**Motherhood, Identity, and the Menopause Transition**
**By: Lindsay Kate Skinner, MA, LPC,**

There are certain transitions in a woman’s life that we expect. We expect puberty. We know pregnancy changes the body. We talk about postpartum, although, as we discussed in the last part of this series, probably still not nearly enough.

But motherhood does not stop changing us when the postpartum years are over. Years later, after pregnancies, sleepless nights, toddler years, school schedules, birthday parties, carpools, sports practices, teenage emotions, and countless seasons of caring for everyone else, many mothers find themselves entering another enormous hormonal transition with surprisingly little preparation: perimenopause and menopause.

And it often arrives during an already complicated season of motherhood. Your children may not need you in the ways they once did. Or perhaps they need you emotionally more than ever. You may be raising teenagers, helping young adults find their way, watching children leave home, becoming a grandmother, caring for your own aging parents, or simply trying to figure out who you are after years of being needed by everyone around you.

At the same time, your body may begin changing again. For some women, the first sign is a changing menstrual cycle. For others, it is waking up at 3 a.m. night after night. Maybe it is a sudden increase in anxiety, irritability, brain fog, exhaustion, sadness, or simply the feeling: Something about me feels different.

And far too often, instead of asking What is happening to my body? women begin asking: What is wrong with me? That distinction matters.

First, What Are Perimenopause and Menopause?

We often use the word menopause to describe this entire season, but clinically there is a difference. Perimenopause is the transition leading up to menopause. During this time, ovarian hormone production fluctuates and menstrual cycles can begin to change. Women may experience irregular periods, hot flashes, night sweats, sleep disruption, vaginal changes, changes in sexual desire, difficulty concentrating, and changes in mood.

Menopause is technically reached once a woman has gone 12 consecutive months without a menstrual period, assuming there is not another medical explanation. The average age of the final menstrual period is around 51, although the timing varies considerably from woman to woman.

And while we sometimes talk about menopause as if it is simply the end of a menstrual cycle, for mothers it can represent something much larger. For many women, fertility, pregnancy, birth, breastfeeding, and motherhood have shaped their relationship with their bodies for decades. Our bodies have carried babies, recovered from childbirth, produced milk, survived sleepless nights, and adapted again and again to meet the demands of motherhood. Then, years later, the body changes once more.

It is a biological transition. But it can also be an emotional transition, particularly when it happens alongside a changing experience of motherhood.

The Mental Health Piece Is Real

One of the reasons I care so much about talking about women’s health from a mental health perspective is because we have historically separated the two far too easily. Your brain is part of your body. Hormonal shifts do not occur in isolation from sleep, stress, mood, cognition, relationships, or emotional regulation. And motherhood certainly does not occur in isolation from any of those things either.

The American College of Obstetricians and Gynecologists reports that approximately 4 in 10 women experience mood symptoms during perimenopause, including irritability, low energy, tearfulness, difficulty concentrating, and mood instability. Research also suggests that the risk for depression increases during the menopausal transition.

A 2024 systematic review and meta-analysis looked at prospective studies involving more than 16,000 women. Researchers found that women in perimenopause had approximately a 40 percent greater risk of experiencing depressive symptoms or a depressive disorder compared with premenopausal women. Interestingly, that same increased risk was not found when postmenopausal women were compared with premenopausal women, suggesting that the transition itself may represent a particularly vulnerable window for mental health.

That matters when we think about mothers. Because the woman saying, “I don't understand why I'm suddenly struggling so much,” may also be the woman who has spent the last twenty years being the one everyone else depends on. She may still be remembering appointments, checking grades, worrying about her children, organizing holidays, caring for parents, working, managing a home, supporting a spouse, and carrying much of the emotional life of her family.

And now she is trying to understand a body and brain that suddenly feel unfamiliar.

Motherhood Is Changing at the Same Time

Hormones are only one piece of this story. Think about the season of motherhood in which perimenopause and menopause often occur.

For years, motherhood may have been intensely physical: holding babies, packing lunches, buckling car seats, bath time, bedtime, school drop-off, being touched, climbed on, called for, and needed almost constantly. And then slowly, motherhood begins to change.

