Perimenopause, Self-Esteem, and Your Relationships: How Therapy Can Help

Cheryl MacDonald

Perimenopause is something that’s rarely talked about and even less understood. This is the time in a woman's life BEFORE Menopause (defined as the cessation of menstruation for at least 12 months), and this is actually when most of the big changes are happening. Even more surprising? That most women over 35 are already in perimenopause, even if they don’t show significant symptoms, this coincides with a woman's drop in fertility. 


Perimenopause isn’t just about hot flashes and irregular periods. It’s a deeply personal transformation that can shake your confidence, impact your relationships, and make you question your sense of self. I know this not just as a psychotherapist but also as a yoga master, health coach, and the creator of YogaPause (and author of best-selling book by the same name)—a method I developed after years of working with women navigating this life stage.



I’ve spent over two decades guiding women through transitions, and I’m currently writing my research thesis on self-esteem and relationships in women aged 40-55. I see more clearly than ever how perimenopause can challenge our identity. The good news is that you don’t have to go through it alone. Therapy can help you navigate the changes, build your confidence and reframe what you want from life going forward.

How Getting Older Affects Your Self-Esteem


Perimenopause has a sneaky way of making us question ourselves. It stirs up emotions, shifts our bodies in ways we don’t always recognize, and brings up thoughts like: Who am I now? Do I still matter? What the hell am I going to do with my life now?

Here are some of the things that could be chipping away at your self-esteem:

1. Your Body Doesn’t Look The Same

Suddenly, the body you’ve known for decades starts to feel foreign. Weight gain, bloating, thinning hair, dry skin—these changes can make you feel very self-conscious. Many of us look in the mirror and don’t recognize ourselves, we’re self-critical and insecure.

2. Brain Fog 

Ever walked into a room and forgotten why? Or struggled to remember someone’s name mid-conversation? Perimenopause can bring cognitive shifts that leave us feeling less than sharpand doubting our abilities. When you start second-guessing yourself, your confidence takes a big hit.

3. Emotional Sensitivity and Self-Doubt

Mood swings, irritability, and feeling emotionally raw are all common. One moment, you feel fine; the next, you're in tears over an advert with an injured hedgehog. When your emotions become unpredictable, it’s easy to start doubting yourself and feeling like you’re “too much” or “not enough.”

4. Women Are Supposed To Be Young FOREVER

Society isn’t always kind to women over 40. From media to workplace biases, we get messages that our worth diminishes with age. Many women struggle with feeling invisible, less desirable, or irrelevant—especially in their careers and relationships.

This Is How Perimenopause Can Impact Your Relationships:

When our self-esteem starts to waver, our relationships feel the strain. I see this time and again in the women I work with. They tell me: I don’t feel connected to my partner anymore. I feel lonely, even when I’m surrounded by people.

Here’s some of the ways perimenopause could be affecting your relationships:

1. You’re Pulling Away From Your Partner

If you’re feeling low about yourself, it’s easy to pull away—emotionally and physically. Changes in your libido, body image worries, and mood fluctuations can lead to less intimacy and more misunderstandings.

2. Your Grumpy and Irrational

Hormonal changes can make emotions feel bigger than normal: Think PMS on Steroids. Small things that never bothered you before suddenly feel overwhelming. If you find yourself snapping at loved ones or feeling unheard, you’re not alone and it’s normal.

3. You Feel Alone In This

Many women say, No one understands what I’m going through. This feeling can lead to withdrawing from social circles, avoiding deep conversations, or even drifting away from close friends. Perimenopause is REAL and big and challenging and you need to be supported by other women who understand and can relate.

4. Changing Family Roles

At this stage of life, many of us are also dealing with our kids growing up and leaving home, ageing parents, or career transitions. All of these stressors can add to feelings of overwhelm, and lack of purpose or sense of self, making it even harder to prioritize relationships.

 

How Therapy Can Help You Figure Out Who You Are AndWhat You Want From Life 40+


Here’s something I want every woman to hear: You are not losing yourself. You are evolving.Therapy can help you navigate this transition with self-compassion, clarity, and confidence. 40+ can be the best stage of your life - you just need to approach it in the right way.

1. It Can Help You Rebuild Your Self-Esteem

Therapy helps you challenge the negative self-talk that can come with ageing. It’s about shifting the focus from what’s changing to what’s still strong within you - or better yet, what’s STRONGER. Learning to redefine beauty, value, and self-worth is an essential part of this process.

