Perimenopause or Burnout? Understanding the Overlap in Mental Health

“I just don’t feel like myself anymore.”

For many women in their 40s and 50s, these words feel both true and confusing. They might assume it’s burnout — the result of too many demands and too little rest. And while that’s sometimes accurate, there’s another possibility we don’t talk about enough: perimenopause.

Understanding the overlap between perimenopause and burnout can help women get the right support, at the right time — and reduce the shame or self-blame that so often accompanies both.

What Is Perimenopause?

Perimenopause is the transition period leading up to menopause, often beginning in a woman’s late 30s or early 40s. It can last for several years, and involves significant hormonal fluctuations — especially in oestrogen and progesterone — long before menstrual cycles stop.

This stage can include symptoms such as:

Mood swings or emotional sensitivity
Sleep disturbances
Cognitive changes (e.g. brain fog, forgetfulness)
Anxiety or reactivity
Changes in energy, motivation, and confidence

Why Perimenopause Looks Like Burnout

There’s considerable overlap between the symptoms of perimenopause and burnout. Both can involve:

Fatigue
Poor sleep
Low mood
Irritability
Mental fog
Reduced stress tolerance

But while burnout is a response to sustained external pressure, perimenopause originates from internal hormonal shifts that affect the brain and nervous system.

Without awareness of perimenopause, many women and professionals attribute these changes solely to workload or personality. That can delay appropriate care.

Why It’s Often Missed

Many women don’t realise they’re in perimenopause — especially if their menstrual cycle is still relatively regular. Contributing factors include:

Lack of education — many health and mental health professionals received little training on menopause.
Cultural stigma — menopause is still under-discussed and often framed negatively.
Gendered assumptions — emotional symptoms are often misattributed to stress, parenting, or age.
Psychological bias — even clinicians tend to look first for trauma, depression, or anxiety.

A Clinical Example

Consider a woman in her mid-40s who comes to therapy describing low motivation, disrupted sleep, and a short fuse. She’s trying hard, attending sessions, using the strategies — but nothing is shifting.

A deeper intake reveals:

She wakes nightly between 2 and 4am
Her periods are getting heavier and closer together
She’s experiencing episodes of overheating and anxiety

What looks like burnout may actually be perimenopause. And if we don’t recognise that, we risk missing the full picture.

What Can Help?

1. Ask About Cycle and Hormonal Shifts

Mental health intakes should include questions about:

Menstrual changes
Sleep quality and timing
Body temperature changes
Mood fluctuations across the month

These signs can point to perimenopause — even when cycles are still regular.

2. Refer or Collaborate Across Disciplines

Mental health professionals don’t need to manage hormones, but we do need to notice them. Referrals to a GP or women’s health specialist can help clients access appropriate medical care alongside therapy.

3. Avoid Misdiagnosis

Symptoms like anxiety, flat mood, or emotional volatility can look like psychiatric disorders — but they may stem from hormonal changes. Medication may help, but without a hormonal lens, we risk overtreatment or mislabelling.

4. Validate the Experience

Perimenopause is often confusing and isolating. Women may feel like they’re failing, or “going mad.” Compassionate, informed care can ease this transition and reduce shame.

Final Thoughts

Burnout and perimenopause often show up with similar faces — fatigue, reactivity, and emotional depletion. But the underlying causes are different. And recognising perimenopause and burnout as distinct (though overlapping) experiences allows us to offer more accurate, respectful, and effective support.

If a woman says “I just don’t feel like myself,” we should be curious — not just about her workload, but about her biology.