I often meet women who say something very similar when they first notice how stress affects them during menopause: “It feels as though something has changed. I am not quite myself.”

It may begin in a very concrete way, when you are sitting in a meeting and realize that you cannot quite follow the thread, even though you are usually the one who summarizes, catches the details, and moves the discussion forward. An email that would previously have been easy to answer remains unanswered longer than usual. At home, you hear yourself responding more sharply than you would like, perhaps to a child who is simply asking an ordinary question, or to a partner who happens to say the wrong thing at the wrong moment. Afterwards, there is often a second wave. Not just the stress itself, but the interpretation of it. What is wrong with me? Why can’t I handle as much anymore?

For most women, this happens in a phase of life when the overall load is already high. A career demands a great deal, often more than before. Children may be older, but not necessarily less in need of support. At the same time, parents may begin to require more help, practically or emotionally. This is sometimes referred to as the sandwich effect: being caught between the needs of several generations while one’s own space grows smaller. Right there, when life demands maximum capacity, the body and one’s cognitive reserves often begin to change.

During menopause, hormonal changes occur that can affect sleep, recovery, emotional regulation, and stress tolerance. This does not mean that everything suddenly “comes down to hormones,” but it does mean that the same responsibilities may feel different in the body. Things that previously could be carried through willpower, structure, and control may begin to cost more. The margins become smaller, and recovery simply takes longer. This is often deeply confusing for high-performing women, especially for those of us who have built an entire functioning life on being able to think ahead, hold things together, read situations, and deliver. When one’s capacity begins to falter, or simply no longer stretches as far, the first impulse is often to push harder. We try to plan better and pull ourselves together. The lists grow longer and longer. Sometimes we get up a little earlier, even though we were answering emails late the night before, just to catch up.

This article aims to explain what is happening in our bodies and to discuss what we can do to create balance in a new life situation shaped by profoundly changed physiological conditions.

Menopause, the Brain, and Stress – Three Phases of Change

During menopause, it is not only the body as a whole that changes, but also the working conditions of the brain and nervous system. Estrogen affects several systems that are important for sleep, temperature regulation, mood, memory, and attention. The brain has estrogen receptors in areas such as the hippocampus and prefrontal cortex — regions that are central to memory, planning, and the ability to keep several things in mind at once. What is often confusing is that estrogen and progesterone do not decline in a smooth, predictable way during the first phase of menopause, known as perimenopause. Instead, they fluctuate in patterns that are not entirely random, but that also do not follow a clear downward curve (Grub et al., 2021).

Because estrogen and progesterone can vary considerably during perimenopause, a single blood test often provides only a limited picture. For that reason, hormone testing is usually not especially useful for determining whether a person over the age of 45 is in menopause; the assessment is instead based primarily on symptoms and changes in menstrual patterns.

For many women, this means that the body begins to feel difficult to predict. On some days, concentration, energy, and emotional regulation function relatively steadily, while on other days there may be fatigue, irritability, or cognitive sluggishness without any obvious external explanation. At the same time, the body’s stress system is affected. Cortisol and adrenaline are central to energy and alertness, but when these increase, sleep becomes more vulnerable. If overall life demands are already high — through teenagers going through puberty, a strained relationship with a partner, and one or more older family members who need care or supervision — the system can become more reactive. The body may then move into a state of activation more quickly and find it harder to settle down again.

Newer research also suggests that the brain actively attempts to adapt to changing estrogen levels. In a study by Lisa Mosconi and colleagues, increased estrogen receptor density was observed in the brains of women in peri- and postmenopause. This can be interpreted as a compensatory response: when less estrogen circulates in the bloodstream, the brain may try to “capture” more estrogen by building more receptors. At the same time, this state was associated with cognitive symptoms such as brain fog and changes in memory function.

Brain fog does not mean that something must be wrong, but rather that the brain is undergoing a neurobiological transition. Even so, this reduction in cognitive sharpness can be difficult to manage over a fairly long period, especially because life often demands so much at the same time. It is not entirely certain that everyone returns fully to their previous baseline after menopause.

