For many women, menopause is often described in physical terms like hot flashes, night sweats, and disrupted sleep. But therapist Alexis de la Rosa believes the emotional and psychological changes that come with midlife are just as important and too often overlooked.
A licensed therapist and founder of Clarity Within Therapy in Maryland, de la Rosa focuses on women’s mental health. She specializes in anxiety, emotional regulation, burnout and the complex identity shifts that often accompany major life transitions. Many of the women she works with are navigating midlife changes – including perimenopause and menopause – sometimes before they even realize that’s what’s happening.
“Sometimes women come in because they feel anxious or sad and they don’t know why,” she explains. “My job is to help women untangle what’s happening and identify the core of the issue.”
When Mental Health and Menopause Intersect
Perimenopause can start as early as the mid-30s and often lasts for years. For Latina and African American women specifically, research shows they experience some of the longest perimenopause durations and some of the highest rates of mood disturbance during this transition. Still, emotional symptoms like mood swings, anxiety, depression, and brain fog are often misunderstood or overlooked – especially in communities where mental health conversations remain stigmatized.
De la Rosa works with clients in their 40s, 50s, and early 60s who are balancing busy careers, parenting, and major life changes like children leaving home, aging parents or getting ready to retire. When hormones start to shift, the emotional stress can feel unbearable.
“We often think perimenopause is only about hot flashes and sleep problems,” she says. “But there are many mental health changes too – depression, anxiety, mood swings, brain fog. Those experiences are real, and they deserve attention.”
Instead of focusing only on psychological symptoms, de la Rosa takes a whole-person approach, looking at physical health, environment, relationships, and life stress together.
“I don’t just look at mental health in isolation,” she explains. “We look at what’s happening physically, emotionally, and environmentally so we can figure out where support is needed.”
A Career Pivot…and a Personal Awakening
De la Rosa’s path to therapy began after a successful career in marketing and nonprofit work. For more than a decade, she worked in the association world in Washington, D.C., organizing trade shows and later supporting organizations through marketing strategy.
But in her early 40s, she started to wonder about the long-term impact of her work.
“I started thinking about purpose and legacy,” she recalls. “What kind of change do I want to leave behind?”
With encouragement from her family, she returned to school and earned a master’s degree in counseling from Johns Hopkins University in 2018. Going back to school also led to an unexpected discovery: she was diagnosed with ADHD in her 40s.
“At first, it shook my identity,” she says. “I thought about how things might have been different if I’d had support earlier.”
But getting the diagnosis brought understanding and self-compassion.
“ADHD in women often looks different than the stereotype suggests,” she explains. “I didn’t have the hyperactivity piece people associate with it. Mine showed up as difficulty sustaining attention on non-preferred tasks, needing external structure, and ironically, thriving under pressure. Executive function challenges masked by high achievement.”
“ADHD gets painted as a deficit, but what I’ve learned is that it also comes with real strengths: pattern recognition, hyperfocus when something captures my interest, creative problem-solving, and an ability to hold complexity and see connections others might miss.”
Getting the diagnosis later in life also shifted how she shows up with clients. Many high-functioning women she works with describe similar patterns: the ability to perform well despite struggling underneath, the shame of not being able to “just focus,” the relief of finally understanding why certain things feel harder.
These experiences help her connect more deeply with the women she works with.
Recognizing the Hidden Role of Perimenopause
De la Rosa often sees women come to therapy without realizing that hormonal changes might be affecting how they feel. Sometimes clients already suspect perimenopause and have talked to their doctors. Other times, the connection comes up naturally during their sessions.
“We start talking about their physical health,” she says. “Headaches, changes in their menstrual cycle, sleep issues. Then we start to piece things together.”
She often suggests that clients track their symptoms along with their menstrual cycle to better see how mood and hormonal changes might be connected.
“Keeping a simple log can be really helpful,” she says. “It helps us understand when anxiety or mood shifts are happening and what might be influencing them.”
She also reminds women that menopause is different for everyone.
“It’s not one-size-fits-all,” she says. “Every woman needs support that’s tailored to her needs.”
The Power of Community
In addition to individual therapy, de la Rosa facilitates a virtual drop-in menopause group which offers guided conversations, expert insights, practical resources and the thing many women need most: connection.
Even she was surprised by the impact.
“What I saw was how powerful it was for women to realize they weren’t the only ones experiencing these things,” she says. “That sense of connection and validation is incredibly important. It shifts the whole experience.”
For many women, the group offered reassurance and tools, even if they didn’t continue with individual therapy.
“They were able to see that their experience wasn’t unique or something to be ashamed of,” she says. “They could hear from other women in the same stage of life, facing the same questions. That alone can be healing.”
The group meets virtually and is open to women in Maryland and Washington, DC. For many, it’s a bridge and a way to build community while navigating this transition. It’s also a space where women of color can show up fully – you’re not the only one in the room, and you don’t have to explain yourself.
Culture, Identity, and Mental Health
De la Rosa’s own background shapes how she approaches care. She identifies as Mexican American and has lived the experience of growing up between two cultures, El Paso, Texas, and Ciudad Juárez, Mexico. Navigating two languages, two sets of expectations, and multiple senses of belonging gave her a unique perspective on identity and the weight of unspoken obligations.
“Growing up between cultures was confusing at times,” she says. “But now I see it as a gift. It helps me understand the weight that many women carry and the pressure to keep everything together, to honor obligations, to navigate expectations that don’t always fit who you are.”
For women who grew up navigating more than one culture, identity, or sense of belonging, menopause can bring up deeper identity questions. Who am I when I’m not performing for anyone else? What do I actually want? These questions can feel especially charged for women managing multiple cultural expectations.
De la Rosa is committed to expanding access to culturally responsive mental health care, particularly for women of color who may experience stigma about getting help.
“In some communities, there’s still the idea that you just have to be strong and handle things on your own,” she says. “But these conversations are important and deserve support that understands the whole story.”
For women who prefer to process their experience in Spanish, Alexis offers therapy entirely in her first language too. It’s not a separate service -it’s part of how she meets women where they are.
Her Personal Menopause Journey
Like many women, de la Rosa didn’t realize at first that hormonal changes were affecting her mental health. She experienced years of slow-building symptoms, like low energy, trouble focusing, and eventually, chronic sleep disruptions.
“I would wake up at three in the morning, and my mind was racing,” she recalls. “Over time, the lack of sleep really affected my energy and my ability to keep up.”
After learning more about perimenopause and exploring different treatment options with a menopause-informed provider, she found a path forward.
Looking back, she wishes she had found support sooner.
“That’s why this work matters so much to me,” she says. “I don’t want other women to go through what I went through. I want them to know that what they’re experiencing is real, worth taking seriously, and doesn’t have to be managed alone.”
A Message for Women in Midlife
Today, de la Rosa sees midlife as a powerful transition, not a decline.
“I really believe this stage can open new possibilities,” she says. “You’re not broken. You’re not falling apart. You’re transitioning.”
Her guiding principle is simple but powerful: “Listen to women,” she says. “When women tell you how they’re feeling, believe them. Validate their experience. Offer support that actually fits their life.”
In a world where conversations about menopause are still evolving, that message may be exactly what many women need to hear.
If you’re in the Washington DC metropolitan area and would like to work with Alexis or learn more about her work, reach out to her at Clarity Within Therapy.
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