought to ask. Knowing enough to say: "I wonder if it's worth exploring whether perimenopause might be contributing to some of what you're experiencing," and to know who to refer to when that exploration needs medical input.

It's about not missing something that affects roughly half the population and is almost entirely absent from our counselling training.

Coming up in this series

Over the next few weeks, we're going to look at some of the specific ways menopause shows up in our clients' lives and in our therapy rooms, often without anyone naming it. We'll cover the mental health overlap, the cognitive symptoms, the identity shifts, and what we can actually do as counsellors.

And professional development is being released this November 2026 — The Menopause-Informed Therapist — for counsellors and mental health workers who want to build this into their practice in a meaningful way.

More on that soon. For now: just sit with the question.

Who's already in your caseload that might fit this description?