Perimenopause isn't just 'hot flashes'—how hormones disrupt women's lives and why support is crucial

'You’re just being hormonal right now, we will talk later.'

Dubai-based Agrima (name changed on request) remembers this particular comment from her cousin, after she had just broken down into tears over her halwa going wrong. “I don’t know what happened to me that day, but I started crying so much. I just wanted to do something for my mother’s birthday, and I messed up my halwa. And so my cousins didn’t know what to do, and just said, ‘Okay, this is your perimenopause’, we will talk later.”

They were right, she agreed, but the dismissal was thorny. “I felt like I was just this overemotional woman, reacting to nothing at all and everyone was looking at me as if I was crazy,” remembers Agrima.

As she says, it’s exhausting. She’s tired of perimenopause becoming a throwaway punchline. She’s tired of the hesitance, the eyerolls that accompany the word. “It is just such a draining experience and I think the attitude around it, just makes it worse,” says Agrima.

Perimenopause is one of the most painful and misunderstood chapters of a woman’s life — not just physically, but emotionally too. This complicated transitional phase begins when the ovaries gradually produce less estrogen. The shift doesn’t just disrupt the menstrual cycle; it also affects brain chemistry, particularly serotonin and dopamine — the neurotransmitters that regulate mood. These may sound like clinical terms, but their effects are very real, triggering a cascade of changes that can impact everything from sleep and focus to emotional stability.

Hiba Salem, psychologist, Adult and Families Specialist at Sage Clinics explains further: “These hormonal shifts are not ‘just in the head,’ they are biological processes that interact with emotional health.”

Obstetrician and gynaecologist Dr. Kinda Al-Ani of Medcare Women and Children Hospital agrees, adding that the body is essentially ‘adjusting its internal settings.’ These hormones don’t just regulate your menstrual cycle. They impact your mood, sleep and brain chemistry. And as a result, women find it difficult to focus, while dealing with menstrual irregularities.

Moreover, women with a history of depression, anxiety, or postpartum depression are more vulnerable. Those experiencing major life stresses, such as relationship strain, work pressure, or caregiving responsibilities, may also feel symptoms more strongly.

Perimenopause is usually more volatile emotionally because hormone levels are fluctuating at unpredictable levels. It is the rollercoaster stage as Dr. Kinda Al-Ani describes.  Menopause, on the other hand, is when your periods have stopped for 12 months and hormone levels have settled into a new low baseline. The emotional turbulence is usually more intense during perimenopause than after menopause.

 “Once menopause is reached, estrogen levels stabilise at a lower level, and while symptoms may persist, the intensity of mood swings often lessens. The unpredictability of perimenopause is what makes it particularly challenging for mental health,” explains Dr Salem.

Quite often, the mental ramifications during perimenopause are often diagnosed. “Many women are misdiagnosed with primary depression or anxiety without recognition that their symptoms are hormonally driven,” says Dr Salem. “Others are told their struggles are ‘just stress’ or ‘part of aging.’ This lack of awareness delays treatment and leaves women feeling invalidated.”

Moreover, as symptoms like panic attacks or sadness can look like depression or anxiety alone, women are treated only for mental health issues without addressing the hormonal cause, explains Dr Al-Ani. “This is why it’s important to mention any cycle changes and physical symptoms like hot flashes, night sweats, or irregular periods — it helps connect the dots.”

Abu Dhabi-based Aashima Mahant feels a little guilty for not being too patient with her mother, who had a particularly turbulent menopausal stage. “We came to blows so often, because I couldn’t handle how quickly she would get irritated, just about the smallest things. I don’t know how many times one of us would end up leaving the house, slamming the door,” remembers Mahant.

She remembers seeing her mother curled up once in tears after a rather brutal argument. “Looking back, I wish I had calmed down and spoken to her calmly. Instead, I too, just left the house,” says a rather tearful Mahant.

No doubt, the resentment bleeds into a relationship. Often, neither the woman nor those around her fully understand what’s happening.

The constant fluctuations can cause tension at home, forgetfulness can affect work performance, and poor sleep leads to fatigue that touches every part of life. Some women describe feeling less confident or ‘foggy’, as  Dr. Kinda Al-Ani explains. Recognising that these challenges are linked to perimenopause – not a personal weakness – is the first step to managing them.

So how do you know when to seek professional help? “If you notice persistent low mood, heightened anxiety, loss of interest in activities you used to enjoy, difficulty concentrating, or major disruptions in sleep, it is important to seek support,” advises Dr Salem.

Dr Al-Ani adds that feeling ‘not like yourself’ for weeks at a time, frequent crying, or sudden anger are also signs that mental health support is needed. “If mood changes start interfering with your daily life — your work, relationships, or ability to function — it’s time to speak to a professional,” she says.

Both experts highlight that a combination of approaches is most effective. “Cognitive-behavioral therapy (CBT) and mindfulness-based therapy have been shown to reduce anxiety, depression, and sleep problems,” says Salem. “Lifestyle interventions, such as exercise and nutrition, also help regulate hormones and mood. In some cases, medical interventions like hormone replacement therapy (HRT) may be recommended, which can ease both physical and emotional symptoms.”

Dr. Al-Ani agrees, noting that HRT can “balance estrogen levels, often easing hot flashes and stabilizing mood.” She also recommends complementary therapies and relaxation techniques. “A tailored plan – sometimes including lifestyle changes – usually works best,” she says.

Perimenopause can be overwhelming, but self-care and advocacy make a real difference. “Regular exercise, a nutrient-rich diet, mindfulness practices, and good sleep hygiene can make a big difference,” says Salem. “Building a strong support network and scheduling regular downtime are powerful protective tools.”

Dr. Al-Ani encourages women to be vocal about their needs: “Bring a clear list of symptoms, including when they started and how they affect your life. Don’t hesitate to ask your doctor if symptoms could be linked to perimenopause. If you feel unheard, seek a second opinion. Remember, your experiences are real, and you deserve compassionate care.”

Bring a clear list of symptoms, including when they started and how they affect your life. Don’t hesitate to ask your doctor if symptoms could be linked to perimenopause. If you feel unheard, it’s okay to seek a second opinion. Remember, your experiences are real, and you deserve compassionate care that addresses both body and mind.