Perimenopause, EMDR, and Equine Therapy: Common Questions Answered

Women searching for information on perimenopause, EMDR, and equine therapy often have similar questions before they ever reach out. Below are evidence-based answers to the ones I hear most.

Perimenopause and Mental Health

Is anxiety during perimenopause normal?

Yes. Anxiety is one of the most common and least discussed symptoms of perimenopause. As estrogen fluctuates, it directly affects the brain's mood and stress regulation systems, meaning the anxiety has a physiological basis, not simply a personal or circumstantial one. Research published by Newson Health in 2024 found that psychological symptoms are common throughout the menopause transition, yet are frequently under-recognized, meaning many women are treated for anxiety or depression without anyone identifying the hormonal transition underneath it.

Why aren't the coping strategies that used to work for me working anymore?

This is one of the most common and least understood experiences in perimenopause. Many coping tools, especially cognitive or talk-based strategies, were built for a nervous system operating under different hormonal conditions- a hormonal "buffer" if you will. When hormonal fluctuation is destabilizing mood and stress response multiple times a day, cognitive reframing or "coping skills" alone have limited power. This isn't a sign that you're doing something wrong. It's often a sign that the support you need has to evolve alongside your body.

What increases the severity of perimenopause symptoms?

New emerging research suggests perimenopause is best understood through a biopsychosocial lens, meaning biological, psychological, and social factors all interact to shape how a woman experiences this transition. This is a new framework from which to view perimenopause. Hormonal fluctuation is the biological driver, but research increasingly shows it doesn't act alone.

One emerging area of research involves adverse childhood experiences, or ACEs (Adverse Childhood Experiences). A 2020 Mayo Clinic study of over 1,600 women found that those with a higher number of ACEs reported significantly more severe menopausal symptoms. With each additional category of childhood adversity associated with greater symptom burden, even after adjusting for age, depression, and hormone therapy use. Related research has also linked higher ACE exposure to increased inflammation during the menopause transition, which may help explain why early life adversity shows up again, decades later, in this particular season of life.

This doesn't mean perimenopause is "caused" by the past. It means the nervous system's history can shape how intensely this transition is experienced, which is part of why therapy can be a meaningful part of care alongside medical treatment. This is a developing area of research I plan to write about in more depth in the future.

Can therapy help with perimenopause if hormones are already being managed medically?

Yes. Hormonal treatment and therapy address different layers of the same transition. Hormones can help regulate physiological symptoms, while therapy works with the emotional, relational, and nervous system patterns that perimenopause often brings to the surface- including any earlier life experiences that may be intensifying this season.

EMDR Therapy

What is EMDR therapy used for?

EMDR- Eye Movement Desensitization and Reprocessing helps process experiences that continue to feel emotionally unresolved, even after time has passed. EMDR is considered a bottom-up approach, meaning it works with how an experience is held in the nervous system, rather than relying primarily on talking and analysis. A formal trauma diagnosis is not required to benefit from it.

Do I need to be in crisis to start EMDR?

No. Many people who benefit most from EMDR are functioning well in daily life but recognize a specific pattern or experience that insight alone hasn't shifted.

Equine-Assisted Therapy

What is equine-assisted therapy, and who is it for?

Equine-assisted therapy partners you with horses, working from the ground, to access what words alone often can't reach. Horses are remarkably attuned- they respond to what's actually happening in your body, not what you're managing or presenting. That kind of honest, immediate feedback creates real opportunities for nervous system regulation, trust-building, and emotional processing.

This work can stand entirely on its own. A structured equine-assisted therapy protocol for PTSD has shown large, meaningful improvements in veterans in clinical trials, encouraging enough that researchers are now pursuing larger studies to confirm and expand on these findings. It can also be a powerful complement to other therapy, depending on what you're working with. Either way, this is real, evidence-supported work, not an alternative to therapy, it is therapy.

Can equine-assisted therapy replace talk therapy?

For many people, yes- equine-assisted therapy can be the primary treatment, not just a complement to something else. The research on its use for PTSD, particularly in veterans, shows meaningful, lasting improvement on its own. For others, it works beautifully alongside talk therapy, offering a different doorway into the same healing.

There's no single right way to do this work. What matters is finding the entry point that actually reaches you, and equine-assisted therapy may be exactly that.

Perimenopause, EMDR, and Equine Therapy- Together

How are EMDR and equine-assisted therapy related?

Both are bottom-up approaches, meaning they work in a similar direction, through the body and nervous system rather than primarily through talking. They are not opposites, but different doorways into similar territory. Some clients find EMDR effective on its own. Others find that equine-assisted therapy offers a more accessible entry point into nervous system work, which can later support and deepen EMDR processing, or stand effectively on its own.

Do these approaches replace talk therapy, or work alongside it?

They can work alongside it, replace it, or be used independently, depending on what's most useful for you. Many clients benefit from combining a top-down approach, like traditional talk therapy, with bottom-up approaches like EMDR or equine-assisted therapy, allowing both understanding and nervous system change to develop together.

Can perimenopause, EMDR, and equine therapy be part of the same treatment plan?

Yes. Many women navigating perimenopause find that old emotional patterns surface with new intensity during this transition. For some, EMDR becomes part of the work. Others find equine-assisted therapy offers a different way to access and shift what talk therapy alone hasn't reached. These approaches are not mutually exclusive- they can be combined based on what's most useful for you.

Finding the Right Support

Where can I find a therapist who offers all of this?

I'm Sydney Burkhardt, a Licensed Marriage and Family Therapist (#161269) in Pasadena, California. I offer therapy for individuals and couples experiencing challenges due to perimenopause, depression, anxiety, life transitions, a trauma history, and relationship challenges/ruptures. I utilize EMDR, Emotionally Focused Therapy, and equine-assisted therapy. In-person sessions are available in Pasadena and Los Angeles, with virtual sessions available to those in San Diego and throughout California.

If something here resonates, I'd welcome the chance to talk.

Sydney Burkhardt, MA, LMFT #161269 is a Licensed Marriage and Family Therapist in Pasadena, California. This post is for informational purposes only and does not constitute clinical advice or establish a therapist-client relationship. If you are experiencing significant mental health symptoms, please consult a qualified mental health or medical professional.