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.

By Jason Woolley March 18, 2026
In recent years, the language of the “nervous system reset” has become increasingly common in wellbeing spaces. Guided relaxation sessions, breathwork classes, meditation workshops, and practices such as NSDR (Non‑Sleep Deep Rest) are often presented as opportunities to step out of stress and return the body to a calmer state. In many ways, this reflects something positive. For people living and working in high‑pressure environments, simply discovering that the nervous system can settle - even temporarily - can be an important experience. When the mind quiets and the body softens, many people realise something they may not have known before: calm is actually possible. Spaces that support rest, reflection, and nervous system regulation can therefore be valuable. They offer a pause in a world that rarely stops moving. But the popularity of the “reset” also reveals something deeper about the conditions many people are living under. For many professionals, life can begin to feel like a cycle of pressure followed by brief relief. A demanding week leads to a meditation class, a breathwork session, a yoga practice, or a relaxation workshop. For an hour or two the nervous system unwinds. Then the session ends, the lights come back on, and the same environment - the same demands, expectations, and internal pressures - are waiting outside. The relief is real. But it is also temporary. This cycle can leave people feeling as though calm exists somewhere outside their daily life, accessible only through occasional experiences designed to reset the system. Yet the nervous system was never designed to be repeatedly “reset”. It evolved to adapt. Long‑term resilience rarely develops through repeated escapes from stress. Instead, it develops when we gradually change how our body and mind relate to pressure itself. This is where deeper forms of psychological and embodied work become meaningful. In counselling, part of the work involves understanding the internal patterns that amplify stress - the beliefs, relational dynamics, and emotional histories that shape how experiences land in the nervous system. At the same time, embodied disciplines offer another pathway. Traditions such as Taiji and Qigong were developed over centuries as methods for regulating the interaction between mind, breath, and body. Their aim is not to produce a temporary state of relaxation. Instead, through consistent practice, they gradually change how the system responds to challenge. Over time, the body learns to release unnecessary tension more quickly. Breath settles naturally. Attention becomes steadier. External pressures may remain the same, but the way they land internally begins to shift. This process is sometimes misunderstood in modern wellness culture. Taiji, for example, is often seen as gentle exercise or slow movement in the park. But within traditional systems of practice, it is something more structured and transformative - a method of cultivating internal balance, resilience, and energy through sustained personal practice. It does not promise a quick nervous system reset. Instead, it invites a longer journey of learning how to live within the nervous system you already have. For many people, the most meaningful shift happens when calm is no longer something that needs to be found outside of daily life. It becomes something that can gradually be carried within it. And from there, resilience stops being something you temporarily borrow from a workshop or retreat. It becomes something you quietly build. ----- Moments of rest and nervous system regulation can be helpful starting points. But lasting change often emerges through deeper exploration and consistent practice. Counselling, reflective work, and embodied disciplines such as Taiji and breath-based practices can support a gradual shift in how the mind and body respond to pressure. If this perspective resonates with you, you are welcome to reach out to learn more about the ways these approaches can be explored together.
