Am I Going Crazy, or is this Perimenopause? When Old Trauma and Hormones Collide

There is a question I hear often from women in their 40s and 50s.

Some version of: "I don’t feel like myself, and I don’t understand what is happening." Or “Now that I’m 50, am I going crazy??”

Sometimes it sounds more specific. Sleep that’s come undone. Anxiety that arrives without an obvious reason. Old memories that are suddenly louder than they have been in years. The sense that the work they did in earlier therapy has somehow stopped working for them.

Most women who ask this question aren’t in crisis even if it might feel like that. They’re paying attention. They’re noticing that something has shifted, and now trying to make sense of it.

I want to offer one piece of the puzzle to consider, because it’s one I don’t see talked about often enough, and because the women I work with often find it useful.

The hormone piece is real, and it is bigger than mood

For a long time, the conversation about hormones and mood in midlife has been framed as a problem of irritability or low mood that needs to be managed. That framing feels too small.

Something I’ve been learning more about lately is just how impactful estrogen is within our bodies and brains.

Estrogen doesn’t just regulate the menstrual cycle. It also works directly inside the brain. The parts of the brain that handle fear, memory, and emotional regulation are full of receptors that respond to estrogen, which means estrogen has been quietly helping those regions do their job for most of a woman's adult life.

Imaging research has shown that when estrogen is given to women after menopause, the connection between two key brain regions, the amygdala (which processes fear and threat) and the prefrontal cortex (which helps us pause, think, and respond rather than react), actually gets stronger [1]. Put simply, estrogen helps these two parts of the brain talk to each other, and that conversation is part of how the brain stays steady under stress.

When estrogen begins to fluctuate and then decline through perimenopause, that conversation gets less reliable and the fear part of the brain becomes more sensitive. The regulating part becomes less consistent. The brain has less of the support it’s had for decades.

This is a measurable and significant shift in how the brain is operating.

What this means in everyday life

For some women, this hormonal shift lands gently. For others, it lands hard. The difference isn’t about willpower or attitude. It has more to do with what the nervous system was already carrying before the shift began.

I found some research from the SWAN study, one of the largest longitudinal studies of midlife women's health. It’s consistently shown that women with a history of trauma carry more of a menopausal symptom burden than women without that history. Women with childhood abuse or neglect had 87% higher odds of persistent insomnia across about 15 years of follow-up [2]. Women with greater trauma exposure also reported and physiologically symptoms such as hot flashes and night sweats which also coincidentally get most of the attention in menopause conversations [3].

A separate longitudinal study following 682 women for nearly 20 years found that a history of physical abuse correlated with worse menopausal symptoms, poorer general health, and more depressive symptoms at midlife, which can be decades after the original experiences occurred [4].

In other words, the menopause transition doesn’t happen in isolation from the rest of a woman's life. Her body remembers what she has lived through. And as the hormonal buffer thins, what the body has been holding tends to surface.

Why old experiences can feel loud again

This is the part that often catches women off guard.

You might have done significant work in earlier therapy and consider certain experiences settled, processed, or integrated. And then, you reach your 40s or 50s and find yourself thinking about those experiences again with an intensity that you didn’t expect (or want).

This isn’t a sign that the earlier work was wasted. It is more often a sign that the conditions have changed. The same nervous system that managed those memories with one set of hormonal supports is now operating with a different set. What was manageable is now harder to hold.

Some clinicians and researchers describe this as the window of tolerance getting narrow again. The zone in which a person can stay regulated and present becomes smaller, and material that used to fit inside it now spills over the edges.

This doesn’t mean you’re regressing, bur rather that your body and mind are asking for a different kind of attention than they needed before.

Is it trauma, or is it hormones, or is it both?

This is one of the most common questions I hear, and the honest answer is that it is usually both, woven together in ways that are hard to separate cleanly.

Hormones can amplify what was already there. History can shape how the hormonal shift is experienced. Trying to sort them into separate categories rarely works, and it’s not necessarily the most useful goal.

What tends to be more useful is a framework that holds both. One that takes the hormonal piece seriously without reducing the experience to chemistry. We want to take your history seriously without ignoring the fact that your body is carrying it.

What I have seen help

The first thing that helps is naming what is happening with accuracy. This isn’t a failure on your part or regression or an undoing of all the hard work you’ve done in the past. It’s also not something that should be powered through. It’s also not just a hormone problem to be patched over on its own, and not as a trauma problem to be addressed (or readdressed). We want to work on them both together.

The second thing that helps is doing the work in the right order. When the nervous system is dysregulated, deep trauma processing is rarely the right starting point. Stabilization comes first. We want to look at you as a whole being, so addressing the immediate needs such as sleep, regulation, present-day stressors, and the basics of being able to feel something without being overwhelmed by it.

The third thing that helps is the medical conversation alongside the therapy conversation. Hormone therapy isn’t the right answer for everyone, and that decision belongs with you and your doctor. But it can be a real option, and the current evidence supports a more open conversation than many of us have been offered in the past. Working through the changes you’re experience in therapy alone is important, and you want to care for your body as well, and address your hormones and the support they need too. Working with brain, body and emotions together in a coordinated effort is very important.

What I want women to know

If you are in this stage of life and recognizing yourself in any of what I have described, I want you to know that you are not imagining things, you’re not making more of it than it is, and you aren’t alone.

You are in one of the most demanding physiological and developmental transitions of your life. Your body and mind are responding to this demand in ways that now have research behind them. You don’t need to figure it out by yourself, and you don’t need to wait until you’re in crisis to ask for support.

If you would like to talk about what trauma-informed therapy could look like at this stage of your life, I would invite you to reach out. This is the work I love most.

Want to keep reading?

If this article spoke to you, you may also be interested in:

- When Menopause Feels Like Trauma: Making Sense of What Nobody Warned You About

- Who Am I Now? Identity Shifts in Midlife

- What Is the Change Triangle?

Notes and references

1. Estradiol modulates resting-state functional connectivity in perimenopausal depression. Increased covariance between the amygdala and prefrontal cortex has been observed with estradiol administration. Source: ScienceDirect, Journal of Affective Disorders, 2024.

2. Thurston, R.C., et al. Childhood trauma was associated with 87% higher odds of persistent insomnia in midlife women in the Study of Women's Health Across the Nation (SWAN). Presented at The Menopause Society 2025 Annual Meeting.

3. Thurston, R.C. Trauma and its implications for women's cardiovascular health during the menopause transition: Lessons from MsHeart/MsBrain and SWAN studies. Climacteric, 2024.

4. Faleschini, S., et al. Longitudinal associations of psychosocial stressors with menopausal symptoms and well-being among women in midlife. Menopause (NAMS journal), 2022. Project Viva cohort, Harvard Medical School.