Perimenopause – When Hormones Begin to Fluctuate

Perimenopause is often the most dynamic and unpredictable phase. This is when ovarian function begins to change, which means that estrogen may be both high and low at different points, rather than consistently low. Progesterone often declines earlier, because ovulation becomes more irregular, and follicle-stimulating hormone rises as the brain attempts to stimulate continued hormone production.

Physically, this may become noticeable because the body no longer follows earlier patterns. Menstruation becomes irregular, sleep is disrupted, and hot flashes or palpitations may appear. You may wake in the middle of the night with a stress response even though nothing in particular has happened, or feel unusually tired despite having slept enough.

Emotionally, this is often the phase in which anxiety and inner restlessness become more pronounced. When hormonal signals fluctuate and the stress system becomes more reactive, the body may move more quickly into activation. It can feel like a kind of anxiety that “lives in the body,” sometimes without any clear thought behind it. Some women describe reacting more strongly in situations that previously felt manageable, or needing more time to return to a sense of calm.

Menopause – When Menstruation Ends

Menopause is defined as having gone twelve months without a menstrual period. Hormonally, this means that estrogen levels have fallen to a lower level and progesterone is very low. FSH remains elevated, reflecting that the body has shifted into a new state. Follicle-stimulating hormone (FSH) is produced in the pituitary gland and signals the ovaries to produce estrogen. When the ovaries respond less effectively to that signal, FSH levels rise. In other words, FSH itself does not cause the symptoms; rather, it is a sign that the system is functioning differently than before.

Physically, some symptoms may ease as the large hormonal fluctuations diminish, while others may persist because estrogen levels are lower. Sleep may still be disrupted, and the body may remain more sensitive to stress.

Emotionally, some women experience a change in anxiety during this phase. For some, it decreases noticeably as hormonal variation becomes less pronounced. For others, a more low-grade tension remains, rather than the earlier rapid peaks. The difference often lies in reduced reactivity, even though recovery may still be challenged.

Postmenopause – A New Hormonal State

Postmenopause means that the body has established a new hormonal condition. Estrogen remains stably low, progesterone remains very low, and FSH stays at a high level. Physically, the changes are more about long-term processes. At the same time, some women may continue to experience heightened sensitivity to stress, particularly during periods of sleep deprivation or high demand.

Emotionally, some women describe anxiety decreasing or disappearing. For others, a different experience emerges — a stillness that may feel unfamiliar. If the body has spent a long time in a more activated state, the contrast can be striking. It may be experienced as a kind of emptiness, not necessarily negative, but different.

Initially, this period may be understood as the nervous system shifting from a more reactive state into a more downregulated one. For some, this brings relief, while for others it takes time to become accustomed to a new normal. This may also be a period when one is trying to cope with life changes that have sometimes unfolded during menopause, such as grief after the death of a parent or the end of a relationship, which can of course make this phase more complicated.

Neurodevelopmental Conditions, Masking, and Increased Demands During Menopause

For women with traits or a diagnosis of neurodevelopmental conditions such as autism or ADHD, this phase of life may become more complex, though often not for the reasons one first assumes. Many have spent a long time developing effective strategies for managing demands related to structure, planning, and social adaptation. These strategies are often highly effective and have made high performance possible, but they depend on there being enough energy, recovery, and a relatively stable internal regulation.

When menopause affects sleep, recovery, and cognitive flexibility, the ability itself does not necessarily change. However, the cost of maintaining the same level may increase. This is rarely visible from the outside. You may still deliver, hold things together, and do what is expected of you. But it may take longer to gather your thoughts before a meeting. You may prepare more than before for conversations that once happened spontaneously. After a day filled with impressions, recovery may fail to come, even though you are trying to do the “right things.”

