The Stresses of Perimenopause

For many women, perimenopause is a challenging time due to the unpredictable yet striking physical changes that occur alongside career and family transitions. Hormonal fluctuations may lead to hot flushes, raging periods that come and go, intense irritability, forgetfulness, awful sleep, and joint pain. All of this can make it hard to live life fully and feel well. With additional challenges, such as children leaving home, caring for ageing parents, and mid-life career and relationship transitions, many women* find themselves struggling with depression and anxiety, and they have nowhere to turn to.

How BRIA Can Help

At BRIA, we understand the complex challenges that perimenopause can place on your life and your body and how these changes can affect your mental health. BRIA clinicians have many years of experience treating women during the menopausal transition and will provide evidence-based treatments with compassion and empathy. We have created inclusive, comprehensive mental health services, a thorough midlife assessment, and educational offerings to support you and treat your concerns. BRIA can help you navigate the physical and emotional issues that may occur alongside common career and family transitions during this stage.

How BRIA works

Get a personalised Care Plan

Start therapy or other services

Get additional MD services, if required

Track mental health symptoms to see progress

Common Challenges

We all face challenges, and it’s ok to ask for help. BRIA can support you as you navigate the menopause transition.


You may be worrying a lot and notice that your mind just won’t settle down.

Anxiety is very common during the menopause transition. Anxiety can refer to a range of symptoms from excessive worries to panic attacks, and is often associated with physical symptoms such as muscle tension, headaches, diarrhea, dizziness, or heart palpitations. Anxiety is also associated with excessive sweating or hot flushes, which can make women feel more anxious; it is a vicious cycle! During perimenopause, it can sometimes be difficult to tell which physical symptoms are due to biological changes in your body, such as heavy periods or poor sleep, and which ones are due to anxiety. At the same time, numerous life changes may be taking place at home, in your family, or at work; and managing life transitions can be very stressful. It is normal to feel anxious at times, but anxiety becomes a concern when it takes over, lasts a long time, and interferes with pleasure, relationships, or daily functioning.

BRIA individual therapists can help you understand the origins of your anxiety and learn strategies to manage it. In BRIA group therapy, you can connect with other women who have similar experiences and learn from our skilled group leaders. Mindful Movement classes can also teach you new skills for managing anxiety. Connecting with a BRIA Care Coordinator and completing a MINI Mental Health Assessment will provide you with a personalized Care Plan. If your symptoms of anxiety are interfering with your everyday life, a BRIA Care Coordinator may suggest a more detailed MAXI Mental Health Assessment where you will receive specific therapy and medication suggestions. Or, the MEDI Assessment may be recommended to you so that you can have a comprehensive midlife assessment to see which stage of perimenopause you are at, and whether you need menopausal hormone therapy to help address anxiety symptoms.


Feelings of sadness, despair, and hopelessness can be painful and consuming.

Depression is an illness that can make you feel intensely sad, and make it hard for you to take pleasure in life or to function productively. The symptoms of depression fall into three main categories: 1) physical symptoms, such as trouble sleeping and low energy; 2) cognitive symptoms that impact your thinking, such as trouble with focus and memory; and 3) emotional symptoms, including sadness, guilt, feelings of worthlessness, and hopelessness. Many perimenopausal women are justifiably overwhelmed and exhausted at this time in their life when they are juggling work and homelife transitions with physical changes in their body. Even though there are many overlapping symptoms between depression and perimenopausal changes – fatigue, weight changes, brain fog, insomnia –  it is never “normal” to feel prolonged sadness, hopelessness, or negativity during perimenopause, and these are signs that you need to get some help.

You may find it helpful to talk to one of our individual therapists who helps women cope with the challenges and transitions of the perimenopause period. BRIA group therapy will help you connect with other women who have similar experiences; seeing that you are not alone can often ease the feelings of sadness. Other BRIA experts, including our sleep therapist and registered dietitian, can help you address additional factors that may be impacting your mood. Connecting with our Care Coordinator and completing a Mini Mental Health Assessment will help you understand how BRIA’s diverse services can help you. If your symptoms of depression are interfering with your everyday life, a BRIA Care Coordinator may suggest a detailed MAXI Mental Health Assessment where you will get personalized therapy and medication suggestions. If you are having any thoughts of self-harm or suicide, this may indicate more severe depression, and you need to get urgent care from your primary care provider, go to the nearest emergency department, or call the Canadian Suicide Hotline at 1-833-456-4566.