The child who once needed you for everything begins needing you differently. Teenagers pull away as they become their own people. Young adults leave home. College begins. Relationships change. Holidays change. Bedrooms become empty.

You may find yourself enormously proud of the people your children are becoming while simultaneously grieving the version of motherhood that is ending. And sometimes mothers feel guilty even admitting that grief. You wanted them to grow up. You wanted them to become independent. You know this is what is supposed to happen. And still, something is changing.

At the same time, many women are also caring for aging parents, navigating changes in marriage, experiencing career pressure, grieving loved ones, noticing changes in their own bodies, and reevaluating friendships, identity, and purpose. ACOG specifically notes that the pressures women often experience in their 40s and 50s can compound the emotional challenges occurring during perimenopause.

So when a mother tells me she feels overwhelmed during this season, I don't think the most helpful question is: “Is this hormonal or emotional?”

Sometimes the answer is: Yes. It can be both. Our biology affects our emotional world, and our emotional world affects how we experience what is happening physically.

“But I’ve Always Been Able to Handle Things”

This may be one of the hardest parts for mothers. Motherhood teaches women to function, sometimes extraordinarily well. We manage calendars, appointments, school schedules, meals, careers, marriages, friendships, homes, sports, birthdays, holidays, medical appointments, aging parents, the emotions of the people we love, and often a thousand tiny things no one else even realizes we are remembering.

We become really good at carrying things.

So when anxiety suddenly feels louder, sleep falls apart, patience feels thinner, concentration becomes harder, or emotions feel closer to the surface, the response is often not compassion. It is frustration.

Why can't I handle this anymore? Why am I so emotional? Why am I anxious when I have never been anxious before? Why am I forgetting things? Why am I snapping at my family? Why don't I feel like myself?

But perhaps those questions need to change. Instead of “What is wrong with me?” maybe we begin with “What is happening to me?”

That question creates room for curiosity instead of criticism.

The Mother Still Needs Mothering, Too

There is something I keep returning to throughout this entire series. Mothers become incredibly accustomed to noticing everyone else's needs. We notice when the baby is tired, when the toddler is overwhelmed, when the teenager is unusually quiet, when our spouse has had a difficult day, and when our parent needs more help than they used to.

We become experts at paying attention. But somewhere along the way, many women stop extending that same attention toward themselves.

And perhaps one of the invitations of this season is to begin doing that again. What is my body telling me? What am I grieving? What am I carrying? What feels different? Where am I exhausted? Where do I need support? What do I need now?

Those are not selfish questions. They are human ones.

Your Body Deserves Curiosity, Not Criticism

This has become one of the themes running through this entire series on the mental health of motherhood. Women's bodies change through fertility, pregnancy, birth, postpartum, breastfeeding, motherhood, perimenopause, and menopause.

And through each transition, there can be a temptation to believe our bodies should simply cooperate while the rest of life continues uninterrupted. But our bodies are constantly communicating with us.

Sometimes the answer is medical. Sometimes it is psychological. Sometimes it is relational. Sometimes we desperately need rest. And very often, it is some combination of all of those things.

Paying attention to those signals isn't weakness. It's health.

Therapy Isn't About Telling You It's “All in Your Head”

If a woman is experiencing symptoms related to perimenopause or menopause, therapy should never be used to dismiss the biological component of what she is experiencing. Quite the opposite. Good mental health care should exist alongside good medical care. Talk with your physician or gynecologist. Ask questions. Discuss changes in your menstrual cycle, sleep, mood, sexual health, hot flashes, night sweats, or other symptoms. There are hormonal and nonhormonal medical treatment options available, and treatment decisions should be individualized with a qualified medical provider. But there is also evidence that psychological support can be meaningful during this transition. Research examining psychosocial interventions during menopause has found that cognitive behavioral therapy can improve symptoms of depression and anxiety, along with sleep difficulties, perceived stress, and how bothersome some menopausal symptoms feel.

As a therapist, I love that distinction. Therapy isn't pretending the hot flash didn't happen. It isn't talking your body out of changing. It is helping you navigate everything happening around that change.

