EMDR Therapy and Perimenopause: Why Old Trauma Can Surface Again and How EMDR Helps

When the Past Comes Back in Perimenopause

You thought you had dealt with it. Maybe years ago, through therapy or simply through time. And then, somewhere in your 40s, it came back. A memory you had not thought about in a decade. A reaction that felt bigger than the situation warranted. A sense of dread or hypervigilance that seemed to come from nowhere.

If this sounds familiar, you are not falling apart. There is a specific biological reason why unresolved trauma, or trauma you thought was resolved, can resurface during perimenopause. It has to do with estrogen, the brain, and how fear memories are stored and regulated.

EMDR, which stands for Eye Movement Desensitization and Reprocessing, was developed specifically to help the brain process traumatic memories. For perimenopausal women experiencing an unexpected return of difficult past experiences, it is one of the most targeted and well-evidenced options available.

Why Perimenopause Destabilizes Trauma Processing

Estrogen does far more than regulate reproduction. It plays a direct role in how the brain stores, accesses, and regulates emotional memories. The amygdala, the brain region responsible for detecting threat and encoding fear, has estrogen receptors throughout it. When estrogen levels are high and stable, it helps modulate amygdala reactivity, keeping fear responses calibrated.

As estrogen fluctuates and declines during perimenopause, that modulation becomes inconsistent. The amygdala can become more reactive. Threat responses that were well-regulated become more easily triggered. Memory consolidation, particularly for emotionally charged memories, is affected.

Research has shown that lower estrogen is associated with reduced fear extinction, which is the brain's ability to learn that something that was once threatening is no longer dangerous. This is the same mechanism involved in trauma recovery. When fear extinction is impaired, old memories can feel current again. They do not stay in the past where you filed them.

This is not a psychological weakness or a sign that your earlier healing was incomplete. It is a neurological shift driven by hormone changes. Understanding that distinction matters, because it changes both how you think about what is happening and what kind of help is most appropriate.

What EMDR Actually Is

EMDR is a structured psychotherapy approach developed in the late 1980s by psychologist Francine Shapiro. It was initially developed to treat PTSD and has since been validated for use with other trauma-related conditions, anxiety, depression, and grief.

The defining feature of EMDR is bilateral stimulation, typically guided eye movements following the therapist's hand, though taps on the knees or alternating tones through headphones can also be used. This bilateral stimulation is applied while the client holds a targeted distressing memory in mind. The process is thought to engage similar neurological mechanisms to those involved in REM sleep, when the brain naturally processes and consolidates emotional experience.

The theory is that traumatic memories sometimes do not get processed properly at the time of the event. They remain stored in a fragmented, high-charge form that gets triggered rather than remembered. EMDR allows the brain to reprocess those memories so they become integrated into normal autobiographical memory, retaining the facts of what happened but losing the overwhelming emotional activation.

EMDR is recognized as an effective treatment for PTSD by the World Health Organization, the American Psychological Association, the Department of Veterans Affairs, and the UK's National Institute for Health and Care Excellence. Its evidence base is substantial.

What an EMDR Session Looks Like

EMDR has a specific eight-phase protocol. The first two phases are history-taking and preparation. Your therapist will want to understand your history, your current symptoms, and your goals. Before any trauma processing begins, you will build what EMDR practitioners call resourcing, developing internal tools like imagery or breathing practices that create a felt sense of safety. This preparation phase is not rushed. A competent EMDR therapist will not move into trauma work until you have these tools in place.

Phases three through six involve the actual processing. You and your therapist identify a specific target memory, the image, negative belief, and body sensation associated with it. You hold these in mind while following the bilateral stimulation. Between sets, your therapist will ask what came up. You report whatever arises: images, thoughts, emotions, body sensations. The process continues until the distress associated with the memory reduces significantly.

Phase seven is closure. Each session ends with a calming exercise, and your therapist will ask you to keep a log of anything that comes up between sessions. Phase eight is reassessment, checking in at the next session on how the processing has held.

Sessions are typically 50 to 90 minutes. Trauma processing sessions are often longer because the protocol needs time to work through to a stable endpoint. You may feel tired after a processing session. Some material that comes up between sessions can be intense, which is why the preparation phase and ongoing therapist contact are important safeguards.

Who EMDR Is Best For in Perimenopause

EMDR is well suited to perimenopausal women in several specific situations.

