Women's mental health at midlife:
Specialized psychotherapy for perimenopause and menopause
Sharon Manning, MSW, LICSW, offers psychotherapy for women navigating perimenopause and menopause in Massachusetts, using an integrative, evidence-based approach that includes EMDR, IFS, and CBT.
Supporting women through anxiety, mood changes, sleep disruption, and the identity shifts that often accompany midlife. Virtual 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 like estrogen and progesterone, certain neurotransmitters like serotonin and dopamine, life history, and mental health. It deserves care that holds all of it together. I'm a licensed clinical social worker (MSW, LICSW) whose interest in this work took root through my time in the Psychiatric Specialties Department at Mass General Brigham. It has since deepened through my current work with the hospital’s Mid-Life and Menopause Clinic, where I serve as a key clinical resource. My private practice is informed by, but operates independently 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.
How is this different from general therapy?
In many ways, it looks like therapy for any concern, but with one key difference: we recognize how much hormonal shifts may be shaping your symptoms, and that shapes everything. There's more psychoeducation involved, and when appropriate, I encourage consulting with HRT prescribers so the medical side gets attention too.
No single framework fits everyone, so I draw on approaches like IFS and CBT as needed. IFS helps us understand what different parts of your experience are trying to tell you; CBT offers practical tools for reframing unhelpful patterns.
What most women notice first is relief, not because anything's fixed yet, but because their experience finally makes sense. One woman told me, after I named a few common experiences of this transition, "oh wow, yes, that's exactly what's happening to me." She'd felt like a scattered cluster of symptoms with no throughline. Naming it brought her anxiety down almost immediately, partly from realizing she wasn't alone, and partly because now we had a direction to work toward, not just a description of the problem.
Recognizing this as a genuine life transition, not something to just push through, makes it easier to work with.
What we focus on depends on what you bring in. Some women move past the hormonal piece quickly and the real work becomes relationships or longstanding patterns; others stay closer to day-to-day symptoms. If trauma is part of your story, we approach it with care, helping you stay grounded as it surfaces.
Why This Can Shake Your Sense of Self
This hormonal transition of midlife doesn't look the same for everyone. Some women experience certain symptoms intensely while barely noticing others, and that sheer variability is part of what has made the mental health impact of this life stage so hard to identify.
For some of the women I work with, the cognitive changes 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. Becoming overwhelmed and fatigued more easily. These moments can shake your confidence in ways that go far beyond simple forgetfulness.
For other women, it's the physical changes that feel most disorienting: hot flashes, disrupted sleep, changes in weight or body composition, and a shift in sex drive that can feel unfamiliar or even like a loss. These changes are real, they're not imagined or exaggerated, and they deserve to be part of the conversation about what this transition actually involves.
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.
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.