This post is part of Couples in Crisis, a blog series drawing on real-life stories from the therapy room. Each post explores common relationship issues, from infidelity to fertility loss, through a therapeutic lens. All names and identifying details have been changed to protect confidentiality. Whether you’re in crisis, at a crossroads, or simply curious about how relationships evolve, you’re warmly invited into the conversation.
Welcome to the next instalment: Perimenopause can cause emotional and physical symptoms that strain even the strongest of marriages. In this post, we explore one couple’s story and share practical advice for navigating this difficult transition together.
At 41, Emma didn’t expect to feel like this.
Sudden bursts of anger. Nights of broken sleep and relentless night sweats. A creeping weight gain that feels out of her control. Brain fog that dulls her once-sharp mind. And a loss of libido that leaves her cold to Tom’s touch.
She looked down at the floor as she told me she feels like a stranger in her own body—and even more so in her marriage.
Emma and Tom have three young children aged three, six, and eight. Their lives are full, busy, and chaotic. But underneath the routines and responsibilities, something deeper is going wrong. Emma is in the throes of perimenopause. The hormonal transition that can begin years before menopause. And it’s taking a toll, not just on her health and identity, but on their relationship.
Emma hates the way she feels. But she doesn’t believe Tom could possibly understand.
She keeps it all in, her sadness, shame, and resentment. She snaps at him over small things, then recoils when he reaches out. For Tom, it feels like rejection. He’s trying to be patient, but he feels unloved, unwanted, and emotionally shut out. Their once-connected partnership feels like it’s slipping away.
Emotional symptoms of perimenopause and how they affect relationships
Many women in their 40s experience the early signs of perimenopause without realising it. Mood swings, fatigue, low libido, anxiety, and irritability are all common symptoms. Add the relentless demands of parenting and work, and it’s no wonder so many relationships come under strain.
For some couples, this stage becomes a silent emotional crisis. The woman may feel overwhelmed and ashamed of her changing body and mind. Her partner may feel confused, hurt, or helpless.
This emotional distance can grow, unless it’s recognised, understood, and addressed.
From a psychoanalytic perspective, transitions like perimenopause stir up deep, often unconscious fears. For many women, it symbolises the end of youth, fertility, or desirability, evoking feelings of grief, rage, or disorientation. Meanwhile, parenting young children cements couples in the roles of ‘mum’ and ‘dad,’ which can stifle desire and spontaneity.
Old defences resurface, such as withdrawal, blame, projection. Partners drift apart, not because they don’t care, but because neither knows how to say, “I’m struggling. I need you.”
How couples therapy helps with perimenopause and relationship problems
In couples therapy, we often see how misunderstood perimenopause is and how deeply it can impact communication, trust, and sexual connection.
Emma’s anger wasn’t really about Tom. It was about grief, mourning the energy, libido, and mental clarity she used to have. Tom’s withdrawal wasn’t about indifference—it was about feeling powerless to help.
Therapy helped them understand what lay beneath the surface. It gave them tools to talk about difficult emotions, rebuild emotional intimacy, and reconnect as partners—not just co-parents.
What couples can do when perimenopause strains their relationship
If you or your partner are experiencing perimenopause and it’s affecting your relationship, here are some things that can help:
- Learn about perimenopause together. Understanding the symptoms helps normalise the experience and reduce blame.
- Talk openly without judgement. Honest communication builds trust—even when it’s awkward or emotional.
- Acknowledge what’s been lost. It’s okay to grieve changes in libido, energy, or identity. Grieving helps create space for something new.
- Stay emotionally close. If sex is difficult, connect in other ways: cuddling, shared routines, kind words.
- Seek couples therapy. A trained therapist can help you understand each other more deeply and navigate the changes together.
- Get medical support. Speak to your GP or a menopause specialist about treatments like HRT, lifestyle changes, or nutrition that may help.
- Be patient. Perimenopause is a phase. It will pass and relationships can grow stronger in the process.
So how did it end for Emma and Tom?
It didn’t end – it changed.
Through gentle persistence, couples therapy, and a renewed commitment to understanding each other, Emma and Tom began to reconnect. Emma found the language to express her fears. Tom learned to listen without needing to fix. They grieved what was lost and discovered new ways to feel close, emotionally and physically.
Life with three kids was still chaotic. The symptoms didn’t vanish overnight. But they were no longer facing it alone. And that made all the difference.
Frequently asked questions
What are the emotional symptoms of perimenopause?
Common emotional symptoms include mood swings, irritability, anxiety, low libido, and brain fog. These can affect a woman’s confidence and relationships.
Can perimenopause cause relationship problems?
Yes. The hormonal and psychological changes can lead to misunderstandings, emotional distance, and conflict between partners—especially if not talked about.
How can I support my partner going through perimenopause?
Start by listening with empathy. Educate yourself, create emotional safety, and be patient. Encourage your partner to seek medical and emotional support.
Is therapy helpful for couples facing perimenopause-related issues?
Absolutely. Couples therapy can help improve communication, emotional connection, and sexual intimacy during this transitional phase.
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