Podcast Summary

Turning Points: Navigating Mental Health
Episode: The Hidden Mental Health Journey of Menopause and Perimenopause (S5E3)
Date: October 22, 2025
Host: Frances Solis (Tufts Health Plan | Boston Globe Media)
Guests: Annalisa Fry (Yoga instructor, lived experience), Dr. Tara Iyer (Medical director, Menopause and Midlife Clinic, Brigham and Women’s Hospital; Harvard Medical School instructor)

Main Theme & Purpose

This episode explores the often-overlooked mental health impacts of perimenopause and menopause. Centering on the firsthand story of Annalisa Fry and insights from menopause specialist Dr. Tara Iyer, the episode seeks to break the silence around the emotional and psychological challenges many women face during this transition. It highlights why these experiences can be so destabilizing, why they are still so rarely discussed, and what support and solutions are available.

Key Discussion Points & Insights

1. Annalisa’s Personal Journey: From Unexplained Anxiety to Understanding Perimenopause

[00:02–07:36]

• Annalisa, formerly seen as stable and energetic, began suffering from new and severe anxiety, insomnia, mood swings, brain fog, and even social withdrawal in her late 40s.
• At first, she assumed COVID-related stress was to blame, but as symptoms persisted and escalated, she realized something physiological was at work.
• The classic menopause symptom, hot flashes, arrived, but emotional symptoms were more disorienting, making her feel "like I'm going crazy" ([00:52]).
• Annalisa felt completely unprepared. Menopause hadn’t been openly discussed in her Italian-American family or among friends.

Notable Quote:

“I was like, oh my God. I’m so mad all the time for no reason...I feel like I’m going crazy.” — Annalisa Fry ([00:52])

2. Lack of Knowledge & Conversation: The Cultural Silence

[05:07–06:11]

• Annalisa describes how her mother and sisters hardly discussed menopause growing up. Cultural norms enforced secrecy.
• She became the first among friends to broach the subject, helping demystify the experience for others.
• She suggests that knowing more beforehand would have helped her seek medical help sooner.

Notable Quote:

“If I knew in advance what was going to happen...I would have already seen the physician I ended up seeing last year who put me on HRT and, like, literally saved my life.” — Annalisa Fry ([05:14])

3. Impact on Identity, Relationships, and Work

[07:36–10:29]

• Annalisa lost her usual confidence, organizational skills, and drive. Socializing and even daily chores felt overwhelming.
• Her brain fog, lack of motivation, and mood swings deeply affected her work, relationships, and her sense of self:

“I didn't feel at 100% capacity, you know when you’re...killing it at work. I did not feel that for like two years.” ([09:46])

• She journaled her distress and considered medication, despite disliking pills.

4. Finding Anchors: Coping and Recovery

[10:41–12:42]

• Exercise, especially strength and bone-building activities, was crucial not only for physical but for mental health.
• Yoga, meditation, and sound healing also provided relief.
• Maintaining social connections, even when difficult, made a difference. Friends noticed her withdrawal and checked in.
• Eventually, hormone replacement therapy (HRT)—despite initial medical concerns—transformed her well-being: improved sleep, mood, and sense of self. After three months, gradual improvement; after a year, a full return to herself.

Memorable Moment:

“Now I’m just like, back to myself...after three months of HRT, I started getting better.” — Annalisa Fry ([12:48])

5. Rediscovering Perspective and Empowerment

[14:53–16:10]

• Annalisa reframed the experience: no more periods became a silver lining.
• The death of a friend her age emphasized that growing older is a privilege, deepening her gratitude and shifting her perspective on aging.

Notable Quote:

“Getting older is a privilege...I was devastated [by my friend’s death], but it put it in perspective—we should all be really grateful that we actually get to see 50.” — Annalisa Fry ([15:28])

6. Why Mental Health Symptoms Are So Distinct in Menopause

[16:15–20:34]
Dr. Tara Iyer's Expertise

• Emotional symptoms (depression, anxiety, irritability, brain fog) are among the top struggles during the menopause transition.
• Estrogen’s fluctuations and decline directly affect brain neurotransmitters (e.g., serotonin) responsible for mood regulation.
• Indirectly, menopause symptoms (e.g., poor sleep, night sweats) increase stress and fatigue, impacting mood further.
• Environmental/life stresses at midlife compound hormonal effects—what Dr. Iyer calls “the sandwich generation.”