2. Understanding and Managing Your Emotions

Cognitive Behavioral Therapy (CBT), mindfulness, and breathwork can be powerful tools for managing hormonal mood swings, anxiety, and self-doubt. In my practice, I often integrate yoga and breathwork and nutrition alongside psychotherapy to help women create a mind-body connection that fosters emotional balance. A full life approach is the most effective way to move forward into this next life stage.

3. Strengthening Your Relationships

Does your marriage have a whole new range of issues? Feeling disconnected from friends? Therapy can help you identify how your self-esteem impacts your relationships and help you communicate what you need and how you’re feeling with confidence.

4. Accepting Your Changing Body

Instead of seeing physical changes as losses, therapy can help shift the narrative to self-acceptance. My YogaPause method combines gentle movement, breathwork, and mindfulness to reconnect women with their bodies in a way that feels empowering rather than defeating. Building physical strength and mental resilience are an essential part of the journey.

5. Finding a New Sense of Purpose

Perimenopause isn’t an ending—it’s also a beginning. Many women feel lost in this transition, but therapy can help them rediscover passions, set new goals, and redefine what fulfillment looks like in this next chapter. This can absolutely be the best time of your life.

You Deserve Support

Perimenopause is more than a biological transition—it’s an emotional, psychological, and deeply personal one. It can feel overwhelming, but help is available.

Therapy provides a space to rediscover yourself, strengthen your relationships, and step into this new life phase with confidence. If you’re feeling lost, struggling with self-esteem, or noticing strain in your relationships, reach out. You are not alone.

The Quiet Struggle Many Women Carry: When Friendship Doesn’t Feel Like Home

By Aki Tsukui Director of Wellness - Leadership & Systemic Coach, Transformational Facilitator • April 30, 2026
In my recent work, I’ve begun to notice a pattern. Many women across different stages of life are quietly struggling. Not with something obvious, but with something much harder to name. Friendship. On the surface, life looks full. There are social circles, dinners, invitations, people to message on a Friday night. There is connection. And yet, beneath that, there is a quiet, persistent feeling: Something doesn’t feel quite right. The Reality Beneath Connection So many friendships begin through circumstance. We meet people through work, shared environments, mutual communities, or simply being in the same phase of life. And naturally, connection forms. These relationships can be warm, supportive, and genuinely meaningful. They often arrive at a time when we need them most: when life is shifting, when we are finding our footing, when we don’t want to feel alone. But there is something many women don’t say out loud: Some friendships are built on situation, not alignment. And over time, that difference begins to surface, not as conflict, but as a quiet undercurrent. The Discomfort That’s Hard to Explain What I hear from female clients is rarely dramatic. It’s the sense of not being fully themselves. Of subtly managing energy instead of simply being. Of leaving an interaction feeling slightly drained, without knowing why. Nothing is obviously wrong. No one has done anything hurtful. In fact, these friendships often include kind, thoughtful people who have shared important moments with us. Which is exactly why it’s so confusing. Because when nothing is broken, it becomes harder to trust the feeling that something isn’t quite right. When Gratitude Silences Truth Many women carry a deep sense of appreciation for the people in their lives. These friendships may have supported them through transitions, offered belonging, or simply been there when it mattered. So, when discomfort arises, it is often softened: I should be grateful. Maybe I’m overthinking this. But gratitude and misalignment can exist at the same time. You can value what a friendship has given you and still feel that it no longer reflects who you are becoming. The Quiet Cost Because there is no clear reason to question the relationship, the adjustment often happens internally. It looks like small things: holding back certain thoughts, avoiding deeper conversations, feeling slightly “on” instead of at ease. Even a quiet sense of relief when plans fall through. Individually, these moments seem insignificant. But over time, they create distance, not from others, but from yourself. Why We Stay Friendships are rarely just about one person. They are intertwined with shared circles, familiar routines, and a sense of belonging that extends beyond a single connection. Which is why stepping back can feel so much bigger than it seems. There is also the quiet weight of beginning again. Building new connections asks for openness. Letting go, even with care, asks for truth. And so, many women stay, not because it feels right, but because it feels easier than facing what change might require. The Quiet Turning Point And yet, something begins to shift. Not suddenly, but gradually. A quiet awareness surfaces: I don’t think I can keep showing up like this. This isn’t about blame or judgment. It’s about noticing yourself more honestly. Where you feel open, and where you feel restricted. Where connection flows, and where it feels effortful. Redefining Connection The shift doesn’t need to be dramatic. It often begins in small, almost invisible ways. Speaking a little more honestly. Setting a gentle boundary. Choosing where you place your time and energy with greater intention. And slowly, things begin to change. Some friendships deepen because they can meet you there. Some soften into something lighter. Some quietly fall away. A Different Kind of Belonging What many women are truly longing for is not more connection, but more alignment within connection. Not just people to spend time with, but spaces where they can exhale. Where nothing needs to be filtered. Where they can be fully themselves without effort, without adjustment. If this resonates, you are not alone. This is not about being ungrateful or difficult. It is about becoming more attuned to yourself, your energy, and your truth. And often, that awareness begins quietly in the middle of a conversation, after a dinner or even in a feeling you can’t quite explain. The question is not, Are these the right friends? But: Where do I feel most like myself and am I allowing myself to move closer to that? Because true belonging isn’t created by proximity. It’s created in the moments where you no longer feel the need to edit who you are and realise you don’t have to leave parts of yourself behind to be accepted. And if something in you is beginning to notice this quietly, gently, it may be worth giving it space. Not to rush into change, but to listen more closely to yourself and to what more aligned, honest connection might begin to look like in your life.

