Perimenopause & Menopause Support

Something has shifted and you’re not sure when it happened or who you are on the other side of it.

Your body feels unfamiliar. Desire has quietly disappeared and you don’t know if it’s gone for good or just hiding. There’s more irritability now, or more anxiety, or a sudden inability to tolerate things that never used to register. Maybe you look at your relationship and wonder how you got here, or look in the mirror and don’t quite recognize the woman looking back.

You’re not falling apart. You’re in the middle of one of the most significant transitions of your life, and nobody prepared you for how much it would impact everything.

This Is More Than Hormones

Perimenopause and menopause are real biological events. The hormonal shifts are real. The physical symptoms are real: the irregular periods, the sleep disruption, the changes in your body that nobody warned you about clearly enough.

But what often goes unaddressed is everything else this transition stirs up underneath.

Who am I now that my body is changing? What do I actually want – in my relationship, in my life, in how I spend my time and energy – when so much of what felt certain no longer does? What do I do with the parts of myself I set aside for years, the needs I minimized, the ways I quietly accommodated everyone else while losing track of what I actually wanted?

This is the work I do. Not just the symptom management (that’s important, and your gynecologist and other providers are part of that picture) but the deeper layer underneath. The identity piece. The relational piece. The erotic piece. The question of who you are becoming and what you want that to look like.

Explore Working Together

What You Might Be Experiencing

Desire that’s changed or disappeared

There was a time when feeling sexual was just part of life. Now it’s either gone, or it shows up briefly and then disappears, or it arrives so slowly and conditionally it barely feels like desire anymore. Sex has become something to get through rather than something to want.

Maybe you’ve been going through the motions just to keep the peace – feeling hollow afterward and hoping your partner doesn’t notice. You don’t know if desire is coming back. And honestly some days, you’re not sure you care anymore.

Feeling like a stranger to yourself

The woman in her thirties felt more knowable. This version is harder to read, harder to predict, sometimes harder to like. Some women describe it as losing themselves. Others say they’re being forced to finally find themselves – but that doesn’t make it any less disorienting to live through.

A relationship showing the strain

The distance has been growing and you’re not sure how to close it. By the end of the day there’s nothing left – not for your partner, not for the relationship, not even for yourself. You’re not checked out, you’re just running on empty and somehow it became the new normal.

A body that feels less familiar

Sex may have become uncomfortable or painful. Arousal takes longer or doesn’t arrive the way it used to. You’re tired of the brain fog and tired of the mood swings that come out of nowhere. Tired of feeling like a slightly worse version of yourself and not knowing why. And underneath all of it, something harder to admit – a quiet grief for the version of your body and your sexuality you used to know, and real uncertainty about what comes next.

What We Work on Together

Desire – and why it’s not just hormonal

Desire is relational, psychological, historical, and contextual. It responds to how safe you feel, how seen you feel, how you’ve been taught to want – and the needs you’ve been talking yourself out of for years. In session, we address all of it.

Who you’re becoming

Many women arrive at midlife having spent decades organizing their lives around everyone else: their children, their partners, their careers. Perimenopause and menopause has a way of making that arrangement suddenly feel unsustainable. The work here is about learning what it means to want things for yourself again – to take up space, to stop performing a version of yourself that no longer fits. It starts with one honest conversation. That’s where the real shift begins.

Your body and your sexuality now

If sex has become painful, loaded, avoided, or loaded with anxiety, we address that directly. As a certified sex therapist, I bring clinical training to this that goes beyond general talk therapy. We work with what your body needs now, not what it needed ten years ago.

Your relationship

The relational impact of this transition is real and often underestimated. We work on improving communication – addressing the conversations that have been put off or have become too tense to approach. The gap between what he wants and where you are. The way sex has started to feel like pressure instead of connection. Or figuring out what you actually need – because half the time you’re not even sure yourself. All of this is workable. That’s exactly what I’m here for.

The grief and what’s on the other side of it

There are real losses in this transition: of fertility, of a particular version of your body, of certainty about who you are. There’s also something that most women don’t expect on the other side of it: a version of themselves that isn’t written by everyone else’s expectations. We make room for both.

Most women who find their way here have been holding it together publicly – at work, in their relationships, for their families –  while something quieter falls apart on the inside. They’re not looking for someone to fix them. They want a space where they don’t have to manage how they appear. And many are surprised to find that this transition, as hard as it is, is the first time in years they’ve actually asked what they want. That question is worth something. This is where we start.

A Note for Your Partner 

If your wife or partner is going through this transition and you’re trying to understand what’s happening, you’re not alone. Many partners feel shut out, confused, or like they’re constantly saying the wrong thing. What she’s experiencing is real -the irritability, the withdrawal, the changes in desire. They are not personal, and they’re not permanent. If you want to come in, we can address your questions or concerns. Or, couples therapy can help both of you understand what’s shifting, communicate more honestly, and move through this as a team rather than on opposite sides of it.

Questions I Hear Often

Can therapy actually help with low libido during menopause?

Yes – and often more than hormone treatment alone. Desire during perimenopause and menopause is shaped by relational dynamics, identity shifts and psychological factors, not just hormones. Therapy addresses what medication can’t.

Do I need to be seeing a gynecologist too?

It depends on your symptoms. I collaborate with primary care physicians, gynecologists and pelvic floor physical therapists when the physical piece needs attention. Therapy and medical care work together, not instead of each other.

Do you offer menopause therapy online?

Yes. All sessions are via telehealth on Zoom, available to clients in California, Florida, Idaho, and Vermont. I also see clients internationally through a virtual office in Hong Kong. 

If you recognized yourself somewhere on this page, you’ve come to the right place.

Ready to Talk?

I offer a free 15-minute consultation to get a sense of how I work and whether this feels like the right fit.

Dr. Kristin Zeising, PsyD, CST | Licensed Clinical Psychologist | AASECT Certified Sex Therapist | San Diego, CA | Telehealth via Zoom