Notable Quote:

“There’s a high prevalence...Probably the top five symptoms are mood related...Estrogen has significant functions in the brain, particularly toward certain neurotransmitters that can modulate mood.” — Dr. Tara Iyer ([18:24])

7. Demystifying Perimenopause vs. Menopause

[20:34–23:16]

• Perimenopause can begin as early as late 30s, with unpredictable hormone swings and cycle shifts; this phase can last 5–7 years.
• Emotional symptoms often precede changes in bleeding.
• Menopause is diagnosed after 12 months without periods, at which point hormone levels are consistently low.

8. Diagnosis and Distinguishing Hormone-Driven Symptoms

[23:16–24:30]

• Tracking the timing of symptoms (e.g., depression worse before periods) helps distinguish hormone-driven conditions from primary mental health disorders.
• Blood tests are less helpful during perimenopause, due to daily hormonal swings.

9. Treatment Options & Holistic Approaches

[24:54–26:57]

• Hormone therapy (HRT) can provide relief even for mental health symptoms, but is only one solution.
• Other options include:
  • Antidepressants/anti-anxiety meds (SSRIs, SNRIs)
  • Cognitive behavioral therapy/psychotherapy
  • Lifestyle modifications for sleep, exercise, and stress management

Notable Quote:

“Hormone therapy can be helpful, but I do want to point out it’s just one of multiple treatment options.” — Dr. Tara Iyer ([24:54])

10. Potential for Reflection & Empowerment

[26:57–28:08]

• The menopause transition can also serve as a catalyst for women to prioritize their long-term health, reevaluate life choices, and take charge of bone/heart health.
• Dr. Iyer calls menopause a “midlife inflection point” that can inspire self-advocacy and self-care.

11. Core Message: Advocacy and Self-Prioritization

[28:08–30:25]

• Dr. Iyer urges women to advocate for themselves, seek physicians with menopause expertise, and not be embarrassed to pursue care or support.
• Cultural and systemic gaps persist in medical training and research for menopause care—so self-awareness and empowerment are critical.

Memorable Quote:

“Advocate for yourself...This is a critical time where things are shifting...recognize those symptoms, advocate for yourself, and prioritize yourself during this time.” — Dr. Tara Iyer ([28:14])

12. Advice for Others: Where to Start

[31:03–32:15]

• Annalisa encourages:
  • Proactive research (e.g., TheMenopauseSociety.org)
  • Seeking specialists, even if waitlists exist
  • Challenging physicians who lack menopause knowledge
  • Seeing the profound interconnection of hormones, body, and mind

Notable Quote:

“Do your own research...advocate for yourself...There’s so much information, even though there’s still a lack of articles on women’s health, which is ridiculous.” — Annalisa Fry ([31:03])

Notable Quotes & Moments with Timestamps

• “I feel like I’m going crazy.” — Annalisa Fry ([00:52], [09:11])
• “If I knew in advance what was going to happen...I would have already seen the physician….who put me on HRT and, like, literally saved my life.” — Annalisa Fry ([05:14])
• “Estrogen has significant functions in the brain, particularly towards certain neurotransmitters that can modulate mood...” — Dr. Tara Iyer ([18:24])
• “Don’t underestimate the power of hormones because they will mess you up.” — Annalisa Fry ([14:22])
• “Advocate for yourself...recognize those symptoms, and prioritize yourself.” — Dr. Tara Iyer ([28:14])
• “Getting older is a privilege...we should all be really grateful that we actually get to see 50.” — Annalisa Fry ([15:28])
• “I would most want them to know first, do your own research...advocate for yourself. ” — Annalisa Fry ([31:03])

Key Takeaways

• Perimenopause and menopause may trigger very real and severe mental health symptoms—including mood swings, depression, anxiety, and profound identity shifts—that are still rarely discussed or understood, even by healthcare providers and close family/friends.
• Normalization, open discussion, and accurate information are essential. Cultural stigma and medical gaps in knowledge leave many women blindsided and isolated.
• Treatment is multifaceted: HRT helps many, but therapy, lifestyle changes, and sometimes psychiatric meds are vital options.
• Advocate for yourself, seek experts, and don’t underestimate the interplay of hormones and mental health.
• Menopause is not the end of a “stable” self—the right support can make this a time of reclaiming agency, wisdom, and well-being.

Resource Mentioned

• TheMenopauseSociety.org — For locating menopause-trained physicians and information.

Structure & Flow

This episode is an engaging blend of intimate personal storytelling (Annalisa’s real struggle and return) and contextualized science (Dr. Iyer’s clear breakdown of symptoms, root causes, and medical/holistic solutions), balanced with practical advice and compassionate guidance throughout.

For anyone navigating (or caring for someone navigating) menopause and perimenopause: You are not alone, your symptoms are real, and reclaiming your well-being is possible—sometimes beginning with a single conversation or question.