Perimenopause and menopause
Perimenopause and menopause are major biological transitions that can affect not only a woman’s physical health, but also her emotional well-being.
What is perimenopause and menopause?
Perimenopause and menopause are major biological transitions that can affect not only a woman’s physical health, but also her emotional well-being. Hormonal changes during this period often influence mood, sleep, stress tolerance, and overall mental health. For some women, these shifts can become overwhelming.
When does it usually happen in Singapore?
- Perimenopause often begins between age 40 and 48 for women in Singapore.
- Menopause typically occurs between age 49 and 52.
- Genetic factors, lifestyle, medical conditions and past treatments (e.g., chemotherapy, oophorectomy) may influence timing.
Because many Singaporean women in this age group juggle multiple roles such as work responsibilities, caregiving for children, supporting aging parents, emotional symptoms can feel more pronounced.
How hormonal changes can affect mental health?
Fluctuations in estrogen and progesterone during perimenopause and menopause can influence brain regions that regulate mood, sleep and stress responses. This can contribute to common emotional and psychological symptoms:
- Low mood or depressive symptoms
- Anxiety or excessive worry
- Irritability or emotional sensitivity
- Difficulty coping with daily stress
- Reduced motivation or energy
- Difficulty concentrating
- Mood swings
- Sleep disturbances (which may worsen mood difficulties)
These symptoms can occur even in women with no prior history of mental health concerns. If emotional symptoms:
- interfere with your daily functioning,
- affect work or relationships,
- or persist for several weeks,
it may be helpful to seek professional support.
Mental health conditions linked to hormonal transitions
Perimenopause and menopause can sometimes overlap with or trigger:
- Major depressive disorder
- Anxiety disorder
- Panic disorder
- Insomnia
- Adjustment-related stress
- Cognitive difficulties (“brain fog”)
Women with a past history of depression, anxiety or postpartum mental health conditions may be more vulnerable to experiencing recurrent symptoms during this phase.
How we can help
Comprehensive assessment
We take the time to understand your symptoms, medical history, life stresses and overall well-being. A detailed assessment helps differentiate between hormone-related changes and mental health conditions that may require treatment.
Personalised treatment
Everyone’s experience of perimenopause and menopause is different. Your treatment plan may include:
- Psychotherapy
- Medication when appropriate
- Sleep and lifestyle strategies
- Support for stress, work-life demands and role transitions
- Coordination with your gynaecologist or endocrinologist if needed
Psychotherapy
Many women find that the emotional and psychological changes of perimenopause and menopause improve psychological support. Psychotherapy is often the first line of care, especially when symptoms are mild to moderate.
We work closely with psychologists who provide evidence-based therapies tailored to the challenges women commonly face during this transition. These approaches can help you:
- Understand how hormonal changes affect mood, energy and stress responses
- Build tools to manage mood swings, irritability or heightened anxiety
- Improve sleep through behavioural and cognitive strategies
- Cope with life-role pressures, such as caregiving responsibilities or workplace stress
- Strengthen emotional resilience and self-confidence
- Develop practical ways to navigate changes in identity, relationships and self-perception
Common therapeutic approaches include Cognitive-Behavioural Therapy (CBT), and other evidence-based methods focused on emotional regulation, stress management, and supportive coping strategies.
Medication management
Medication is not necessary for everyone, and many women do well with psychotherapy, lifestyle adjustments, and supportive care alone. However, for some individuals, medication may be a helpful part of a broader treatment plan, depending on the severity of symptoms, co-existing mental health conditions, and overall health.
We will only consider medication when appropriate, based on a careful assessment of your needs and preferences.
Understanding medication options
If hormonal treatment is not suitable for you, there are non-hormonal medications that may help with certain physical or psychological symptoms. It is important to note that menopause guidelines generally advise that:
- Antidepressants are not considered first-line treatment for low mood caused purely by menopause-related hormonal changes
- They can be considered second line if symptoms persist, or when an individual has a diagnosed depressive or anxiety disorder
- Common antidepressants used in such situations (depending on individual suitability) include venlafaxine, fluoxetine, and sertraline
For women who struggle with hot flushes and are unable to take hormonal therapy, medications like gabapentin or pregabalin may sometimes be used under medical guidance. Not everyone will need these medications, and treatment decisions are made collaboratively, based on your clinical presentation and comfort level.
When to reach out
If any of the following have been weighing on you, speaking with someone may offer relief and clarity:
- Experiencing persistent mood changes
- Feeling unusually overwhelmed or emotionally reactive
- Finding it hard to cope with work or family responsibilities
- Struggling with sleep despite lifestyle adjustments
- Unsure whether your symptoms are hormonal or psychological
Seeking support early can help you manage symptoms more effectively and maintain your quality of life during this transition.
You’re not alone
Perimenopause and menopause are natural parts of a woman’s life, but that does not mean you must navigate them alone. If you’re finding this phase emotionally challenging, support is available.
Our team is here to help you understand what you’re experiencing and guide you towards feeling more grounded and confident.