Perimenopause, Menopause & Mental Health: You’re Not Just Tired, Crazy, or Lazy—You're Hormonal, and It's Real

Perimenopause, Menopause & Mental Health: what you deserve to know

You’re exhausted. You forget what you were saying mid-sentence. You feel like crying, screaming, or sleeping for 72 hours—and then feel guilty about all of it.

If you’re between 35 and 55, this isn’t a breakdown. It’s not weakness. It’s not “just aging.”

It’s likely perimenopause or menopause—and the hormonal shifts behind it can wreak havoc on mental health, emotional resilience, energy levels, and cognitive functioning.

At Open Road Psychiatric Services, we understand how often this is ignored, dismissed, or misdiagnosed—and how much you need someone to actually listen.

🌪️ What Is Perimenopause and Why Does It Wreck Me?

Perimenopause is the stage leading up to menopause, when hormone levels start to fluctuate and drop. It can start in your mid-30s to early 40s and last anywhere from 2 to 10 years. Menopause is defined as 12 months with no period, but the symptoms often start long before—and linger after.

Most people know about hot flashes, but perimenopause can bring a storm of physical and mental symptoms that feel like they came out of nowhere.

🧠 The “Invisible” Symptoms of Perimenopause & Menopause

💨 Chronic Fatigue

This isn’t “I stayed up too late” tired. This is bone-deep exhaustion that no amount of sleep or caffeine seems to fix. Hormonal changes—especially drops in estrogen, progesterone, and testosterone—impact your mitochondrial functionand nervous system regulation, leading to persistent fatigue.

Research published in Menopause found that up to 85% of women in perimenopause report moderate to severe fatigue, often worsening with poor sleep and mental health symptoms (Koloski et al., 2021).

🧊 Brain Fog

You walk into a room and forget why. You blank on the name of a coworker you’ve known for years. You start a sentence and then completely lose the thread.
Estrogen plays a crucial role in memory, attention, and verbal recall—and when it fluctuates or drops, your cognitive clarity can go with it.

Neuroimaging shows decreased activation in the hippocampus and prefrontal cortex during verbal tasks in postmenopausal women—especially those not on hormone therapy (Weber et al., 2014).

🌊 Mood Swings and Emotional Sensitivity

One moment you feel fine; the next you’re sobbing in the car because your coffee order was wrong. Sound familiar? Hormonal shifts affect the serotonin and dopamine systems, both of which regulate mood.

A 2018 Harvard Review of Psychiatry article reported that women in perimenopause are 2–5 times more likely to develop new or worsening depression and anxiety, even without a prior mental health history (Epperson et al., 2018).

😶 Low Motivation, Apathy, and Executive Dysfunction

Tasks feel overwhelming. Projects sit unfinished. You know you need to do something but can’t start—or can’t stop doom-scrolling. This isn’t laziness. It’s a dopamine and cortisol mismatch, and it affects your ability to plan, prioritize, and complete tasks—especially if you’re also experiencing or uncovering ADHD.

🧠 The Overlap Between Perimenopause & ADHD

As estrogen drops, so does dopamine regulation—a core problem in ADHD. Women with previously undiagnosed ADHD often see their symptoms explode in perimenopause: disorganization, overwhelm, impulsive spending, emotional outbursts, missed deadlines, and serious self-doubt.

But unlike men, women’s ADHD often goes unrecognized—masked by overcompensation, people-pleasing, and shame.

In a 2020 study from The Journal of Clinical Psychiatry, women were more likely to receive an ADHD diagnosis decades after symptom onset, usually during a significant life stressor or hormonal shift (Quinn & Madhoo, 2020).

🚫 Why You’ve Probably Been Ignored (And Why It’s Not Your Fault)

Despite all this research, women are frequently told:

• “It’s just stress.”

• “You’re overreacting.”

• “You’re getting older, what do you expect?”

• “Have you tried yoga?”

The problem isn’t you—it’s a healthcare system that has historically prioritized male models for mental health. Most studies on depression, ADHD, and medication have been conducted on young men, excluding women due to hormonal “complications.”

Even now, less than 30% of neuroscience research includes female subjects—and only a fraction focuses on menopause-related changes (Shansky, 2019).

This creates a massive knowledge gap—and women pay the price with missed diagnoses, inappropriate treatment, and preventable suffering.

💊 What Treatment Looks Like (and Why It’s Not One-Size-Fits-All)

Here’s the good news: you don’t have to just “wait it out.”

At Open Road Psychiatric Services, we create individualized treatment plans that can include:

• Psychiatric evaluation that considers hormone status, life stage, and neurocognitive changes

• ADHD screening and stimulant or non-stimulant medication as appropriate

• Medication support for anxiety, depression, insomnia, or executive function

• Therapy referrals or collaboration to support emotional regulation and identity transitions

• Education and tools to help you advocate for yourself and track your symptoms

• Support with insurance reimbursement via Reimbursify—so you don’t have to stress about paperwork on top of everything else

Whether it’s a low dose of an SSRI, a stimulant for focus, or just finally getting validation that you’re not losing your mind—we’re here for it.

💬 We Believe You. We See You. We’ve Got You.

Open Road Psych offers virtual psychiatric services for women in Delaware, Florida, Massachusetts, and Pennsylvania. We understand that mental health care should be collaborative, validating, and grounded in real science.

You're not “crazy.” You're not “lazy.” You're not “just hormonal.”
You're changing—and that change deserves compassion, clarity, and care.

📅 Ready to Feel Like You Again?