This article provides a clinically grounded overview of the psychological and neurobiological impact of perimenopause for an informed adult audience. It covers the neurobiological basis of perimenopausal psychological symptoms — including oestrogen's role in serotonergic, dopaminergic, and noradrenergic systems, HPA axis modulation, hippocampal neuroplasticity, and sleep architecture — and addresses the window of vulnerability for mood disorders during late perimenopause (Freeman et al., 2006; Soares, 2014).
The symptom profile is addressed in detail, including anxiety, depression, rage and irritability, cognitive changes, sleep disruption, and identity disruption. The diagnostic pattern of perimenopausal women receiving psychiatric diagnoses in the absence of hormonal evaluation is noted (Maki et al., 2019).
Evidence-based management options are covered: menopausal hormone therapy with reference to the revised post-WHI evidence base (NICE, 2015), antidepressants, CBT-M (Ayers et al., 2012), CBT-I, and exercise (Daley et al., 2015). Guidance on how to structure the GP consultation is included.
A dedicated section addresses the neurodivergent-perimenopause intersection — specifically, oestrogen's modulating effect on dopamine systems in ADHD, and the compounding of autistic burnout through the removal of hormonal scaffolding supporting masking — which is not adequately represented in current clinical guidance.
Dr Melanie du Preez | HPCSA-registered Clinical Psychologist | 26 years clinical experience | Founder, Mindpath Academy | Maudsley/FBT-certified | Specialisations: neurodivergence, trauma, burnout, LGBTQ+ mental health