The Mind You Think You Are Losing

What the Research Actually Shows

Start with the part almost nobody tells you plainly: the risk is real, it is measurable, and it is time-limited. In 2024 a team at University College London pooled 17 prospective cohort studies covering 16,061 women and asked a narrow question — at which stage of the menopause transition does depression risk actually rise? The answer was unambiguous. Perimenopausal women were at significantly higher risk of depressive symptoms and diagnoses than premenopausal women, with a pooled odds ratio of 1.40. Postmenopausal women were not at significantly raised risk compared with premenopausal women (Badawy et al., Journal of Affective Disorders, 2024).

Read that second sentence again, because it is the one that changes how the years ahead feel. The elevated risk belongs to the transition — the unstable stretch — not to the state on the other side of it. Whatever this is, it is a passage through weather, not a permanent change in climate.

The same pattern shows up in the largest American dataset on midlife women. In the Study of Women’s Health Across the Nation, 3,302 women aged 42 to 52 were followed for years. The odds of scoring in the depressive range were significantly higher when a woman was early perimenopausal, late perimenopausal or postmenopausal than when the same woman had been premenopausal — and higher in late perimenopause than early (Bromberger et al., Journal of Affective Disorders, 2007). Because these were the same women compared against themselves over time, the finding cannot be explained away as personality or circumstance.

Now the mechanism, which is the genuinely counter-intuitive part. It is not low estrogen that destabilises mood. It is moving estrogen. In a study of 52 women aged 45 to 60 whose hormones and mood were sampled repeatedly over fourteen months, greater variability in estradiol predicted the emergence of depressive symptoms — and the effect was strongest in women who had also experienced very stressful life events (Gordon et al., Menopause, 2016). Hormonal turbulence does not create suffering on its own. It removes the buffer that used to absorb everything else.

Which is why a blood test so often fails to settle the argument. A single measurement of estradiol during perimenopause tells you where the wave was on the morning it was drawn, not how violently it has been moving. Women are frequently told their levels are normal and leave the appointment feeling more unmoored than when they arrived.

And the fear underneath the question — am I losing my mind? — deserves its own answer. In the SWAN cognition study, 2,362 women were tested repeatedly across the transition. Processing speed and verbal memory did dip during perimenopause — and then returned to the expected trajectory once women were postmenopausal (Greendale et al., Neurology, 2009). The mind you think you are losing is being borrowed against, not spent.

What Perukua Says About the Feelings Themselves

Perukua is an Australian singer and facilitator who has spent more than two decades leading women’s voice and body practice in more than 63 countries. She is not a doctor, and she does not offer a hormonal explanation of anything. What she offers is a stance — and for this particular question, the stance is the medicine.

Her first observation is about a silence. Women, she says, are taught to run their lives as though their internal state were a constant, and then to treat every deviation from that fiction as a personal fault — “not acknowledging that the energy inside us changes every single day, with the shift of hormones, with the phase of the cycle. And when we come out of that cycle, when we pass through menopause, we meet total denial. Cancellation. Meaning: you are no longer needed by society, except perhaps as a grandmother” (interview, Ekaterina Petersil).

That is not a medical claim, and it does not need to be. It names the reason the question arrives in the form it does. A woman whose body has been changing in a documented, well-described way for years, with almost nobody naming it out loud, will reach for the only explanation left in the room — that the problem must be her.

Her second observation is the one that does the real work. Emotional intensity in this decade, she argues, is not evidence of breakdown; it is a signal system doing its job. “Our over-emotionality is not something unnatural,” she says. “The body and the emotions are always sincere. They never lie” (interview, Ekaterina Samoylova).

This is a different proposition from the two on offer everywhere else. One camp says the feelings are hormones and should therefore be discounted. The other says the feelings are pathology and should therefore be treated. Perukua says a third thing: the feelings are accurate. Hormonal change turns up their volume, but it does not invent their content. The rage is usually about something. The tears usually have an address.

She is also unsentimental about what happens when the signal is ignored for long enough. In her account, suppressed emotion does not disappear — it stiffens. “Everything becomes rigid, unmanageable, it begins to wither, it loses its life force.” And she has watched what the alternative looks like in the room. Asked by a sixty-five-year-old woman on one of her courses, “what is left for me?”, her answer was not consolation. “What is left for you is to wake the beauty inside you. Begin giving yourself the love you have given to everyone else your whole life” (interview, Ekaterina Petersil).

Why It Feels Like Losing Your Mind

Put the research and the stance together and the mechanism is clear enough to act on.

Three things are happening at once, and they are usually mistaken for one thing. First, the hormonal signal is erratic — and it is the erraticness, not the level, that matters (Gordon et al., 2016). Second, the buffer is thinner: the same argument, the same email, the same offhand remark now costs more than it did at forty. Third — and this is the part that produces the phrase losing my mind — you have no framework for any of it, so every episode gets filed under character.

