Perimenopause can feel like a wild and unpredictable ride. For many people, it affects nearly every aspect of life — physically, emotionally, mentally, relationally, and spiritually. Physical symptoms may include hot flashes, sleep disruption, hair loss, changes in libido or genital tissue, and shifts in body composition. Energetically, people may experience fatigue, restlessness, or difficulty falling or staying asleep. Emotionally and mentally, perimenopause can bring brain fog, anxiety, depression, grief, difficulty concentrating, or the resurfacing of unresolved trauma.
This transition can also deeply impact relationships and identity. Many people begin reevaluating intimate partnerships, parenting, work, creativity, and the ways they have moved through the world up until this point. Things that once felt sustainable or acceptable may no longer fit. There may also be a profound reckoning with aging, sexuality, self-worth, and one’s relationship with the body itself.
And yet, alongside the challenges, perimenopause can also bring tremendous gifts. Many women describe caring less about others’ expectations and feeling more connected to their authentic selves. Boundaries become clearer. Self-care becomes more accessible. Intuition may feel louder and easier to trust. There can be a deepening sense of wisdom, discernment, and personal truth.
Perimenopause is a major hormonal transition, in some ways similar to puberty. For some, it feels chaotic and overwhelming; for others, gradual and manageable. As with the menstrual cycle, there is no right or wrong way to experience this transition.
For many women, puberty was not marked with ritual, support, or celebration. If we were lucky, someone — perhaps a mother, aunt, or teacher — explained what menstruation was and how to use pads or tampons. But many people received little emotional support, reassurance, or acknowledgment of the significance of the transition. If you were welcomed and supported during puberty, I am so happy for you! I would love to hear how you were welcomed so my 13 year old can relish in that! If you were not, it can be difficult to imagine what it might look like to intentionally support yourself through this next hormonal initiation.
One of the things I value most about ketamine-assisted therapy is its intentionality. We pause to reflect on why we are engaging in this work, what we hope to receive from it, and what support or practices we want to put in place beforehand. The process itself becomes a ritual — a conscious act of turning toward ourselves with curiosity, care, and presence.
Many people in midlife have little time or space to contemplate ritual or intentional transition. Life is often filled with caregiving, work responsibilities, maintaining relationships, and supporting aging parents. Yet whether we consciously acknowledge it or not, change is happening. It may begin subtly: forgetting words that once came easily, changes in sleep, shifts in libido, emotional sensitivity, or feeling disconnected from yourself in unfamiliar ways. Many women have learned to override these signals and “just keep going” because there is always something or someone needing attention.
These symptoms — whether quiet whispers or loud disruptions — may be invitations to slow down and listen more deeply. They may be asking you to reflect on what this stage of life requires from you, what needs tending, and what can no longer be ignored.
A ketamine journey can offer space to explore both the obvious and subtle dimensions of perimenopause. It can provide an opportunity to slow down, reconnect with yourself, and consider how you want to move through this transition. It may help illuminate what support, boundaries, healing, or life changes are needed. It can also create space for grieving, honoring, and integrating the many phases of your life and identity — including the years shaped by fertility, caregiving, creativity, partnership, or motherhood, whether literal or symbolic.
In addition to supporting emotional reflection and ritual, ketamine may also help alleviate some of the other symptoms associated with perimenopause. For some women, this transition intensifies anxiety, depression, hopelessness, or emotional overwhelm. Ketamine has been studied for its rapid-acting antidepressant effects and may provide meaningful relief for some individuals. Many women are prescribed low-dose antidepressants during perimenopause, which can be an important and supportive option. Ketamine may also serve as an alternative or complementary approach, particularly for those experiencing medication side effects or seeking additional support. It can also work alongside MHT (menopausal hormone therapy), which may help address some of the hormonal and neurological shifts that occur during this stage of life.
Many women feel isolated in their perimenopause experience, which is one of the reasons Vanessa Weiland, NP and founder of Phases Clinic, and I are offering The Unfolding Series: Perimenopause — From Transition to Transformation. This workshop is an opportunity to gather with others navigating this life stage and develop a clearer understanding of the hormonal and neurological changes occurring during perimenopause — and why so many people feel as though they are navigating it without a map.
Together, we will explore somatic practices that honor the full arc of hormonal change and participate in a guided hypnosis designed to support resilience, self-awareness, and intentional transition. Participants will also receive priority access to the upcoming Ketamine-Assisted Perimenopause Support Group launching this fall.





















