There is a particular kind of disorientation that many women describe in perimenopause, and it does not always make it onto the standard list of symptoms alongside hot flashes and disrupted sleep. It is more subtle and more unsettling than that. A sense of not quite recognising yourself. Of feeling present in your life but somehow not fully in it. Of looking back at the person you were two years ago and struggling to locate the thread between her and the person you are now. This is not a sign that you are losing your mind. But it is worth taking seriously, especially if you have a history of trauma.
When hormones and trauma history meet
Perimenopause involves significant and often unpredictable fluctuations in oestrogen and progesterone. Those hormones do not only regulate physical symptoms. They play a direct role in mood, memory, the stress response, and the brain’s ability to feel safe and settled. When they become unstable, the nervous system registers that instability, and for women with a trauma history, that registration can be acute.
Research now suggests that women who have experienced trauma show heightened sensitivity to the hormonal shifts of the menopausal transition. The nervous system that spent years learning to stay alert does not suddenly find rest when oestrogen drops. In many cases it becomes more reactive, more easily dysregulated, more prone to the kinds of responses that were once managed but now feel suddenly harder to contain.
One of those responses is dissociation. The word sounds clinical, and for many people it conjures extreme presentations they do not recognise in themselves. But dissociation exists on a spectrum. At the milder end, it looks like spacing out, feeling foggy, going through the motions of a day without feeling quite connected to it. It looks like forgetting what you came into the room for, but in a way that feels different from ordinary forgetfulness, heavier, more like a gap in your sense of continuity. It can look like watching yourself from a slight distance, going through your life while not entirely feeling that you are in it.
For women with trauma histories, this kind of experience is not new. Many will have learnt to dissociate as a way of managing overwhelming feelings in childhood. Perimenopause can lower the threshold at which that familiar response kicks in, making it more frequent, more noticeable, harder to dismiss and difficult to manage.
The identity question
Perimenopause asks something of you beyond the physical. It tends to coincide with significant life changes, children leaving home, parents ageing or dying, shifts in professional identity, relationships evolving or ending. The question of who you are, separate from the roles you have always occupied, becomes harder to avoid. For women who built their sense of self around being capable, contained, and in control, this can feel particularly destabilising. The body is changing without your permission. The emotional regulation that felt hard-won is less reliable. Things you had managed for years are surfacing in ways you did not expect.
This is not a crisis of character. It is a collision between a significant life transition and a nervous system that has been working hard for a very long time. What it can open up, in the right conditions, is something genuinely useful. Perimenopause, for all its difficulty, is also a moment when old patterns become more visible precisely because they are less easy to sustain. Some women find that this is when they finally seek help, not because they have fallen apart, but because the version of themselves that held everything together has become too costly to maintain.
Therapy during perimenopause is not about managing symptoms. It is about understanding the relationship between your history, your nervous system, and the person you are becoming. That kind of work takes time and requires a space that is consistent and unhurried. But many women find it to be some of the most meaningful work they have ever done. If you recognise yourself here and would like to explore whether therapy might help, you are welcome to get in touch.
About the author
Samantha Merry is a BACP Senior Accredited Psychotherapist and Clinical Supervisor based in Bromley, South East London. She specialises in menopause, trauma, burnout, and complex family dynamics, working with adults in longer-term psychodynamic therapy. She is currently completing a Professional Doctorate in Psychotherapy and Psychological Trauma at the University of Chester.
Further reading and listening
Books
- Flash Count Diary by Darcey Steinke. An exploration of menopause as a passage of identity, ageing, and the body
- Burnout by Emily and Amelia Nagoski. Why women’s stress responses function differently, and what recovery requires.
- Break the Cycle by Mariel Buqué. This book looks at intergenerational trauma and its effects identity
Podcast
- Menopause and Mental Health hosted by Professor Jayashri Kulkarni, a psychiatrist with expertise in reproductive hormones and mental health. https://open.spotify.com/episode/1D4XNCjqMK8PSFui0XoUNR
TED Talk
- Dr. Lisa Mosconi is a neuroscientist a whose research focuses on the female brain, hormonal transitions, and cognitive health. Her TED Talk offers a neuroscience-grounded perspective on what perimenopause does to the brain. https://www.ted.com/talks/lisa_mosconi_how_menopause_affects_the_brain