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.

Breathing Into the Essence of Who You Are: A Journey of Identity through Yin Breathwork

By Aki Tsukui • June 2, 2025
What does it mean to truly know who you are? During Pride Month, we celebrate the beauty of diverse identities and the courage it takes to live authentically. But beyond the labels and roles, there is a deeper essence waiting to be seen—a core self that exists beneath the surface. At Elemental Wellness, we believe that reconnecting with this essence is both a sacred and scientific journey. And breath is the bridge. The Breath: A Portal to the Subconscious Yin Breathwork, rooted in Leonard Orr’s Rebirthing Breathwork, offers a gentle yet profound way to access inner truth: not through thinking, but through feeling and presence. This form of conscious, connected breathing helps shift our awareness from the everyday, thinking mind (conscious) to the deeper, quieter terrain of the subconscious. Why does this matter? Because the subconscious holds the stories, emotional imprints, and beliefs we’ve absorbed, often unconsciously, from culture, family, and lived experience. These inner patterns shape how we see ourselves and how freely we live out our identities. Through slow, circular breath, Yin Breathwork helps bypass habitual thought loops and opens the door to neuroplasticity: the brain’s natural ability to rewire. When we breathe with intention and softness, we create a relaxed yet alert state, similar to light meditation or REM sleep, where old emotional imprints can surface and be gently released. Science Meets Soul: The Nervous System and Breath From a physiological perspective, breath is one of the few automatic functions we can consciously control. When we slow and deepen our breathing, we signal safety to the brain through the vagus nerve, activating the parasympathetic nervous system, our body’s natural state of rest and repair. This matters deeply for identity work. If we've lived in fight-or-flight, bracing against judgment, discrimination, or internalized shame, our nervous system may associate authenticity with risk. But breath offers another way. It teaches the body that it is safe to soften, to open, to be seen. Over time, regular Yin Breathwork can help regulate the nervous system, reduce anxiety, and increase emotional resilience. It becomes a quiet revolution within: an unlearning of fear and a return to inner freedom. Identity: A Living, Breathing Process We often think of identity as something to define or declare. But what if identity is not fixed, but fluid? What if it’s something we remember , layer by layer, breath by breath? In a Yin Breathwork session, there is no need to force answers. We simply lie back and breathe, allowing what wants to emerge to rise. The experience can feel meditative, emotional, or quietly powerful. As tension releases from the body, insight often follows about who we are beneath the roles, the expectations, the old stories. Rather than striving for authenticity, we relax into it . This isn’t a quick fix. It’s a return to the self—a remembering of what has always been there. And in that remembering, healing happens Pride as a Return to Wholeness Whether you're navigating your gender, sexuality, cultural heritage, or your evolving sense of self, Yin Breathwork offers a sanctuary—a space to return to your body and your truth. There’s no performance. No pressure. Just breath. Just presence. Just you. This Pride, instead of stepping out, we invite you to step in. To soften. To listen. To discover who you are beneath the noise gently, fully, and unapologetically. Yin Breathwork isn’t about changing yourself; it’s about remembering who you’ve always been. Join us for a Yin Breathwork session and reconnect with who you truly are. For booking: info@counselingperspective.com

