Perimenopause Anxiety, Depression and Mood Swings: Understanding Your Options

The word “perimenopause” tends to call up images of hot flashes and irregular periods. What it rarely prepares you for is the sudden, irrational rage in a grocery store checkout line, the anxiety that wakes you at 3am without a discernible reason, the flatness that settles in on an otherwise ordinary afternoon, or the unsettling sense that you are watching yourself from the outside and not recognizing what you see.

These experiences can occur during perimenopause, but they can also have other causes. New or worsening symptoms deserve assessment rather than an assumption that hormones explain everything.

Some people describe this transition as a second puberty. It can change how familiar your body and emotions feel, while work, family responsibilities, sleep, and other health concerns continue to make demands on you.

The women who come to see me at Red Leaf Wellness often carry something specific: the confusion of not recognizing themselves. They are competent, capable people who have managed a great deal, including careers, families, aging parents, and their own health, and now find that the internal resources they relied on are not behaving the same way. What used to work, does not. The strategies that carried them through difficulty before are failing. And in most cases, nobody told them this was coming.

What Is Actually Happening in Your Brain and Body

Estrogen and progesterone do not simply decline in perimenopause. They fluctuate, sometimes dramatically and unpredictably, as whole-body systems recalibrate over what can be a span of several years before the final menstrual period.

Hormonal changes may contribute to mood symptoms, but the precise mechanisms are not fully understood. The Menopause Society’s mental health guidance also identifies sleep changes, hot flashes, stressful circumstances, and a history of depression as relevant considerations.

Sensory input can feel more intense. Emotional responses can feel disproportionate to their triggers. Sleep becomes less restorative. The threshold for overwhelm can feel lower. These symptoms are real, even when their causes are not immediately clear.

If you are exploring complementary approaches, the Red Leaf Wellness guide to natural menopause treatments introduces options to discuss with your clinician. For the wider transition, see the complete perimenopause guide.

Stress, the nervous system, and perimenopause

The nervous system is one part of the picture. Mood symptoms can reflect interacting hormonal, psychological, social, and physical factors. Considering stress does not mean that symptoms are imagined, or that everyone needs the same approach.

The CDC’s overview of adverse childhood experiences explains how prolonged stress can affect health and stress-response systems. This broad evidence does not show that trauma explains an individual person’s perimenopause symptoms or that BCST treats those symptoms.

A conversation about care can make space for what you are experiencing, including a sense of overwhelm or not recognizing yourself. You do not need to tell a detailed story about past experiences to ask questions about a hands-on appointment.

What Biodynamic Craniosacral Therapy involves

Biodynamic Craniosacral Therapy is a gentle, hands-on approach. A session involves light, sustained contact, commonly at the head, sacrum, or along the spine. You remain fully clothed and can discuss what feels comfortable.

In the biodynamic approach, the practitioner follows a philosophy of allowing rather than imposing change. I am not trying to force a particular experience. This describes how I approach a session; it is not proof of a biological mechanism or a promised result.

Some people describe stillness or relaxation during a session. Others may notice little change. Feeling relaxed is different from demonstrating that a treatment improves a diagnosed anxiety disorder or depression.

A 2024 systematic review of craniosacral therapy trials found no convincing clinical benefit for the conditions it assessed. It did not establish BCST as a treatment for perimenopausal anxiety or depression. BCST should not replace assessment, psychotherapy, or prescribed treatment.

Before, during, and after a BCST appointment

The Red Leaf Wellness BCST service page explains the session format and current booking options.

BCST alongside hormone therapy and other care

A question I hear often is whether BCST can fit alongside hormone therapy, naturopathic care, supplements, or other treatments. The relevant question is whether it is appropriate for your circumstances and goals. There is no established evidence that adding BCST makes hormone therapy, medication, or supplements work better.

For women receiving hormone therapy through the Nurse Practitioners at Red Leaf Wellness, or following a naturopathic care plan with one of the clinic’s NDs, any complementary appointment should fit around appropriate assessment and ongoing care. You can learn more about the options on the Menopause and Perimenopause program page.

Medical and mental health care may include talking therapy, medication where indicated, and support for sleep and daily routines. Hormone therapy is an individual clinical decision. Do not stop or change prescribed treatment because you are trying BCST.

When to seek medical or mental health support

Speak with a clinician about new, persistent, or worsening anxiety, low mood, or changes that interfere with daily life. Johns Hopkins Medicine emphasizes assessment of other possible causes and more urgent help for symptoms that prevent usual daily activities or involve hopelessness or suicidal thoughts.

If you are in immediate danger or may act on thoughts of harming yourself, call 911 or go to the nearest emergency department. In Canada, call or text 9-8-8 for suicide crisis support. Do not wait for a complementary-care appointment.

What does an appointment cost?

See the current fees before booking, and ask the clinic which appointment fits your needs. Confirm coverage directly with your benefits provider. A BCST appointment is separate from medical, naturopathic, or other visits in your care plan.

Frequently asked questions

This article provides general information and describes a BCST practitioner’s approach. It does not diagnose anxiety, depression, or perimenopause and does not replace individual medical or mental health advice.