That filing error is the injury. A woman who cries in a meeting and thinks my hormones are all over the place this month has had a bad hour. A woman who cries in the same meeting and thinks I am becoming someone I don’t recognise has had a bad hour plus a crisis of identity. The physiology was identical. The interpretation was not.

There is a well-replicated finding about exactly this. When people put an emotional experience into words — simply naming it — amygdala activity drops and regulatory prefrontal activity rises (Lieberman et al., Psychological Science, 2007). Naming is not a coping platitude. It is a measurable change in how the brain handles the feeling.

Which is where Perukua’s framing stops being poetic and starts being useful. If emotions are information rather than malfunction, then noticing and naming them is not indulgence — it is the intervention. And it is available on a Tuesday afternoon with no appointment.

One more piece of the mechanism deserves saying out loud, because it is the difference between a hard year and a dangerous one. Perimenopausal mood change and clinical depression are not the same thing, and the second is not cured by reframing. If low mood has been continuous for weeks rather than fluctuating, if pleasure has gone flat across everything at once, if you are not sleeping or eating, or if there are thoughts of not wanting to be here — that is a conversation for a doctor, now, not a practice.

The Practice: Fourteen Days, Two Lines a Day

Fourteen days. Two lines a day. The goal is not to feel better this week; it is to convert an unexplained experience into a pattern you can see. Almost every woman who does this discovers she has been living inside a rhythm she could not perceive because she was never looking. It is the same principle Perukua teaches at length in her course Woman’s Guide to Wholesome Period — that the body is running a pattern, and reading it is more useful than fighting it.

One. Keep the log to two lines. Each evening, write the date and two things only: a mood number from 1 to 5, and three or four words on what was loudest that day (“snapped at everyone”, “flat, no interest”, “cried at an advert”, “fine, actually”). If you are still bleeding, note the day of your cycle. If you are not, note nothing else. Two lines is the whole design — longer entries are abandoned by day five, and the pattern lives in the sequence, not in the detail.

Two. Add the four physical markers. Once a week, in the margin, mark whether sleep, night sweats, energy and concentration were better, the same, or worse. These are the columns your doctor will want and the ones you will not remember accurately in the appointment. They are also what turns “I feel insane” into a description a clinician can act on.

Three. Take one minute in the morning, before the phone. Perukua’s instruction here is deliberately physical: place the right palm on the chest and the left hand low on the belly, breathe down into the hands, and simply notice what is already present before the day tells you what to feel. Sixty seconds. You are not trying to change the state — you are finding out what it is, which is the only thing the log needs from you.

Four. Name it in one sentence, out loud, once a day. Not analysis — a label. “I am irritable and underneath it I am exhausted.” “I am sad about my daughter leaving.” “Nothing happened; my body is loud today.” This is the step people skip because it feels too small to matter, and it is the one with the neuroimaging behind it (Lieberman et al., 2007).

Five. On day fifteen, read it as a stranger would. Not to judge the fortnight, but to answer three questions. Does the difficulty cluster — around certain days, certain nights, certain people? Is it fluctuating, or is it constant? Is there a single recurring theme in the four-word entries? Fluctuating and clustered points towards the transition. Constant and flat, for two weeks or more, points somewhere else and should be taken to a doctor.

Six. Take the pages to the appointment. Fourteen days of dated entries is data, and it changes the conversation entirely — from a woman describing a feeling to a woman presenting a record. If you have been told your bloods are normal and left feeling dismissed, this is the thing that gets you heard.

A note on safety. Nothing here is medical advice, and Perukua is an artist and facilitator, not a doctor. If low mood has been continuous for two weeks or more, if you have lost interest in everything, if you are not sleeping or eating, or if you have thoughts of not wanting to be here, contact a doctor or a crisis line without waiting. Questions about hormone therapy, antidepressants or stopping any medication belong with your clinician — never adjust a prescription on your own. And symptoms such as very heavy or unusual bleeding, bleeding after twelve months without a period, or severe fatigue deserve investigation rather than explanation.

In Closing

There is a particular loneliness in this question, and it is not really about hormones. It is the experience of watching yourself behave in ways you cannot account for, and having no story that fits — so you reach for the worst one available, which is that something is wrong with you at the level of who you are.

The research takes that story away. The instability is documented, it is measurable, it is concentrated in the transition, and it is driven by fluctuation rather than depletion. The dip in memory and speed reverses. The raised risk of depression does not follow you into the years afterwards. This is a passage, and it has a far side.

What Perukua adds is the part the research cannot give you: what to do with the feelings while you are still in it. Not discount them as chemistry. Not treat them as evidence of collapse. Read them. They point precisely — to what was conceded, to what has been ignored, to what still hurts. The years when the volume goes up are, inconveniently, the years the signal is easiest to hear.

So tonight, write two lines. Tomorrow morning, take one minute with your hands on your body before you take the phone. In two weeks you will have something no article can give you: your own evidence, about your own life, in your own handwriting.

References & Quote Sources

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