Shaping Selfhood: How Tech and Social Media Influence Teens’ Identity Formation

By Emanuela Koch • June 2, 2025
Adolescence is a time of profound self-discovery: teens experiment with interests, values, friendships, and personal style as they build their emerging identities. Yet in today’s hyperconnected world, much of that identity work happens on screens. Rather than exploring who they are through face-to-face interaction, teens now look to social-media feeds, influencers, and online communities to test different selves. Every “like”, filter, and “follow” becomes a data point that algorithms use to mirror back a curated version of the self. This digital reflection can empower creativity and connection, but it can also distort self-worth, foster comparison, and lock teens into narrow, algorithm-driven identities. In fact, a 2024 Mozilla study1 found TikTok locks in on a user’s niche within 40 minutes, after which 80% of videos reinforce that same theme, even if the user stops engaging. Over time, teens learn to judge their worth by these algorithmic reflections, embedding a fragile, externally dictated self-image. Why Teenage Years Are Crucial for Identity Formation During adolescence, the brain undergoes a dramatic reorganization. The limbic system, which governs emotions and reward processing, matures rapidly around puberty, making teens especially sensitive to social feedback and novelty. In contrast, the prefrontal cortex, responsible for impulse control, planning, and reflection, continues developing into the mid-twenties. This imbalance creates a window where emotional drives often outweigh rational oversight. Simultaneously, the brain undergoes synaptic pruning and myelination, strengthening neural pathways through repeated behaviors. Online, every click, like, or share provides immediate emotional payoff and simultaneously reinforces circuits that link identity to digital validation loops. This makes adolescence a uniquely malleable, and vulnerable, time for forming a lifelong sense of self. A World Where Identity Is Always “On” and the Pressure of Perfection A January 2025 CNA–Institute of Policy Studies survey2 found Singaporean teens spend an average of 8.5 hours per day on screens, more time than they devote to school or sleep. Globally, 46% of U.S. adolescents report being online “almost constantly,” and 60% feel pressured to present an idealized self for likes and followers3. In this nonstop digital stage, every scroll, post, and reaction wires directly into the neurons shaping a teen’s self-concept. Physical appearance is central to many teens’ identities, and social feeds are flooded with airbrushed ideals. Internal Meta research4 leaked in 2021 revealed 32% of teen girls said Instagram made them feel worse about their bodies. Add to that nighttime scrolling, KK Women’s & Children’s Hospital (2024)5 found each extra hour of screen use after 10 p.m. raises next-day mood-swing odds by 21%. A sleep-deprived brain struggles with memory consolidation and self-reflection, processes vital for a coherent self-image, rendering teens more vulnerable to comparison and self-critique. Algorithms can also amplify harmful behaviors as identity expressions. In the Center for Countering Digital Hate’s Deadly by Design (2022) report6, new teen TikTok accounts encountered self-harm content within 2.6 minutes, and after 30 minutes, one in three videos promoted self-injury or suicide​. Likewise, a December 2024 CCDH study7 of YouTube recommendations found one-third of suggested videos contained harmful eating-disorder content, and 81% were not age-restricted. These loops trap vulnerable teens in a damage-defined identity, where pain and deprivation become badges of belonging. Community and Exploration It’s not all negative. Digital spaces can offer critical support for identity exploration, particularly for teens who feel marginalized offline. Online communities around neurodiversity, LGBTQIA+ experiences, or niche interests allow adolescents to test labels, find peers, and receive affirmation they might lack in real life. For example, transition narratives on TikTok help gender-questioning youth learn terminology, access resources, and spot role models. When stories of gender euphoria, the joy and comfort of affirmed identity, are shared online, some teens gain the language and confidence to live authentically. The key is ensuring these affirming narratives support rather than prescribe any one pathway. Autonomy Under Threat A stable identity requires privacy and agency over one’s own story. Yet Europol’s EU-SOCTA 2025 report8 highlights a 1,400% surge in AI-generated nude images of minors as deepfake tools proliferate. In response, schools in Europe and North America now run “deepfake drills” to teach students how to spot synthetic abuse and report incidents. Simultaneously, every tap and like is harvested as data capital: TikTok was fined €345 million in 20239 for mishandling under-16 data , and by age 13, the average U.S. teen accumulates 72 million data points that shape ads, credit offers, and even college recruitment. These incursions can leave teens feeling exposed, monitored, and reduced to a data profile, undermining self-determination. Building Resilient Identities Parents can’t, and shouldn’t, unplug technology. Instead, we can transform digital pressures into opportunities for intentional identity work using the these tips: 1. Presence: Weekly 5-minute Tech Tours where teens guide parents through their favorite apps, validating interests and spotting harmful patterns together. 2. Educate: explain algospeak and data harvesting, teaching teens they’re authors of their digital profiles, not products of them. 3. Agreements: Co-create a Family Tech Charter with mutually agreed limits (e.g., bedtime Downtime, screen-free zones) to bolster self-regulation. 4. Role-model: Demonstrate healthy detachment, charge devices outside bedrooms and share your own Screen Time stats openly. 5. Support and Boundaries: Bookmark crisis lines (SOS: +65 7672 4357; IMH helpline: 6389 2222) and enable in-app filters to safeguard mental health. 6. Alternatives: Encourage one daily offline “dopamine” activities (like sports, music, volunteering) to anchor identity beyond screens. The Takeaway: Authentic Selfhood in a Digital Age Technology can accelerate identity exploration and foster creative communities, but without guidance, it can also narrow, distort, and commodify self-concept. By weaving together clinical insight, data-driven understanding, and collaborative strategies, parents can guide teens toward authentic, resilient identities, both online and off. References 1 Mozilla Foundation. “TikTok: Unpacking Algorithmic Personalization.” Mozilla Research , April 2024. https://foundation.mozilla.org/en/research/tiktok-algorithmic-personalization-study/ 2 CNA & Institute of Policy Studies. “Singapore teenagers spend nearly 8.5 hours per day on screens.” Channel News Asia , January 2025. https://www.channelnewsasia.com/singapore/screen-time-devices-survey-teens-spend-daily-stress-490828 3 Pew Research Center. “Teens, Social Media & Technology 2023.” Pew Research Center , October 2023. https://www.pewresearch.org/internet/2023/10/25/teens-social-media-technology-2023/ 4 The Wall Street Journal. “Facebook Knows Instagram Is Toxic for Teen Girls, Company Documents Show.” September 2021. https://www.wsj.com/articles/facebook-knows-instagram-is-toxic-for-teen-girls-company-documents-show-11631620739 5 KK Women’s & Children’s Hospital. “Screen Use and Sleep Patterns in Adolescents.” Journal of Pediatric Sleep , March 2024. https://www.kkh.com.sg/health-information/child-screen-time-sleep-study 6 Center for Countering Digital Hate (CCDH). Deadly by Design . December 2022. https://counterhate.com/wp-content/uploads/2022/12/CCDH-Deadly-by-Design_120922.pdf 7 Center for Countering Digital Hate (CCDH). YouTube’s Anorexia Algorithm: Key Findings . November 2024. https://counterhate.com/wp-content/uploads/2024/12/CCDH.YoutubeED.Nov24.Report_FINAL.pdf 8 Europol. European Serious and Organised Crime Threat Assessment (EU-SOCTA) 2025 . March 2025. https://www.europol.europa.eu/activities-services/main-reports/eu-socta-2025 9 Irish Data Protection Commission. “TikTok Fined €345 Million for Breaching GDPR.” DPC News , September 2023. https://www.dataprotection.ie/en/news-media/tiktok-gdpr-345m-fine

