As women journey through the natural life stages of perimenopause and menopause, many find themselves facing surprising emotional challenges. These hormonal shifts bring not just physical symptoms—like hot flashes or insomnia—but also significant mental health changes, including anxiety, mood swings, and even depression.

According to the National Institute on Aging (NIA) and the National Institutes of Health (NIH), up to 23% of women will experience mood symptoms during perimenopause, and around 20% may meet the criteria for clinical depression. These numbers rise even higher for women with a personal or family history of mood disorders, postpartum depression, or trauma.

That’s where Dialectical Behavior Therapy (DBT) steps in—offering structure, self-compassion, and skills for emotional resilience. Originally developed for individuals with intense emotional sensitivity, DBT is now widely used for life transitions, including those unique to midlife women.  More on DBT in this article.

The Mental Health Landscape of Menopause

Hormonal fluctuations during perimenopause—particularly declining estrogen and progesterone—can affect mood-regulating neurotransmitters like serotonin and dopamine. This biological shift, combined with social, relational, and physical changes, can lead to mental health symptoms such as:

• Emotional reactivity and mood swings
• Anxiety and irritability
• Sleep disturbances
• Difficulty concentrating (“brain fog”)
• Feelings of grief, identity loss, or loneliness
• Increased vulnerability to depression

According to Mental Health America (MHA), hormonal changes can exacerbate pre-existing mental health conditions, especially in women with a history of trauma, chronic stress, or mood disorders. Women often describe this phase as an “emotional rollercoaster”—and many feel dismissed or misunderstood.

How DBT Supports Midlife Women

DBT offers four structured modules—Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness—which are particularly well-suited to support women in this stage of transition.

1. Mindfulness: Grounding in the Present

Mindfulness helps women cultivate awareness and reduce reactivity, especially helpful when hormonal surges make emotions feel unpredictable.

“Mindfulness practices can reduce emotional intensity and improve overall emotional well-being in women experiencing menopausal symptoms.” — NIH/National Center for Complementary and Integrative Health (NCCIH)

Try this: A morning body scan or “what’s happening now” journaling to increase emotional awareness without judgment.

2. Distress Tolerance: Riding the Emotional Waves

DBT’s distress tolerance skills help women cope with crisis moments without making the situation worse.

• SAMHSA emphasizes that “emotional regulation becomes more difficult during midlife hormonal changes,” which can lead to impulsive behaviors or withdrawal if left unaddressed.

Try this:

• Cold water splashes, paced breathing, or aromatherapy
• Distraction through movement – Take a brisk walk, dance in your kitchen, or follow a short yoga video
• Engage your five senses to soothe and ground yourself

Physical activity, even in short bursts, is a powerful distress tolerance tool. Research from the North American Menopause Society shows that exercise not only helps with hot flashes and fatigue but also reduces anxiety and depressive symptoms.

3. Emotion Regulation: Naming and Managing Mood

Learning to name, validate, and manage emotions can decrease their intensity and increase a woman’s sense of control.

“More than 60% of perimenopausal women report emotional symptoms severe enough to impact their quality of life.” — North American Menopause Society (NAMS)

One of the most effective yet underrated emotion regulation tools is exercise. According to the NIH, regular physical activity boosts mood-enhancing endorphins, improves sleep quality, and decreases cortisol levels—all critical during hormonal transitions.

Tip:

• Aim for 30 minutes of movement most days of the week—walking, swimming, cycling, stretching, or strength training.
• Use DBT’s “ABC PLEASE” to build emotional resilience:
  • Accumulate positive experiences
  • Build mastery
  • Cope ahead
  • PLEASE (tend to Physical health, eat balanced, avoid substances, sleep well, and exercise regularly)

4. Interpersonal Effectiveness: Redefining Boundaries and Roles

Midlife often brings shifting family roles—empty nesting, caregiving for aging parents, or marital changes. DBT teaches women how to assert needs, set limits, and maintain self-respect.

• According to NAMI, “the cumulative stress of caregiving, work demands, and aging can significantly impact a woman’s ability to care for her own mental health.”

Try this: Practice “DEAR MAN” to ask for what you need. For example:

“I know the house is chaotic right now, but I need 45 minutes for a walk to clear my head before I can jump back in.”

Validation and Radical Acceptance: The Heart of DBT

A core component of DBT is Radical Acceptance—acknowledging reality as it is, without judgment or resistance. For many women, just having their emotional experience validated can be profoundly healing.

You are not weak. You are not “just hormonal.” You are navigating a complex and meaningful transformation of identity, physiology, and purpose.

What the Research Says

• NIH: Women in perimenopause are at increased risk for major depressive episodes, especially in early transition stages.
• MHA: 75% of women report psychological symptoms like mood swings, anxiety, or depression during perimenopause.
• SAMHSA: Stresses the need for age- and gender-specific mental health interventions for women in midlife.
• NAMI: Recommends physical activity and therapy as first-line mental health supports for women in transition.

A Therapist’s Perspective

As a Licensed Clinical Mental Health Counselor and Certified Perinatal Mental Health Provider, I see many women in their 40s and 50s who say things like, “I don’t recognize myself anymore.” DBT helps them reconnect with their bodies, thoughts, and needs. Often, we integrate physical

movement into the healing process: walking sessions, grounding, or assigning “joyful movement” as homework.

You don’t have to choose between being strong and being vulnerable. You can be both.

In Closing

Perimenopause and menopause are not an ending—they are an invitation to grow into a wiser, more self-defined version of yourself. With DBT’s compassionate framework and the grounding force of physical movement, you can find your way back to emotional balance, strength, and joy.

If you’re walking through this season, know that help is available—and you are never alone.

Article by:  Kim Matone, LCMHC

Kim Matone, LCMHC, is Co-Founder of Matone Counseling and Testing. She specializes in women’s mental health, perinatal mental health and uses DBT and trauma-informed care to support clients through life’s most significant changes.