Brain Fog

Feeling fuzzy and forgetful can make it hard to function well.

Whether you have word-finding issues, forget the names of familiar  objects or people, or have trouble focussing, these cognitive symptoms are common during perimenopause. There is strong medical data indicating that women experience a decrease in memory and learning functions during the menopause transition. This can make it difficult for a woman to feel sharp and on top of  the many things she needs to take care of –  at home and at work – and can lead to feelings of insecurity and self-doubt. When it feels like you can’t function at your best, your mental health can decline. We also know that depression and anxiety lead to poor memory and concentration.

At BRIA, we can help. Join a group of other women at the same stage of life to get emotional support and learn tools to address the many transitions of perimenopause. Our registered dietitian can look at your nutritional intake and optimise your meal plans to decrease fatigue and support perimenopausal brain health. There is also medical data to indicate that exercise can help with brain fog, so you can try our Mindful Movement classes to help with mind and body activation. Connecting with our Care Coordinator and completing a MINI Mental Health Assessment will help you understand how BRIA’s diverse services can help you. If you have symptoms of depression and anxiety causing insomnia, cognitive issues, and interfering with your everyday life, a BRIA Care Coordinator may suggest a detailed MAXI Mental Health Assessment so we can treat any significant underlying mental health issues. Or, she may recommend a MEDI Assessment to focus on your physical and hormonal health at midlife.


Perimenopause can bring on intense anger and other strong emotions.

Rage, frustration, irritability — you name it, women going through perimenopause experience it. Women may find themselves getting very angry over seemingly small issues, and may find it difficult to control their rage. Anger is often a secondary emotion and may be a manifestation of underlying sadness, grief, helplessness or anxiety. These emotions can emerge during perimenopause as women juggle multiple stressors and changes. But for many women, the significant and often unpredictable biological hormonal transitions of perimenopause can trigger episodes of intense irritability. Some women find that they develop horrible premenstrual symptoms (PMS) through this phase. Plus, insomnia and exhaustion, two common perimenopause symptoms, can worsen anger and rage and make it hard to control these feelings. You may feel ashamed that your emotions are getting the best of you, but this is usually a sign that something deeper is going on– in your mind and your body– and you need supportive help.

Talking to a BRIA individual therapist can help you process your feelings during this stressful time of life. If you have a partner and find that your relationship is suffering, a BRIA couples therapist can help you and your partner with better communication to diffuse the anger. In addition, Mindfulness Movement classes can allow you to identify and channel strong feelings and release them. Connecting with our Care Coordinator and completing a Mini Mental Health Assessment will help you understand how BRIA’s services can help you during this difficult transition. If your symptoms of anger are interfering with your everyday life, a BRIA Care Coordinator may suggest a MAXI Mental Health Assessment where you will receive more detailed therapy and medication suggestions. A BRIA Hormone MD can also complete an assessment to understand whether you need menopausal hormone therapy to help manage these symptoms.

Sleep Problems

Stress, anxiety, depression and hormonal fluctuations can all interfere with quality sleep.

For many perimenopausal women, a good night’s sleep is an elusive dream. Sleep problems may present as trouble falling asleep, difficulty staying asleep, or waking up too early in the morning. Sometimes women have hot flushes or night sweats that disrupt their sleep, others have pain or medical issues that keep them awake. And once they are awake, many women have trouble falling back asleep because they “can’t shut their mind off”. Insomnia or sleep disturbances are also common symptoms of depression, stress, and anxiety. Untreated insomnia can make you feel awful during the day,  dread going to sleep each night, and impact your overall functioning and well-being— this can become a vicious cycle.

