Perimenopause for Counsellors and Mental Health Professionals: Caring for Others When Your Own Mind Feels Unreliable

You Know How to Hold Space. But What About for Yourself?

You have trained for years in the art of being present with other people's pain. You know about emotional co-regulation, compassion fatigue, the importance of self-care as a professional requirement. You have probably said some version of "you can't pour from an empty cup" to more clients than you can count.

And then perimenopause lands, and the cup has a hole in it.

Counsellors and mental health professionals at every level, from NHS counsellors and private practice therapists to school counsellors and community mental health workers, share a particular challenge with perimenopause. The work demands something that the transition temporarily disrupts: sustained emotional presence, cognitive steadiness, and the capacity to keep your own experience out of the way of the client's.

This is a real and specific occupational challenge. You are not failing at your work. You are navigating a transition that your profession has not always been transparent about.

Concentration and the Counselling Session

Counselling requires a specific kind of attention. You are tracking content, process, non-verbal cues, your own internal responses, the therapeutic relationship, and the clinical formulation all at once. It is cognitively demanding work that most practitioners do so automatically it stops feeling effortful.

Brain fog and concentration difficulties are among the most commonly reported perimenopause symptoms. They are driven partly by sleep disruption, partly by fluctuating estrogen's effects on how the brain uses energy. For counsellors, this shows up as losing the thread of a client's narrative, struggling to hold the session plan in mind, or leaving sessions feeling like you were not quite there.

The session itself is not the moment to problem-solve this. But before and between sessions, there are practical adjustments. Brief notes immediately after each session, while the material is fresh, protect against memory gaps. Reducing back-to-back booking where possible gives your brain recovery time. Limiting caffeine that might heighten anxiety without genuinely improving concentration is worth experimenting with.

Naming this to yourself clearly, as a temporary physiological change with a biological cause rather than as evidence that you are losing your clinical edge, matters more than it might sound.

Emotional Fatigue and the Counsellor's Particular Vulnerability

Compassion fatigue is an occupational risk in counselling that exists entirely separately from perimenopause. When you add perimenopause to the equation, the emotional depletion can be harder to distinguish and harder to recover from.

Perimenopause can lower the threshold for emotional reactivity and reduce the emotional resilience that normally buffers the weight of client material. You may find yourself more affected by client disclosures that you previously held more easily. You may feel a permeability at the end of the day that takes longer to resolve. The boundary between the counselling room and your own emotional life can feel thinner.

This is not a clinical failure. It is a physiological reality that your supervision and peer consultation can help you manage. Bringing the honest question of how your current state is affecting your therapeutic presence into supervision is not oversharing. It is good clinical practice.

If your supervision does not feel like a safe place to bring this, that is worth noting, both for your own support needs and as a reflection on the supervisory relationship.

School Counsellors and Community Settings: Added Pressures

School counsellors and those working in community mental health settings face challenges that private practice counsellors may not. You often have less control over your caseload, your scheduling, and your physical environment.

School environments can be hot, noisy, and lacking in private space for the cooling breaks or quiet resets that help manage symptoms during the day. Community mental health workloads are frequently high, with limited capacity to reduce caseload temporarily during a difficult phase.

If you work in a school or community setting and feel hesitant to raise perimenopause with management, you are not alone in that hesitation. Many women in these roles describe a culture where disclosure feels professionally risky. In the UK, the Equality Act 2010 includes provisions for health-related adjustments, and perimenopause has been increasingly recognised within these frameworks. In other countries, similar employment law protections may apply.

You do not have to frame it as perimenopause if that feels too exposing. A general request for minor adjustments, such as a cooler office space or a slightly lighter caseload during a specific period, is reasonable to make without full medical detail. Your occupational health service, if one is available to you, is a confidential resource.

Your Own Therapy and Support During This Transition

Being a counsellor does not mean you process perimenopause more easily than anyone else. In some ways it can make it harder. You may have a sophisticated internal critic that applies professional standards to your own coping. You may intellectualise your way around what you actually need to feel and say out loud.

If you are in your own personal therapy, this is a time to use it well. Not as professional development or reflective practice alone, but as genuine personal support. Bring the frustration of finding your own work harder. Bring the identity disruption of being the expert who is struggling. Bring the ambivalence, if it is there, about a life stage that your culture does not always honour.

Peer support from other counsellors navigating the same transition is also genuinely useful. Many professional bodies and counselling networks have informal communities where this is discussed. Breaking the silence with trusted colleagues can shift the experience from an isolating private struggle to a shared professional reality.

Practical Adjustments That Support Your Practice

Here are concrete adjustments counsellors and mental health professionals have found helpful during perimenopause.

Review your session scheduling. If you can protect a short gap between sessions rather than booking back-to-back, the cognitive and emotional recovery time helps. Even a five-minute walk between sessions can reset your nervous system.

Consider your session load honestly. The right caseload varies enormously by person and by work setting, but an honest appraisal of what you can hold well right now is a clinical responsibility, not just a personal preference.

Manage your environment where you can. A small desk fan, a slightly cooler room temperature, and access to cold water during sessions are minor adjustments that make a real difference to hot flash management.

Track your patterns. Knowing which days in your cycle your concentration tends to be sharper, and which days are harder, lets you schedule your most demanding clinical work more strategically. PeriPlan can help you log symptoms daily and identify those patterns over time.

Talk to your GP or a menopause specialist. You may have been managing symptoms that have treatment options you have not yet considered. Hormone therapy, non-hormonal options, and lifestyle approaches all have evidence behind them. You deserve that conversation as much as any of your clients would.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.