Situations that require rapid shifting, flexibility, or social presence may begin to feel more draining. What was previously carried through structure, control, or sheer effort becomes harder to compensate for over time. For some, it also becomes clearer how much energy has previously gone into adapting. Reading cues, staying one step ahead, and functioning in complex settings may still work outwardly, but at a higher internal cost. This does not mean that the ability disappears, but that the margins shrink. And when the margins shrink, it becomes harder to carry the same load in the same way as before.

For women with neurodevelopmental conditions during menopause, treatment needs to be adapted — something I will explore further in the next article. I will keep you posted and update this with a link in the future.

What Happens in the Body During Stress and Menopause

When stress increases, it is not only thoughts that are affected. The body is involved all the time. The nervous system registers strain, signals, risk, and demands, often before you have had time to put into words what is happening. This may show up in everyday situations: you receive a message from your manager and feel your stomach tighten before you have even finished reading it. You hear the children arguing in the hallway and notice that your body has already shifted into a higher gear. Or you wake at four o’clock every night and begin solving problems that cannot actually be solved at that hour.

In light of what occurs during menopause, this becomes more understandable. When hormonal signals fluctuate, sleep is affected, and the stress system becomes more reactive, it is not only how the body responds that changes, but also how quickly it responds and how long the activation remains. These changes do not occur in isolation. They can make stress feel more intense, prolong recovery, and reduce the margins available. For a woman who is used to performing, this can feel deeply confusing. What once happened almost automatically now suddenly requires more effort. Not because the ability has disappeared, but because the system is operating under different conditions.

When the Brain Tries to Make Sense of Things – Body, Stress, and Interpretation

For many high-performing women, menopause is not a simple return to how things were before. Rather, it may mark the beginning of a different direction. Modern neuroscience describes the brain as predictive. As emotion researcher Lisa Feldman Barrett has shown, the brain continuously interprets signals from the body and the surrounding environment in order to create a coherent picture of what is happening. This means that the body’s state influences how situations are experienced. If the body is tense, tired, or activated, the brain may be more likely to interpret everyday events as more emotionally charged than they actually are. An email without an exclamation mark may feel like criticism. A teenager shutting a door may be experienced as rejection. A partner asking, “Did you pay the bill?” may land as an accusation, even though the question was purely practical. The thoughts that arise in such situations often feel true in the moment. They come easily and fit with what the body is signalling. When the body is in a more activated state, it becomes easier to interpret the world through a more strained or threat-focused lens.

Newer research suggests that the brain actively attempts to adapt to hormonal changes. When hormonal changes coincide with high demands in life — work, relationships, teenage children, young adult children who cannot afford to move out, or parents who need more support — the burden is often greater than it appears from the outside. This is why many women describe it as suddenly “not being able to cope with their own life,” even though they are in fact carrying more than ever. At this point, it becomes important not simply to push through, but to notice that it feels as though your body is signalling that something is no longer sustainable and that it has different, or greater, needs that are not being met.

Support During Menopause – Hormone Therapy and Psychotherapy

If you notice that sleep, memory, energy, or emotional regulation is affecting your everyday life, it is reasonable to seek help. Not because something is automatically seriously wrong, but because support is available and there are different ways to understand what is happening in your particular body and in your psychological well-being. Research on menopause and long-term brain health is developing rapidly, and although the picture is complex, there is reason to take cognitive symptoms seriously rather than dismissing them as “just stress.” Seeking help can also be a way to stop carrying everything alone.

When these changes affect sleep, memory, energy, or emotional regulation in everyday life, it is reasonable to seek support. For some, hormone therapy may be an important medical option to discuss with a health-care provider, particularly when symptoms are clear and affect quality of life. For others, it may not be appropriate, or it may need to be combined with other forms of support.

Therapy serves a different function. It does not replace medical assessment, but it can help you understand how your own way of managing stress, responsibility, thought patterns, bodily signals, and life circumstances interact. If hormone therapy can influence the body’s biological conditions, therapy can help you orient yourself within how you live, react, and recover under these new conditions. For many, what is most helpful is not choosing either medical treatment or psychotherapy, but creating a whole in which the body, the brain, and the life situation are all taken seriously at the same time — and in which one actually begins to meet oneself with greater compassion. That last part is not always something we know how to do.

