Amanda Thebe thought she was dying when she developed severe vertigo and migraines at the age of 42. When these symptoms were joined by chronic fatigue and debilitating depression, she worried that she was also going crazy.

Amanda’s doctor was flummoxed, so for two years, she suffered from misdiagnoses and ineffective treatments. It wasn’t until a routine visit with her OBGYN that Amanda learned what was wrong with her: Amanda was in perimenopause.

Amanda is among thousands of women whose mental health symptoms are misunderstood by their healthcare providers. Although immense strides have been made in the diagnosis and treatment of conditions like premenstrual dysphoric disorder (PMDD), researchers are only beginning to appreciate the complex relationship between female reproductive function and mental health.

Effective women’s mental health care requires special consideration of both their biology and sociocultural experiences. If your caseload includes patients who were assigned female at birth, here are a few factors to keep in mind.

  1. Hormonal changes: Women experience hormonal fluctuations throughout their lives, including around menstruation, pregnancy, postpartum, and menopause. These hormonal shifts can drastically impact mood, energy levels, and even cognitive functioning. If you think your patient’s symptoms may be hormonally influenced, encourage them to keep a log or use a symptom-tracking app like Clue. You can also provide a referral to an OBGYN who specializes in hormonal health throughout the reproductive cycle.
  1. Reproductive health: Issues such as infertility and pregnancy loss also warrant special consideration when it comes to providing effective mental health care for women. For many women, the ability to conceive and bear children is closely tied to their identity and self-worth. Infertility or miscarriage are losses not only of the child that could have been, but also of the prospective identity of mother.
  1. Trauma and violence: One in 3 women report having experienced severe physical violence by an intimate partner in their lifetime, and over half of women have experienced sexual violence. These collective traumas reach beyond their immediate victims, creating an atmosphere of fear, anxiety, and vulnerability among women. Moreover, because women’s experiences with violence have historically been discounted, women are often hesitant to be open about their experiences, fearing disbelief, victim-blaming, or retaliation.
  1. Body image and objectification: We live in an appearance-obsessed culture. Women, in particular, are under immense societal pressure to attain an unrealistic standard of beauty. At a minimum, this can create poor body image and low self-esteem. Left unaddressed, these issues can lead to additional mental health concerns such as eating disorders, anxiety, and depression. The ongoing objectification of women in media and popular culture further undermines women’s self-worth and reinforces damaging stereotypes of what it means to be feminine.
  1. Perimenopause, menopause, and aging: Menopause is a significant life transition for women, accompanied by both physical and emotional changes. Symptoms like mood swings, hot flashes, fatigue, brain fog, and insomnia can negatively impact mental health. In addition to psychotherapy, women in perimenopause or menopause may benefit from hormone replacement or other treatments aimed at restoring hormonal balance. But hormones are often only the tip of the iceberg. As women approach menopause, they may grieve the loss of their reproductive years, grapple with age-related changes to their bodies, or struggle to confront their own mortality.
  1. Cultural and social influences: Women face a number of sociocultural issues that can impact their mental health, such as persisting gender roles, discrimination, and societal expectations. Women often take on the lion’s share of childcare and household duties while also pursuing careers. This “double burden” of work can lead to stress, exhaustion, and limited opportunities for personal and professional growth. In addition, women continue to experience discrimination at work, earning less and occupying fewer positions of leadership. Finally, women’s reproductive rights, including access to contraception and reproductive healthcare, are often subject to social and cultural constraints, disempowering them from family planning and other health-related decisions.


Women’s mental health is influenced by a number of biological and sociocultural factors. Keeping their unique experiences in mind, and tailoring support and resources accordingly, can help therapists ensure that women’s mental health needs are effectively met. In addition, we can all work towards social change on a macro level so that women encounter fewer obstacles to physical and mental well-being.

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