Friendship sits at the core of a meaningful life - it’s not just a “nice to have,” it’s essential

By Nick Jonsson – Supervised Counselor and Executive Coach • April 30, 2026
Friendship sits at the core of a meaningful life - it’s not just a “nice to have,” it’s essential  Over the years, I’ve done a lot of work on myself, and that has naturally changed how I show up in my friendships. In the past, I might have been more focused on what I could get from relationships. Today, it’s very different. Now, it’s about being of service. It’s about being present, listening deeply, and showing up consistently for the people who matter. For me, being a good friend means being there not only in the good times, but especially when someone is struggling. It means putting the phone away, giving full attention, and truly hearing what’s being said - and sometimes what’s not being said. This is something I also bring into my coaching and therapy work. I often ask clients to reflect on their friendships - how healthy they are, where they feel supported, and where things may be broken. Because the truth is, we cannot go through life carrying unresolved friendships. If something is broken, we need to take responsibility, make amends, and do the work to make it right. There’s powerful research from Dr. Robert Waldinger that shows how critical relationships are to our wellbeing. In fact, a lack of meaningful connection has been compared to smoking 14 cigarettes a day. That’s how serious this is. So friendship is not just about connection - it’s about health, longevity, and the quality of our lives. Today, I focus on a small circle of real, authentic relationships. People I can be honest with. People who hold me accountable. People I can support, and who support me in return. At the end of the day, it’s simple - be the friend you wish you had. Show up. Listen. Care. And when something is broken, have the courage to fix it.