By Aki Tsukui February 4, 2026
When we hear the word intimacy , we often think of sex: touch, desire, romance. Yet true intimacy lives far beyond these moments. It is felt in silence, in a shared glance, and in the quiet courage it takes to be fully present with yourself, with another, and with life itself. Real intimacy does not begin by reaching outward. It begins within. In the rhythm of your breath. In the pulse of life moving through your body. In the willingness to meet yourself honestly and gently. Meeting Yourself The deepest intimacy is the relationship you cultivate with your own heart. To meet yourself is to witness your thoughts, contradictions, joys, and aches without judgment or urgency. Can you stay present with fear rather than turning away? Can you allow sadness to settle in your chest and still honor it as meaningful? Can you sense the subtle movement of breath and energy within you? In moments of stillness and awareness, we often discover how much of ourselves we have learned to hide: emotions pushed aside, sensations ignored, patterns inherited and carried unconsciously. Yet every doorway to genuine connection already exists inside you. When you reclaim your inner world, you reconnect with the source from which all intimacy flows. Being Felt Emotional intimacy is not something we explain; it is something we allow. It lives in presence in the unguarded moment, the pause that stretches, the vulnerability that remains uncovered. To be emotionally intimate is to let the quiet pulse of your inner life meet another without the need to justify or repair it. Breath becomes a bridge, gently moving awareness between your inner world and the shared space. In this soft surrender, the heart remembers that it is safe to open, to soften, to simply be. Being Known Psychological intimacy asks for the courage to see and name the patterns that shape how we move through the world: our fears, defenses, and habitual ways of relating. “I withdraw when I feel unseen.” “I hesitate to ask for support because I fear being a burden.” These patterns rarely belong only to us. They often arise from family systems, ancestral histories, and cultural conditioning, unseen forces carried across generations. When we begin to recognize these influences, compassion naturally deepens. We stop judging ourselves and instead meet our patterns with curiosity and care, honoring the lineage that lives within us. Meeting Beyond Roles Spiritual intimacy emerges when roles and narratives fall away. It is found in the space between breaths, in shared silence, and in the quiet recognition of essence meeting essence. It may appear while sitting together in stillness, in a gaze that needs no explanation, or while walking side by side through ordinary moments that suddenly feel sacred. When attention softens and awareness deepens, intimacy arises naturally. Breath, presence, and a wider systemic awareness allow us to meet one another with greater freedom, depth, and reverence. Intimacy Beyond Another You do not need another person to access this depth of closeness. Intimacy can be cultivated entirely within. In moments of stillness, you may begin to honor every layer of your being. As your breath deepens, its rhythm may echo the larger cycles of life. Subtle currents of energy become more perceptible, as does the quiet presence of ancestral threads shaping your experience. When inner intimacy is nurtured, relationships transform. Connection is no longer about filling a void, but about resonance: two beings meeting from wholeness rather than need. The Sacredness of Vulnerability To be intimate is to be seen and being seen can feel risky. Old wounds, inherited fears, and unmet needs often surface, making closeness feel uncomfortable. Yet vulnerability is the doorway. Breath and embodied awareness gently anchor you in the present, reminding you that you are alive, supported, and connected. As presence meets presence, intimacy deepens naturally. Intimacy as a Way of Being Intimacy is not something to earn or achieve. It is a state of presence, openness, and deep respect for life. It lives in meeting yourself with compassion, keeping your heart soft even in the presence of fear, holding space for another without expectation, and recognizing the sacred thread that runs through all connection. As you move through the days ahead, you might gently notice where intimacy is already presentin your breath, in moments of quiet honesty with yourself, in the spaces between words. There is nothing to strive for and nothing to fix. Intimacy is already here, waiting to be met. Warmly, Aki Tsukui
By Esther Oon-Bybjerg February 4, 2026
Chemistry is often treated as a decisive force in romantic life. When it is present, people feel justified in leaning in. When it is absent, even after a pleasant and promising date, interest tends to stall. Chemistry appears to offer clarity, but what it actually provides is something narrower: an early signal, powerful in its immediacy, yet limited in what it can reliably tell us. Most people recognise this tension intuitively. They know chemistry matters, but they also sense that it does not explain everything that makes a relationship viable or sustaining. And yet, in practice, chemistry is frequently asked to carry more authority than it deserves, shaping decisions about who to pursue, who to dismiss, and how long to remain invested. What is chemistry? In relationship research, romantic chemistry is recognised as a multifaceted, emergent experience. It can include attraction, emotional connection, interactive engagement, and a sense of mutual responsiveness. Importantly, chemistry is not viewed as a fixed trait residing in one person, but as something that arises between two people through interaction. When researchers examine how people themselves describe chemistry, however, a more specific pattern