Angry one moment, tearful the next? Hot and uncomfortable, mentally foggy, and suffering from insomnia? For women in perimenopause, these are only some of the symptoms that make up the physical and emotional whiplash they experience during a typical week (or day!). The impact of perimenopause on women’s lives is real, if under-discussed and not widely understood.
Perimenopause Is a Rocky Transitional Period for Most Women
Perimenopause is a time of significant hormonal instability that affects the lives of millions of mid-life women. Women often experience a roller coaster of new problems during the anything-but-quiet transition from their reproductive years to menopause. Estrogen skyrockets, then plummets unpredictably, and with it, the neuroendocrine system is sent into a spiral. Eventually, hormones settle in at stable, low levels, indicating menopause (typically defined as 12 months without menstruation).
What makes this time especially challenging is that women often don’t know they’re in perimenopause, so they don’t realize their symptoms could be hormone-induced. There are few clear markers of perimenopause, and its duration varies widely; plus, there exists a strong reliance on subjective symptom assessment to diagnose perimenopause, often in cultures that normalize or provide alternative explanations for the symptoms (Poorvi et al., 2024). For many women, perimenopausal symptoms are explained away by stress, exhaustion, or other problems. The real reasons are not recognized.
If perimenopause disrupts adult women in a way parallel to how puberty rattles teenagers, it makes sense that women’s relationships will feel the effects of perimenopause.
The Cognitive Problems of Perimenopause Make Way for Relationship Problems
Brain fog, anyone? Women experience a wide array of cognitive challenges during perimenopause, ranging from trouble concentrating and “brain fog” to working memory problems and slower processing speed (Metcalf et al., 2023; Woods & Mitchell, 2005).
These cognitive issues can open the door for frustration and irritability. Maybe they manifest in a growing number of “I-told-you-that-already” responses from a partner or the self-directed annoyance of being unable to find the right word. In either case, interactions become disjointed: Partners end up sharing a negative, frustrating experience rather than enjoying a coordinated conversation.
Evidence suggests that, for romantic partners, more co-experiencing of negative emotions during everyday conversations corresponds with lower relationship well-being (Brown et al., 2022). If the cognitive changes that occur during perimenopause introduce new frustrations into conversations with partners, this might contribute to lower relationship quality over time.
Perimenopausal Depression May Have Diffuse Effects on Relationships
More than menopausal women or pre-menopausal women, women who are in perimenopause have a uniquely high risk for depression (Badawy et al., 2024). The vulnerability of perimenopause to depressive symptoms is sometimes explained through the effect of hot flashes and night sweats on sleep, but this link has also been observed when controlling for these vasomotor symptoms.
In romantic relationships, depressive symptoms are understood to contribute to communication problems, feelings of isolation and a lack of intimacy, low energy that colors how a couple or family experiences their time together, a sense of uncertainty, and a lack of understanding (Sharabi et al., 2015). When healthy women with no history of depression find themselves in the throes of perimenopause, their potential depressive symptoms are well-poised to add new complexity and challenges to their relationship.
Poor Sleep in Perimenopause Introduces New Relationship Challenges
Hot flashes and night sweats are not in the recipe for a good night’s sleep. Indeed, these vasomotor symptoms of perimenopause can wreak havoc on women’s ability to sleep, alongside more direct effects of changes in estrogen and progesterone and sleep quality (Troìa et al., 2025).
A strong body of relationship research points to the benefits of good sleep for healthy (and happy!) relationship functioning. If perimenopause disrupts sleep, it may make important relationship maintenance work all the more difficult. Offering affection, social support, and responsiveness might be easy to do in a well-rested state, but becomes an effort when sleep-deprived. On top of that, most people would agree that patience runs thin and irritability runs high in states of chronic fatigue. In so many ways, sleep issues may be a key mechanism by which perimenopause introduces relationship challenges.
Sexual Challenges in Perimenopause Pose Risks for Relationships
Changes in estrogen can alter women’s experiences with sex and their intimacy in relationships. Cross-cultural meta-analytic evidence suggests that the prevalence of sexual disorders, including sexual desire disorder, among perimenopausal women jumps above 50 percent (Khani et al., 2021). Further, a large community-based study found that women in perimenopause often report vaginal dryness that may explain their greater pain during sex, reduced sexual interest, and reduced sexual pleasure (Avis & Green, 2011).
Menopause Essential Reads
Along with higher sexual dissatisfaction, perimenopausal women have been shown to suffer from poorer body image compared to pre-menopausal women (Séjourné et al., 2019). This may be estrogen’s fault. Reductions in estrogen can lead to weight gain and shifts in body composition, including increased abdominal fat (Karaflou & Goulis, 2024). Given that lower body image predicts lower sexual satisfaction, which in turn predicts lower perceived relationship quality (van den Brink et al., 2018), perimenopausal women have a considerable hurdle to overcome on account of their hormonal changes.
Awareness Could Help With Relationship Well-Being
If people don’t talk much about perimenopause, they certainly don’t talk about its potential role in the relationships of midlife women. But they should. This is especially worth discussing given that women are more likely to initiate divorce than men (Kalmijn & Poortman, 2006). If women don’t realize that perimenopause might explain some of their surprisingly intense frustrations, they might try to explain them by attributing them to other sources (e.g., their relationship partner).
In other words, being able to attribute negative emotions to hormones rather than husbands could serve as a relationship-protecting factor for perimenopausal women.
Further, if women find themselves grumpy, frumpy, sweaty, and unattractive, the right support at the right moment could not only help them but also their relationship. If romantic partners understand the challenges women encounter during perimenopause, they are in a better position to support them. Good conversations on what women might need during this vulnerable time could help set up a committed relationship for long-term success.
