Women's mental health at midlife:
Specialized psychotherapy for perimenopause and menopause
Sharon Manning, LICSW, offers psychotherapy for women navigating perimenopause and menopause in Massachusetts.
Using an integrative, evidence-based approach that includes EMDR, IFS, and CBT, Sharon supports women in managing anxiety, mood changes, sleep disruption, and the identity shifts that often accompany midlife. Virtual therapy sessions are available via telehealth.
Most people recognize the emotional challenges of puberty or pregnancy — but menopause is different. It's not just another phase in the reproductive journey. It marks a profound life transition that often arrives alongside shifting roles, cumulative stress, evolving relationships, and deep questions about identity, meaning, and aging.
Menopause sits at the intersection of hormones, life history, and mental health — and it deserves care that understands all three. I'm a licensed clinical social worker (MSW, LICSW) whose interest in this work took root through my time within Mass General Brigham's hospital-based menopause program; this private practice operates separately from that work. I've focused my training and practice on how hormonal changes interact with emotions, cognition, and a woman's personal history, so we can address what you're experiencing as a whole — not as separate pieces. Together, we can address the challenges you're facing while helping you reclaim a sense of clarity, purpose, and well-being.
What's Actually Happening
Neurobiological shifts in perimenopause and menopause can directly affect mood, anxiety, and thinking. As estrogen levels drop — often unpredictably, before they decline for good — they influence how the brain's serotonin and norepinephrine systems function. This is part of why so many women experience sudden panic, a new sense of dread, or depressive episodes unlike anything they've felt before, even without any prior history of anxiety or depression.
But unlike earlier hormonal milestones, menopause is more likely to arrive alongside caregiving for older relatives, career changes, grief or loss, and the re-emergence of old wounds. So these symptoms aren't simply "hormonal" — they're shaped by the broader context of your life and history. Common experiences at this stage include:
Mood swings or heightened anxiety
Brain fog or word-finding difficulties
Sleep disruption and persistent fatigue
Irritability or low mood
A sense of disconnection from yourself or others
These experiences are real, and far more common than most women realize. If you've been wondering whether this is normal, you're not alone.
It's also common for old grief or past trauma to resurface during this time. Hormone-driven nervous system changes can thin the emotional "buffer" that once helped you push through, leaving your system more easily overwhelmed. Past trauma — rooted in childhood, relationships, or health experiences — may resurface and leave you feeling emotionally raw, especially when layered on top of ongoing stress from work, caregiving, or major life changes. It can be confusing and exhausting, but it's also an opening for real healing and clarity.
Why This Can Shake Your Sense of Self
For many of the women I work with, the cognitive changes of menopause are often the most destabilizing part of all, whatever form your sharpness has always taken. Losing a word mid-sentence. Forgetting things you'd never normally forget. Feeling a half-step behind in something you used to do without thinking. These moments can shake your confidence in ways that go far beyond simple forgetfulness.
If this is you: this isn't a sign that you're declining. Brain fog is rarely just one thing — sleep, stress, and mood all tangle into it, and some of those pieces do respond well to treatment. What I won't promise is getting you back to exactly who you were before all this started, because that's not really what this transition is asking of you. Perimenopause and menopause aren't a decline; they're a passage into the next stage of your life. My work is to help you work through whatever this shift brings up for you, and to support you as you move into this next stage of your life.
How I Work With You
In many ways, therapy here looks like therapy for any other concern — but with an important difference: we understand how much physical changes and hormonal shifts may be activating your symptoms, and that awareness shapes everything. There's more psychoeducation involved, and when it's appropriate, I encourage consultation with HRT prescribers so the medical side of this transition gets attention too.
No single framework fits everything you might feel during this transition, so I draw on a combination of evidence-based approaches — including Internal Family Systems (IFS) and CBT — tailored to what's most useful for you. IFS helps us understand what different parts of your experience are trying to tell you, so we can work through them and find real relief. CBT adds practical, structured tools for reframing unhelpful patterns and building strategies you can use day to day.
What most women notice right away is relief — not because anything's been fixed yet, but because their experience finally has a coherent shape. One woman I met with recently, after I'd named a handful of things that often go sideways during this transition, said, "oh wow, yes — this is exactly what's happening to me too." She'd felt like a strange, disconnected cluster of symptoms that didn't add up to anything. Suddenly there was a context for all of it, and that coherence brought her anxiety down almost right away — partly because she realized she wasn't alone in it, and partly because being able to name what was happening meant I could also help guide her from where she was to where she wanted to be, not just describe the problem back to her.
Over time, recognizing this as a genuine life transition — not a problem to muscle through — helps you understand what's happening, which makes it easier to work with.
What each woman brings into a given session determines what we focus on. Some talk about hormones very little after the first few sessions, and the real work becomes untangling relationships or long-standing difficulties; others stay closer to the day-to-day symptoms. If trauma is part of your story, we approach it with care, helping you stay grounded as you make sense of what's surfacing.
Why I Made This My Focus
My work in menopause and midlife therapy began with one patient: a woman who, after an oophorectomy, was plunged into menopause within hours. Because it happened so fast, her symptoms rose in real time, inside a window with a hard, clear boundary — unlike the typical perimenopause-through-menopause process, where symptoms can shift, worsen, resolve, and return in sometimes mystifying ways over years. Her story changed how I listened.
I began noticing how many women at midlife described the same things: anxiety and low mood that felt different than before, antidepressants that no longer seemed to help, aches and pains, even GI issues that raised worried medical questions. Each symptom sent them to a different doctor, and each was treated separately — when all of it was unfolding amid midlife hormonal change. Understanding how physical symptoms and mental health intersect at this stage, and making sure women get real information and real support, became a focus of my practice.
Getting Started
I offer secure online therapy sessions for women located in Massachusetts. To find out if we're a good fit, schedule a free 20-minute consultation using the link below.