Perimenopause and Intrusive Thoughts: Why They Happen and How to Cope
Intrusive thoughts during perimenopause are distressing but surprisingly common. Learn what causes them and the strategies that help you manage them.
What Are Intrusive Thoughts and Why Do They Increase in Perimenopause
Intrusive thoughts are unwanted, involuntary thoughts that pop into your mind without invitation. They can be frightening, disturbing, or simply bizarre, and they often feel completely at odds with who you are and what you value. Almost everyone experiences them occasionally, but during perimenopause, many women notice them becoming more frequent and harder to dismiss. The reason is neurological. Oestrogen supports the regulation of serotonin, which plays a key role in filtering and suppressing irrelevant or distressing mental content. When oestrogen fluctuates sharply, this filtering system becomes less reliable. Your brain generates more noise, and some of that noise is unpleasant.
The Types of Intrusive Thoughts Women Report
Intrusive thoughts during perimenopause can take many forms. Some women experience catastrophic thoughts, imagining accidents, illness, or the death of people they love. Others notice repetitive worst-case scenarios that play out despite having no basis in reality. Some encounter thoughts that feel morally troubling or out of character, which is particularly distressing because it can generate shame on top of the original discomfort. It is important to know that the content of an intrusive thought is not a reflection of your desires, values, or intentions. Having a frightening thought does not make you frightening.
Why Trying Not to Think About Them Makes Things Worse
The natural response to an unwanted thought is to push it away. This works in the short term but tends to increase the frequency and intensity of the thoughts over time, a phenomenon psychologists call the rebound effect. The more firmly you instruct yourself not to think about something, the more mentally available that thing becomes. A more effective approach is to acknowledge the thought without engaging with it. Notice it the way you would notice a passing cloud. You do not need to analyse it, argue with it, or assign meaning to it. It is a brain event, not a message.
Practical Approaches That Help
Mindfulness practice is one of the most well-studied tools for managing intrusive thoughts. Regular practice builds the capacity to observe mental content without reacting to it, which reduces the distress that intrusive thoughts generate. You do not need to meditate for hours. Even ten minutes of daily practice can make a meaningful difference over several weeks. Labelling thoughts, internally noting this is an intrusive thought, helps create distance between you and the content. Writing them down in a journal can also reduce their power by externalising them and making them feel less urgent.
Addressing the Underlying Anxiety
Intrusive thoughts rarely exist in isolation. They tend to be more frequent and more distressing when overall anxiety is elevated. Managing anxiety through regular exercise, adequate sleep, reduced caffeine, and structured relaxation creates a calmer baseline from which the thoughts are easier to manage. Tracking your symptom patterns over time can also help. Some women notice that intrusive thoughts cluster around particular phases of their hormonal cycle, or in the days following poor sleep, which makes the experience feel less random and more manageable.
When to Talk to a Professional
If intrusive thoughts are frequent, distressing, and beginning to affect your daily functioning, talking to a therapist is a wise and genuinely helpful step. Cognitive behavioural therapy and acceptance and commitment therapy both have strong evidence for this type of difficulty. A doctor can also assess whether the hormonal component of your perimenopause is contributing significantly and discuss what options might help. You are not alone in this. Many women going through perimenopause experience exactly what you are experiencing, and effective support exists.
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