How Can Therapy Help During Menopause?

When the body begins to respond differently, it is not always enough to understand everything through analysis alone. In therapy, the work can instead begin with the interaction between body, thought, and behaviour. This may involve starting to notice when the body moves into activation before you have time to think clearly — for example, in a meeting, in a conversation at home, or when you open an inbox that already feels overwhelming. It may also involve recognizing how quickly the mind fills in an explanation — that you are not enough, that you should be able to handle more, that something is wrong — and how that interpretation, in turn, affects the body.

Acceptance and Commitment Therapy offers a way of relating to thoughts and feelings so that they do not automatically govern behaviour, but instead become something you can observe and respond to more flexibly. A body-oriented perspective within Somatic Experiencing means noticing and working with these signals earlier. Not in order to control or eliminate them, but to create a different relationship with them.

For women with neurodevelopmental conditions, this is particularly relevant. When so much energy has previously gone into holding things together, planning, and adapting, therapy needs to take into account that these strategies may no longer be sustainable in the same way. The work is then not about performing better, but about finding a way of functioning that can be maintained over time. If changes in memory, sleep, concentration, or emotional regulation are affecting everyday life, it is also reasonable to address this medically. Psychological and medical support can often complement one another. This kind of understanding is frequently a starting point in therapeutic work.

In the next article, I will go more deeply into the treatment process itself: how ACT, body-oriented exercises, Somatic Experiencing, and neurodevelopmentally informed adaptations can be used to create more sustainable ways of meeting stress, menopausal symptoms, and life demands.

Summary – Body, Stress, and Changed Conditions

The experience many women describe in this phase of life can be understood as an interplay between biological changes, life circumstances, and individual conditions, including neurodevelopmental differences. It is not about a loss of ability, but about changed conditions. When hormonal changes coincide with sleep difficulties, increased stress, and high demands in everyday life, mental capacity may feel more vulnerable. For those who already have a sensitivity to sensory input, shifting demands, or executive load, these changes may be especially noticeable. They can affect concentration, memory, recovery, and the feeling of being able to meet expectations.

Understanding these experiences as a consequence of changed conditions, rather than as personal inadequacy, is essential. It opens the door to a more nuanced response, in which support, adaptations, and recovery take on greater importance. With the right knowledge and the right conditions, many women can find strategies that reduce strain and strengthen both functioning and well-being.

Common Questions About Menopause, Stress, and Therapy

How do I know whether my symptoms are caused by menopause or stress?

Often, it is an interplay between the two. Hormonal changes can make the nervous system more reactive, which means that stress may feel more intense and recovery may take longer. For that reason, it is often more helpful to look at the whole picture than to search for a single cause.

What is brain fog during menopause?

Brain fog can involve difficulties with concentration, changes in memory, or a sense of mental sluggishness. It may be linked to hormonal changes, sleep, stress, and the brain’s adaptation during menopause.

Can neurodevelopmental conditions affect how menopause is experienced?

Yes. For women with neurodevelopmental traits or a neurodevelopmental diagnosis, earlier strategies for structure, planning, and social adaptation may become more energy-intensive when sleep, recovery, and cognitive flexibility are affected. This does not mean that ability disappears, but that the margins may shrink even more than for women without these conditions.

Should I seek medical care for menopausal symptoms?

If sleep, memory, energy, or emotional regulation is affecting your everyday life, it is reasonable to seek support. An individualized medical assessment can help clarify what is relevant in your particular situation.

How can therapy help during menopause?

Therapy can help you understand the relationship between your body, your thoughts, your experience of stress, and your life situation. ACT and Somatic Experiencing can contribute to more sustainable ways of meeting changed conditions by helping you learn to read and regulate your nervous system.