The Beauty and Complexity of Family: Healing the Flow of Love

By Aki Tsukui (Leadership & Systemic Coach) • April 2, 2026
Family is often where love begins. It is our first experience of connection, belonging, and identity. Within the family system, we learn how to give and receive love, how to relate to others, and how to see ourselves in the world. At its best, family can be a place of deep nourishment: a source of strength, safety, and unconditional support. And yet, for many of us, family can also feel complicated. There may be moments of tension that seem disproportionate, patterns that repeat across generations, or emotional burdens that are difficult to explain. We may find ourselves reacting in ways we don’t fully understand, feeling responsible for others in ways that feel heavy, or struggling to step into our own lives freely. This is because family is not just about the people we see. It is also about the invisible threads that connect us across generations. The Hidden Dynamics of Family  Every family system carries a history. Alongside love, there may also be unresolved grief, unspoken pain, losses that were never fully processed, and experiences that were too overwhelming to be integrated at the time. These experiences do not simply disappear. Instead, they often live on within the system, quietly shaping the dynamics of future generations. This can show up as what we call entanglements—where one family member, often unconsciously, carries emotions, roles, or burdens that do not fully belong to them. For example, a child may feel an unexplained sadness that mirrors a grandparent’s unresolved grief. Someone may take on the role of “holding the family together,” even at the expense of their own well-being. Others may struggle with relationships, self-worth, or a sense of belonging, without understanding the deeper roots of these experiences. These patterns are not signs that something is “wrong” with us. Rather, they reflect a deep loyalty to our family system. At an unconscious level, there is often a desire to remain connected, to belong, to honor those who came before us, and to ensure that no one in the system is forgotten. The Flow of Love In family constellation work, there is a concept known as the flow of love. Love, in its natural state, flows from those who came before to those who come after: from parents to children, and from ancestors to descendants. When this flow is unobstructed, it supports a sense of grounding, vitality, and ease. We feel supported by what came before us, while being free to move forward into our own lives. However, when there are disruptions, such as trauma, exclusion, or unresolved events, the flow of love can become blocked or distorted. For example: When a child feels the need to care for a parent emotionally, the natural order is reversed. When a family member is excluded or not acknowledged, others in the system may unconsciously “represent” them. When trauma is not processed, its emotional imprint may be carried by future generations. These disruptions are not caused by a lack of love. In fact, they are often expressions of love: just in forms that have become entangled. Understanding Intergenerational Trauma What we often refer to as “intergenerational trauma” is the transmission of emotional experiences, survival patterns, and coping mechanisms across generations. This can include: Loss and grief that were never fully expressed War, displacement, or migration experiences Family secrets or hidden histories Patterns of abandonment, rejection, or emotional absence Survival strategies that once served a purpose but are no longer needed These experiences can shape how individuals relate to themselves and others, often outside of conscious awareness. It is important to approach this with compassion. Our ancestors did the best they could with the resources they had. Many carried burdens that were too great to process at the time. What we experience today is often a continuation of those unfinished stories, not as a burden to blame, but as an invitation to bring awareness and healing. Family Constellation: Bringing the Invisible to Light Family constellation work offers a powerful way to explore these hidden dynamics. Through this approach, individuals are able to “map” their family system and observe the relationships, patterns, and entanglements that may be present. What is often revealed is not just personal, but systemic showing how individual experiences are connected to a larger family context. Another important principle in this work is that everyone belongs. This includes not only those we know and remember, but also those who may have been forgotten, excluded, or never spoken about—such as miscarried or aborted children, former partners, or family members who experienced difficult fates. Even if their stories were hidden or unknown, they remain part of the family system. When someone is excluded, the system often seeks balance by unconsciously including them through another member. Gently acknowledging and giving each person their rightful place allows the system to settle, restoring a deeper sense of harmony and connection. One of the most profound aspects of this work is that it allows what has been unseen to be acknowledged. When forgotten or excluded members are recognized, when grief is given space, and when each person is seen in their rightful place within the system, something begins to shift. The system moves toward balance. The flow of love is restored, not by changing the past, but by relating to it differently. Returning What Is Not Ours A key part of healing within the family system is learning to gently release what does not belong to us. This does not mean rejecting our family or disconnecting from our roots. Rather, it is about honoring our connection while allowing each person to carry their own experiences. This can look like: Recognizing when we are holding emotions that may not fully be ours Releasing the need to fix or carry others Acknowledging our parents and ancestors as they are, without needing them to be different Taking our place as the next generation, receiving life and moving forward There is a quiet strength in this process. It allows us to remain connected, while also reclaiming our own path. The Possibility of Healing Healing within the family system does not require perfection. It begins with awareness. As we become more conscious of the patterns we carry, we create space for choice. We are no longer moving purely from inherited dynamics: we are able to respond with intention, presence, and clarity. This is where transformation happens. When we restore the natural flow of love, we not only support our own well-being. We also create a shift for future generations. The patterns that once repeated can begin to soften. The burdens that were once carried can be laid down. In this way, healing is both personal and collective. Honoring Where We Come From Family is not always simple. It can be a place of great beauty and deep challenge. It can hold both love and pain, connection and complexity. To truly engage with family is to embrace both aspects: to honor the love that exists, while also acknowledging the parts that are difficult. When we do this with openness and compassion, we create the possibility for something new. We begin to relate to our family not just from habit or conditioning, but from awareness. And from this place, love can flow more freely supporting us as we step into our own lives, while staying rooted in where we come from. There is a quiet wisdom within every family system, always moving toward balance and wholeness. When we are willing to turn toward what has been unseen with openness and respect, healing begins to unfold in its own time and way. As the flow of love is restored, we find ourselves both deeply rooted and gently freed: able to walk forward in life supported by those who came before us, rather than bound by what was left unresolved. For those who feel called to explore this work more deeply, we offer Family Constellation sessions in a variety of formats, including in-person and online, as well as individual and group settings, creating safe and supportive spaces for this gentle yet powerful process of healing and reconnection.