Reclaiming agency: how women build mood, confidence and social connections during perimenopause

OBJECTIVE: This study aimed to understand women's lived experiences of perimenopause, with reference to brain fog, mood, confidence and social connectedness, and identify opportunities to promote well-being. METHOD: A qualitative, exploratory study was conducted using semi-structured interviews with 30 midlife women in Australia from culturally diverse backgrounds. Interviews were audio-recorded, transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS: Participants described perimenopause as a recurring disruption-stabilization cycle rather than a linear decline. Destabilization was often triggered by sleep loss, cumulative life load and symptom variability, shaping appraisals of mood and confidence. Brain fog was experienced as cognitive disruption accompanied by fatigue and self-doubt, commonly worsened by stress, poor sleep and diet. Participants actively engineered stability using individualized, multi-component strategies, including pacing and withdrawal, sleep optimization, physical activity and well-being practices, organizational and compensatory tools, acceptance and reframing, dietary adjustments, leisure and cognitive stimulation, and social support. Social connectedness was recalibrated, with shifts in engagement, mixed experiences of support versus misunderstanding and a strong preference for validating spaces and relationships. CONCLUSION: Perimenopause was experienced as dynamic yet manageable through structured self-management and supportive contexts. Findings support holistic, multimodal care that integrates symptom management with sleep, behavioral, cognitive and social interventions.