Bridging hormones and trauma history: an integrated framework for perimenopausal mental health care.

Ms Daniela Provedel1

1Dreamlab Psychology, Beecroft – Sydney, Australia

Biography:

Daniela Provedel is a Registered Psychologist and founder of DreamLab Psychology in Sydney, with over twenty years of experience integrating psychodynamic, traumainformed and evidencebased approaches. She is a member of the Australasian Menopause Society, the Australian Psychological Society, the Australian Association of Psychologists Inc. and the EMDR Association of Australia. She recently completed the Harvard Medical School Women's Health and Menopause Intensive Course (2026), and has advanced training in complex trauma including EMDR, Internal Family Systems with Frank Anderson and cognitive therapy at the Beck Institute. She lectured and supervised in at the University of São Paulo for fourteen years.

Aims:

To propose an integrated framework for traumainformed clinical assessment of mental health in perimenopausal and postmenopausal women, and to synthesise evidence on the relationship between trauma history, midlife development and the menopause transition.

Methods:

A narrative review of literature on adversity, posttraumatic stress, intimate partner violence, midlife developmental processes and the menopause transition was undertaken. Sources included reviews on trauma and menopause, lifecourse models of trauma and female reproductive health, longitudinal data on mood and anxiety across the menopause transition, estradiol, stress physiology and autonomic regulation.

Results:

Traumaexposed women show greater menopausal symptom burden and higher rates of depressive, anxiety and posttraumatic stress symptoms during the menopause transition than nonexposed women. Perimenopause may be a window of heightened neurobiological vulnerability, in which estradiol fluctuations interact with prior adversity, sleep disruption and autonomic dysregulation. Midlife is a distinct developmental stage, marked by shifting roles, caregiving demands, loss, identity change and existential reflection. An integrated fourdomain framework is proposed, encompassing hormonal/endocrine, trauma history, autonomic/neurobiological and psychosocial/identity domains.

Conclusions:

Integrating traumainformed, midlifeaware assessment into menopause care may reduce misattribution of complex psychological distress to menopause alone, clarify distinctions between menopausal symptoms and mental health conditions, and guide appropriate use of hormonal, psychological and pharmacological treatments.