At BRIA, we can address your perimenopausal sleep issues. Our sleep consultant can offer expert guidance to get your sleep back on track. Mindful Movement classes can teach you ways to relax and get more sleep. We may also recommend a more comprehensive MAXI Mental Health Assessment to determine if you are struggling with an underlying mental health issue that can impact your sleep — then we will focus on treating that specific issue. If your sleep is disrupted primarily due to hot flushes and night sweats, we may refer you for a MEDI to assess and treat hormonal issues.


Intense exhaustion in the menopause transition can impact a woman’s quality of life.

It is not easy to pinpoint the exact causes of fatigue for perimenopausal women, but many women at this stage of life report feeling deeply exhausted much of the time. Even women who can sleep for 7-8 hours each night may find that they wake up feeling unrefreshed and have trouble getting through the day. Fatigue might be the result of hormonal changes, a diet that is deficient in important nutrients, physical pain, medical conditions, and medication. Sometimes extreme fatigue and wanting to sleep more “as an escape” are the first signs of depression, anxiety or too much stress. 

Connecting with our Care Coordinator and completing a MINI Mental Health Assessment will help you understand how BRIA’s diverse services can help you. Our Registered Dietitians can offer support by analyzing nutritional intake and optimizing your meal plans to improve energy. Even though it may seem counter-intuitive, there is also medical data to indicate that exercise can help alleviate fatigue, so you can try our drop-in Mindful Movement classes. If you have symptoms of depression or anxiety associated with fatigue, a BRIA individual therapist can help you process the underlying stressors to improve your mood. If your fatigue is significantly interfering with your everyday life, a BRIA Care Coordinator may suggest a detailed MAXI Mental Health Assessment where you will get personal treatment recommendations for specific therapies or medications to address your needs. 

Decreased Libido

Many people going through the menopause transition wonder if it’s okay to never want to have sex again.

Many women find that their desire and interest in sex– whether they have a partner or not– is reduced during perimenopause. Sexual desire is a complex phenomenon that can be impacted by many variables, and may not even be directly related to fluctuating hormonal levels. Sometimes perimenopausal women avoid sex because of vaginal dryness or recurrent urinary tract infections, which lead to pain. Common medications, such as antidepressants or blood pressure pills, can affect a woman’s ability to enjoy sex or have an orgasm. In addition, psychological concerns such as depression and anxiety, and relationship issues such as boredom or conflict can impact a person’s sexual desire. 

At BRIA, we can help. If you are in a relationship that you feel is impacted by your limited sexual desire or is triggering these concerns, a BRIA couples therapist can help you and your partner reconnect on an intimate level. A BRIA individual therapist can help you address mental health symptoms, stress, or trauma that may be impacting your sexual desire. BRIA perimenopause groups will introduce you to other women struggling with similar issues, and under the guidance of an expert clinician, you will learn how to navigate changes in your sexual functioning as you age.  Connecting with our Care Coordinator and completing a MINI Mental Health Assessment will help you understand how BRIA’s diverse services can help you. Then, she may suggest a more in-depth MAXI Mental Health Assessment where you will get tailored therapy and psychiatric treatment recommendations, or a re-evaluation of your current medications, with your libido in mind

Severe PMS

Many people experience terrible premenstrual emotional symptoms during the menopause transition.

One of the main features of perimenopause is an irregular menstrual cycle, often accompanied by heavy, long-lasting periods. The physical symptoms during this time cannot be understated; bloating, cramping, back pain, sore breasts, insomnia, and fatigue. And the emotional symptoms associated with irregular periods can be crippling; especially in the two weeks before your period starts, also known as the “luteal phase”. During this phase, perimenopausal women often describe “really, really bad PMS”— the worst irritability, anger, sadness and anxiety they have ever felt. Some women also feel suicidal in this phase. Once their period starts, it can be “like a switch has been flipped”; they suddenly feel lighter, more tolerant, calmer and generally happier–back to themselves. When severe PMS lasts for a few days, it can be frustrating and an inconvenience. When it lasts for 1-2 weeks, it can have a significant impact on work, relationships, pleasurable activities and overall functioning.