When Compromise Feels Like Losing Yourself: How to Know What’s Worth Adjusting For

By By Esther Oon-Bybjerg • May 15, 2025
When James* (not his real name) walked into my office still holding his motorcycle helmet, he laughed sheepishly. "My wife hates this thing," he said, nodding at the matte-black shell in his arms. "She thinks I’m reckless. But I don’t ride for the danger. I ride because it’s the one place I can think. It clears my head." His eyes lit up as he described a weeklong ride he’d taken the year before along the Mae Hong Son loop in Northern Thailand with a group of friends. He told me how every twist in the road felt like freedom. "That adrenaline makes me feel powerful," he admitted. "And I feel like I’m supposed to give that part up." This wasn’t just about motorcycles. This was about what made him feel most alive and whether there was room for that part of him in the marriage. As we learnt more about the layers of their dynamic, a pattern emerged: James adjusted himself to avoid conflict. He skipped out on group rides, sold one of his bikes, made himself smaller, hoping this would preserve peace. Meanwhile, his wife, who deeply feared for his safety, viewed these concessions not as love, but as overdue maturity. I still remember the moment James asked, in despair, "How much more do I have to give up for this to work?" It’s easy to overlook how love can subtly ask us to trade parts of ourselves away. When the road that once gave you joy becomes a source of tension at home, when your values and interests feel incompatible with your relationship, what are you really being asked to let go of? How do we know when we’re adapting for love, or slowly disappearing inside it? When Compromise Turns Into Self Loss In long-term relationships, some flexibility is necessary. Two adults will never agree on everything. But there’s a difference between adjusting with integrity and eroding your identity. When compromise becomes chronic accommodation, it can stop feeling like love and starts feeling like self-loss. Most people don’t abandon their needs overnight. The erosion happens in small, well-meaning increments. You learn to read the room. You anticipate disappointment. You shrink in the name of "keeping the peace." Some clients tell me they’ve always been the reliable one, so they suppress their disappointment to keep the relationship steady. Others confuse love with self-sacrifice, believing that asking for too much will threaten the relationship. And many simply never learned that their emotional needs were valid to begin with, let alone how to express them. The danger lies in how socially sanctioned these behaviors are. Excessive compromising often masquerades as emotional intelligence or resilience - until the quiet resentment sets in. In my work with clients, I strive to help them unpack not just what they’ve agreed to but why they said yes in the first place. Sometimes it stems from early beliefs about their worth being tied to how easy they are to love. Sometimes, it’s an unconscious habit of keeping harmony at any cost. And often, it’s because no one ever asked them what they needed, so they learned not to ask either. How to Tell When You’re Compromising Too Much It is quite hard to know when the line has been crossed. Here are some common indicators. Healthy compromise should feel like a mutual effort that still honors your core. When it starts to feel like self-censorship, quiet resentment, or emotional shrinking, something needs attention. Ask yourself: Do I still recognize myself in this relationship? When I tried setting boundaries, does my partner listen or shut me down? Have I stopped asking for what matters because it feels like more trouble than it’s worth? When I adapt, does it come from a place of love or fear? Am I growing in this relationship, or becoming smaller within it? These questions cut deeper than the surface frustrations. They ask you to look at the structure you’ve built and whether it still honors the life you envisioned. If You’re Already Caught in the Cycle Start with reconnecting to your internal compass. When was the last time you felt fully yourself? What parts of you have gone quiet? Name your core emotional needs, in terms of what you value. These are not luxuries; they’re the roots of relational sustainability. Invite your partner in. Speak before the resentment calcifies. Use affirming language: “I miss the part of me that felt light and spontaneous. I want to bring that back into our relationship, and I need your help to do that.” And finally, stop trying to fix old patterns with old tools. If the usual ways of working things out aren’t helping, it’s time to step back and rethink the setup, not just who does what, but how you show up for each other and what kind of life you’re building together. Back to the helmet When James came in last week, he was still riding. Just less often, more thoughtfully. He told me they had started a new habit: each week, they share one thing they’ve done to support the other’s core needs, and one thing they hope for moving forward. “She still nags at me about my riding,” he said with a half-smile. “But now, she listens. And I’m starting to get why her sense of safety is tied to care, not control.” They’re not finished. But they’re just beginning to rewrite what healthy compromise looks like. It’s not perfect agreement, but a shared effort to make room for both people to matter. By Esther Oon-Bybjerg esther@counselingperspective.com