Perimenopause Therapy
Perimenopause is the hormonal transition that begins years before menopause itself, sometimes as early as your late thirties.
Your period is still coming. Nothing on paper has changed. And yet you don't feel like yourself, and you can't quite explain why.
Many of the professional women I work with come to me thinking they are dealing with anxiety, or burnout, or the general exhaustion of doing too much for too long. Sometimes that is exactly what is happening.
Often, it is that and something else. Perimenopause can amplify old patterns and introduce entirely new ones, and untangling which is which is part of the work.
What Perimenopause Can Feel Like
The women I work with often describe it as pieces that do not add up until you name what is happening underneath them:
Irritability that arrives fast and feels disproportionate to what actually happened
Nights where sleep will not come, or where you wake at 3 a.m. and your mind will not slow down
A wave of heat or a soaked shirt that catches you off guard, at your desk or in the middle of a meeting
Losing a word mid-sentence, or walking into a room and forgetting why
Anxiety that seems to come from nowhere, layered on top of the anxiety you already knew how to manage
Periods that used to be predictable and now are not
None of this means something is wrong with you. It means your hormones are shifting, and your nervous system is adjusting to a change most women are never actually taught to recognize.
Why This Gets Missed, Especially in High-Achieving Women
Perimenopause is easy to miss, particularly if you are used to functioning at a high level no matter what is happening underneath. You push through the fog. You explain the irritability as a bad week.
You tell yourself the anxiety is just work stress, the same stress you have always known how to manage. And when the usual tools stop working as well as they used to, you assume you are simply not trying hard enough.
For many of the women I see, the confusing part is not the symptoms themselves. It is not knowing which of them belong to hormones, which belong to older anxiety patterns, and which belong to a life stage that is genuinely asking something new of you.
Untangling that is not something you have to do alone, and it is not something a single label solves on its own.
What We Work On Together
Mood swings, irritability, and rage that feels out of proportion
Anxiety and racing thoughts, including anxiety that feels new or unfamiliar
Sleep disruption and the exhaustion that follows it
Brain fog, self-doubt, and the fear that your mind is not as sharp as it used to be
Grief for the version of yourself before this transition, and questions about identity and what comes next
Strain on relationships, at home or at work, when you do not feel like yourself
What Changes With Perimenopause Therapy
Therapy does not stop perimenopause. It is not a hormone treatment, and it will not make the physical symptoms disappear on its own. What it can do is help you understand what you are experiencing, separate what is hormonal from what is emotional, and build a relationship with your nervous system that does not depend on pushing through.
Many women leave this work more able to name what is happening in the moment, instead of spiralling into confusion or shame about it. Some come to understand old anxiety patterns that perimenopause has brought back to the surface. Others find that the identity questions this stage raises, about ambition, about aging, about who you are becoming, are worth their own attention.
Results vary, and this work moves at your pace.
How Therapy Can Support You Through Perimenopause
My approach is integrative. We look at how hormonal changes may be interacting with your nervous system, emotions, relationships, and patterns you have developed over time.
Together, we may explore:
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What feels new and what feels familiar.
Perimenopause can intensify old patterns or bring up experiences that feel completely new.
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Your nervous system.
We work with the anxiety, irritability, overwhelm, and sleep disruption that can leave you feeling more reactive than usual.
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Old patterns.
Perfectionism, people-pleasing, self-criticism, and over-functioning can become harder to maintain during this transition. Therapy can help you understand what is underneath them and what you need now.
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Identity and change.
We make space for grief, uncertainty, and questions about your body, relationships, priorities, and who you are becoming.
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Past experiences and trauma.
Sometimes the transition activates experiences or emotional patterns that have been sitting beneath the surface for years.
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The goal isn't to simply get back to who you were before.
It's to better understand what is happening, feel more grounded, and develop ways of caring for yourself that fit this stage of your life.
Because perimenopause is a physiological transition, therapy works alongside, not instead of, medical care. I encourage you to speak with your healthcare provider about the physical and hormonal aspects of what you're experiencing.
Working With Lucia Gallegos, RP
I bring an integrative approach to this work, drawing on CBT, somatic practices, polyvagal theory, and body-based approaches like EMDR and Deep Brain Reorienting, depending on what is actually happening for you. Some of what perimenopause stirs up lives in the body more than in words, and I want to have the right tool for whichever one shows up.I am not able to treat the physical or hormonal side of perimenopause directly. That is medical territory, and I will always encourage you to also talk with your family doctor about what you are noticing physically. If you are already working with me and a psychiatric consultation would be useful, that collaboration is available too.Sessions are held virtually, in English or Spanish, for 50 minutes, at a consistent day and time each week. A free 15-minute consultation comes first, so we can talk before you decide anything.If some of what you are carrying also sounds like anxiety and stress more broadly, or like the fuller shift of menopause, those are places to look too. I've also written about the emotional side of this transition on the blog.
Ready to Talk?
If any of this sounds like where you are right now, even if you are still not sure what to call it, I would be glad to talk it through. Reach out through the contact page to set up your free consultation.
Ready to Reclaim Your Mental Health?
You don’t have to navigate menopause depression, anxiety, or mood swings alone. Therapy helps you manage symptoms, regain clarity, confidence, and emotional balance, and move through this stage with freedom and self-compassion.