At BRIA, we understand the interplay of hormones, physical symptoms and emotional responses during the menopause transition. BRIA’s individual therapists can help you with your mood, anxiety and irritability during this time. You may also consider joining our Mindful Movement classes to help relax your mind and body. BRIA’s Registered Dietitians are trained in “period health” and can help you establish regular eating patterns with a focus on healthy foods and antioxidants, so periods are more manageable. They also offer standard medical nutrition therapy for underlying chronic illnesses like endometriosis and diabetes. If your premenstrual dysphoria is getting longer and more severe, our Care Coordinator may suggest a referral to a MAXI Mental Health Assessment or to our MEDI Assessment.

Let’s measure your symptoms

1 in 5 Canadian women is struggling with a mental health problem today — you are not alone.
Start by taking BRIA’s quiz to understand your symptoms and stressors.

BRIA Services

MINI Mental Health Assessment

The BRIA MINI will provide you with a personalized Care Plan.

MINI Mental Health Assessment

When a BRIA Care Coordinator meets with you for a MINI Mental Health Assessment, she will learn about your symptoms, stressors, and struggles and will create a Care Plan just for you. Your Care Plan will outline which BRIA services may help you. The MINI is your starting point on your MD-designed journey with BRIA.

MEDI Health Assessment

The MEDI offers an in-depth assessment by women’s health experts to address hormonal, mood, and sleep issues during perimenopause and beyond.

MEDI Health Assessment

If our Care Coordinator recommends a hormonal assessment after your MINI, you will be referred to the MEDI Health Assessment. This is an assessment by a trained women’s healthcare professional. In the MEDI, you will get an assessment of your physical, hormonal, and mental health at midlife. Following this assessment, you may get recommendations for hormonal treatments, medications or other therapies.

Individual Therapy

Our team of professional therapists can teach you the tools you need to feel better.

Individual Therapy

Women who are going through the menopause transition often find that therapy can help them cope with feeling overwhelmed, worried, or depressed. BRIA therapists are experts in mental health counselling for perimenopausal women, and have experience addressing many of the issues that commonly arise at this stage.

Couples Therapy

You and your partner can talk to a therapist to address conflict and communication issues.

Couples Therapy

During major life stresses or transition times, including perimenopause, people often find that the relationship with their partner takes a hit. The perimenopause period can be a stressful time, and even the best relationships can suffer.

MAXI Mental Health Assessment

The MAXI offers an in-depth assessment of mental health concerns by an expert mental health professional.

MAXI Mental Health Assessment

If our Care Coordinator recommends further mental health evaluation after your MINI, you will be referred to the MAXI Mental Health Assessment. This is a more detailed assessment by a mental health professional. In the MAXI, you will get recommendations for therapy and other services to address your concerns.

Group Therapy

You will join people who are experiencing similar issues to openly share, receive support, and learn new skills.

Group Therapy

People who are going through perimenopause often feel uncertain and in the dark about the changes in their bodies, minds, emotions and lives. This is an overwhelming experience for many women, and it can be difficult to muddle through it alone. Group therapy is a safe and confidential place to be honest and open about your struggles. You will get non-judgemental support from others who share the same experiences, and the expert guidance of a compassionate mental health professional.

Sleep Consultant

Getting a good night’s sleep is critical for mental health and well-being. We can assess sleep issues during perimenopause to help you get night time rest.

Sleep Consultant

At BRIA, we know sleep is crucial. We also know how many women struggle with sleep, especially during perimenopause. This is why we have created a specific sleep assessment and treatment program to understand the issues interfering with your sleep during perimenopause, and to help you address these issues and improve your sleep.

Mindful Movement Classes

Classes by an expert yoga and mindfulness instructor will teach you tools to support mental health during perimenopause.

Mindful Movement Classes

BRIA offers an accessible movement class that will include yoga, breath-work, and relaxation. Classes encourage physical openness, strength, stability, and harmony. Mindfulness meditation will be infused throughout the classes to address an array of mental health concerns, such as anxiety, depression, and even insomnia. No previous experience is required.


As experts in women’s mental health care, we understand that part of recovering from mental health struggles is learning about them. Knowledge improves awareness, reduces stigma, and helps everyone feel less ashamed.