emerges. A recent qualitative study published in Behavioral Sciences, found that while participants acknowledged chemistry could involve multiple elements, the most commonly cited and immediately recognised experience was an instantaneous spark - a felt sense of connection, intensity, or attraction early in an interaction, rather than a gradual assessment of compatibility or emotional safety (Devenport et al., 2025). Why the spark feels so convincing That immediate spark carries weight because it is physiological as much as psychological. Early romantic chemistry is associated with activation of the brain’s reward and motivation systems, including increased dopamine and norepinephrine, which are neurochemicals involved in focus, pursuit, and salience. The body feels energised, attention narrows, and the other person begins to stand out in a way that feels meaningful. This response is not irrational. From an evolutionary perspective, rapid bonding had adaptive value. From a learning perspective, our nervous systems are shaped by repeated relational experiences. Attachment research helps explain why this kind of activation can feel meaningful so quickly. Our nervous systems learn through experience what closeness feels like, and over time they become efficient at recognising familiar patterns. When past intimacy involved emotional intensity or heightened engagement, the body may respond swiftly to similar cues, even before conscious evaluation has a chance to catch up. (Mikulincer et al., 2020). 1Chemistry, then, is neither imagined nor accidental. But it is also not a verdict. It is a signal that arrives early and speaks loudly. When chemistry starts doing more than it should Problems arise when chemistry shifts from being an opening signal to becoming the deciding factor. When people over-index on chemistry, two familiar patterns tend to emerge. In one, the absence of chemistry limits pursuit. Dates can go well. Conversation can flow. The other person may be emotionally available, respectful, even aligned with what someone says they want. And yet, without chemistry, interest stalls. Many people describe this not as rejection, but as resignation: “I know they’re good for me, but I don’t feel anything.” The relationship does not end; it simply never begins. In other cases, the opposite happens. A relationship starts with strong chemistry. People invest quickly and overlook early warning signs. That initial pull shapes the decision to begin the relationship and continues to guide it even if doubts surface. Concerns are registered, but they carry less weight. Over time, it becomes clear how much chemistry has been steering judgment from the beginning. Because the nervous system is activated, the mind works to maintain coherence, often finding reasons to persist rather than pause. In both cases, chemistry is doing more work than it should either preventing people from staying curious enough for other forms of connection to develop or pulling people forward too quickly. What chemistry can and cannot tell you Research consistently shows that long-term relationship satisfaction is far more strongly predicted by responsiveness, repair after conflict, and emotional attunement than by early intensity alone (Overall & Lemay, 2021). Chemistry does not reliably predict these capacities. Chemistry can tell you that your system is activated, your attention is engaged, and something feels compelling or familiar. What it cannot tell you is how conflict will be handled, whether needs will be met consistently, or whether emotional safety will deepen or erode over time. From a nervous-system perspective, this distinction matters. Stephen Porges’ work on Polyvagal Theory describes how the autonomic nervous system continuously scans for cues of safety and threat, shaping whether we feel socially open, vigilant, or withdrawn. When systems are accustomed to high arousal, intensity can be misread as connection and calm can register as disinterest. In such cases, chemistry reflects nervous-system conditioning more than relational compatibility (Porges, 2022). 2The consequences of over-indexing on chemistry often appear later, in hindsight. When chemistry dominates judgment, it can obscure both warning signs and possibilities. Chemistry as one voice among others A more grounded way to relate to chemistry is to treat it as one voice in a larger conversation. It deserves attention, but it should not be allowed to dominate the discussion or determine the outcome on its own. Qualities such as emotional safety, mutual responsiveness, values alignment, and repair after conflict tend to speak more slowly. They require time and exposure to reveal themselves. When chemistry drowns them out, decisions are made with incomplete information. Wanting chemistry is not the problem. The issue arises when it is allowed to outweigh every other form of relational information. Chemistry can open the door, spark curiosity, and make connection feel alive, but sustaining love depends on quieter, more consistent signals - emotional presence, repair, respect, and reliability over time. The goal is not to mute the spark, but to place it in context. Chemistry speaks loudly, but wisdom often emerges only after the initial intensity had time to settle.  References Devenport, L., et al. (2025). Exploring lay understandings of romantic chemistry. Behavioral Sciences, MDPI. https://www.mdpi.com/3592440 Mikulincer, M., Shaver, P. R., & Ein-Dor, T. (2020). Attachment orientations and emotion regulation in close relationships. Current Opinion in Psychology, 25, 86–91. Overall, N. C., & Lemay, E. P. (2021). Attachment, responsiveness, and well-being in romantic relationships. Current Opinion in Psychology, 43, 110–115. Porges, S. W. (2022). Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 16, 871227. https://doi.org/10.3389/fnint.2022.871227 3