For a mother, that might mean challenging the thought I'm falling apart. It might mean learning how to respond differently to anxiety. It might mean understanding why your patience suddenly feels so thin with the people you love most. It might mean grieving children growing up, navigating the transition into an empty nest, rediscovering intimacy with your spouse after years of parenting together, or working through changes in body image.

It might mean questioning who you are now that your children do not need you in quite the same way. It might mean acknowledging resentment or exhaustion after years of carrying the mental load of a family. And sometimes it is simply having one space where nobody needs anything from you. One space where you don't have to minimize how hard this season feels.

When Motherhood Changes, Who Am I Now?

This is a question I think deserves more attention. Early motherhood often consumes enormous parts of our identity. Sometimes beautifully. Sometimes painfully. Usually both.

For years, life may revolve around children: their needs, their schedules, their development, their friendships, their activities, their struggles, their futures. Then something begins to shift. Children become more independent, and suddenly there can be space where there wasn't space before.

That sounds freeing, and it can be. But space can also feel uncomfortable when you have spent years filling every minute with caring for someone else.

Who am I when everyone doesn't need me quite so much? What do I enjoy? What do I want my marriage to look like now? What friendships matter to me? What dreams did I put away? What does purpose look like in this next season?

Those questions are not evidence that motherhood mattered less. They may actually be evidence of how deeply motherhood has shaped you.

The goal is not to become the woman you were before children. That woman has changed. The question may instead be: Who am I becoming now?

Menopause Isn't the End of the Story

We also need to be careful about the language we use around menopause. Our culture has historically had a strange way of attaching a woman's value to youth, fertility, appearance, and motherhood. Then children grow older, fertility ends, bodies change, and somehow women can receive the message that their most meaningful years are behind them.

Motherhood does not end when pregnancy is no longer possible. It does not end when your child graduates. It does not end when they move out. It changes. And so do we.

There can absolutely be grief associated with leaving one season behind. And there can also be freedom, growth, clarity, deeper relationships with adult children, new boundaries, a changing relationship with your body, a stronger marriage, new friendships, new purpose, and maybe even becoming a grandmother.

And perhaps, after years of asking what everyone else needs, there is finally room to ask: What do I need now?

Not what do my children need. Not what does my spouse need. Not what does my job need. Not what does everyone else need from me. What do I need in this season?

That can be an uncomfortable question for a mother. It can also be an incredibly important one.

Every Season of Motherhood Deserves Care

When I began thinking about this series, I wanted to talk about more than diagnoses or symptoms. Because the mental health of motherhood cannot be reduced to pregnancy and postpartum.

Motherhood is a lifelong relationship. And mothers continue changing, too.

Fertility can carry hope, uncertainty, disappointment, grief, and longing. Pregnancy can ask a woman to surrender control over a body that is changing by the week. Postpartum can bring extraordinary love alongside sleep deprivation, identity shifts, anxiety, depression, hormonal changes, and the enormous responsibility of caring for another human being.

Then the years move forward. Babies become toddlers. Toddlers become children. Children become teenagers. Teenagers become adults. And somewhere during those years, the mother continues becoming someone, too.

Then perimenopause and menopause may ask her to learn her body all over again.

Different seasons. Different experiences. Different versions of motherhood. But perhaps the same reminder through all of them:

You are allowed to pay attention to what is happening to you, too.

You are allowed to ask questions. You are allowed to need support. You are allowed to talk with your doctor. You are allowed to talk with a therapist. You are allowed to grieve the version of motherhood that is changing while deeply loving the version that comes next.

You are allowed to care for yourself even after decades of caring for everyone else. And you do not have to wait until you are completely overwhelmed before deciding that what you are experiencing matters.

Because motherhood may ask us to give an extraordinary amount of ourselves, but becoming a mother never meant that the woman underneath the role stopped mattering.

Women’s mental health is women’s health.

And every version of you, through fertility, pregnancy, postpartum, motherhood, perimenopause, menopause, and everything that comes after, deserves to be cared for.

Apollo Blog Series- From Fertility to Menopause: The Mental Health of Motherhood