If you have a history of trauma, whether childhood adversity, sexual trauma, medical trauma, or other significant events, and those experiences feel more alive or intrusive than they have in years, EMDR is a direct match. The neurological changes of perimenopause are specifically affecting the mechanism EMDR addresses.

If you have been diagnosed with PTSD at any point in your life and notice your symptoms worsening during perimenopause, EMDR is the treatment with the strongest evidence base for PTSD specifically.

If you experience disproportionate emotional reactions that you cannot trace to the current situation, for example, a comment from a colleague that triggers an intensity of shame or fear that feels too large for the context, EMDR can help identify and process the underlying material driving those reactions.

If you experience anxiety that has a strong physical component, sudden racing heart, difficulty breathing, feeling frozen, EMDR works with body sensations directly as part of its processing protocol. These somatic components are not separate from the emotional content. They are processed together.

EMDR is not the right fit for everyone. It requires sufficient stability to tolerate the processing work. People in acute crisis, active substance use, or without basic coping skills in place may need to build those foundations before EMDR processing is appropriate. A skilled EMDR therapist will assess readiness carefully before beginning.

EMDR Versus Other Therapy Options for Perimenopause

CBT and EMDR are both well-evidenced for anxiety and trauma-related conditions, but they work differently and suit different presentations.

CBT focuses on changing thought patterns. It is excellent if your anxiety is primarily driven by distorted thinking or behavioral avoidance. It works well for general anxiety, health anxiety, and mood management. It is more structured and directive and often produces results in a shorter timeframe for non-trauma anxiety.

EMDR works with the emotional and somatic charge of specific past experiences. It does not require you to analyze or discuss your memories in detail, which some women find much more tolerable than talk-based trauma therapy. For trauma with a clear narrative, EMDR often reaches the roots more directly than CBT.

ACT and somatic therapy can complement EMDR well. ACT helps with the values-based navigation of perimenopause as a transition. Somatic approaches prepare the body to tolerate processing. Some women find that a period of somatic work or body-oriented stabilization before beginning EMDR makes the processing more effective.

The therapist matters as much as the modality. A thoughtful, well-trained therapist who understands the hormonal context of perimenopause and is skilled in their modality will outperform any perfectly chosen therapy delivered by someone who does not get the full picture.

Finding a Qualified EMDR Therapist

EMDR has a formal training and certification structure. The EMDR International Association (EMDRIA) certifies therapists who have completed the required training and consultation hours. The EMDRIA therapist directory at emdria.org is the most reliable starting point for finding someone qualified.

When contacting a potential EMDR therapist, ask whether they completed an EMDRIA-approved basic training, whether they have been consulting with an EMDRIA-approved consultant, and whether they have experience working with women in midlife or with hormonally-related mental health changes. Not everyone will have that last specialty, but the question signals what you are looking for.

Telehealth EMDR is widely available and has been validated as effective in research. The eye movements can be conducted via screen. Some therapists use tap devices that clients hold in each hand for bilateral stimulation during video sessions. This significantly expands the geographic range of therapists you can access.

If cost is a barrier, some EMDR therapists offer sliding scale fees. Training clinics at universities that run EMDR training programs sometimes offer supervised sessions at reduced cost. EMDR Humanitarian Assistance Programs (HAP) also maintain directories of low-cost providers.

What to Expect From the Process

EMDR is not a quick fix, and it requires active engagement between sessions as well as during them. Most people need between 6 and 20 sessions for a defined trauma target, though complex trauma history may require more. The pace depends on how much preparation work is needed, how many trauma targets exist, and how you process.

The preparation phase, which can take two to four sessions, should not feel like delay. It is building your capacity for the processing work. Women in perimenopause may need a bit more preparation work because the neurological changes of this phase can make emotional regulation more effortful. A good therapist will not rush this.

The processing itself can feel disorienting in the session, particularly the first time. You may be surprised by what comes up. The goal is not to make the memory comfortable but to change its charge, so that it can be remembered without hijacking your present experience. Most people describe the shift as the memory feeling more distant, like something that happened to a younger version of themselves rather than something happening now.

PeriPlan can be a useful companion during EMDR work, helping you track mood and symptom patterns between sessions. Noticing when difficult material comes up in relation to your cycle phase can provide useful context for your therapist about hormonal influences on processing.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.