More than biology, womanhood is identity and evolution. Therapy helps women navigate change, loss, and purpose on their own terms.
There is a quiet truth about womanhood that often goes unspoken—our bodies do not merely age; they transform. Each hormonal shift marks a passage, a recalibration not
just of biology but of identity. Pregnancy and menopause, in particular, are more than
physical events; they are psychological milestones that demand an emotional
reckoning. And yet, women are often left to navigate these changes in silence,
expected to be grateful for their transitions rather than overwhelmed by them.
At every turn, society has something to say about a woman’s body. It is debated in
parliaments, regulated in policies, scrutinised in healthcare, and picked apart in the
media. A woman who becomes a mother is expected to find fulfilment in self-
sacrifice. A woman who doesn’t is expected to explain why. Those who cannot have
children sit with a grief that often goes unacknowledged, while those who reach
menopause find themselves written out of the story entirely. If womanhood is
anything, it is a relentless negotiation with expectation.
But beyond all the noise, there is the deeply personal experience of being a woman.
The real work—the emotional, psychological, and deeply human work—is in
reclaiming these transitions as our own.
Pregnancy and Mental Health Challenges in Motherhood
If adolescence is the stormy bridge between childhood and adulthood, matrescence
is the equally profound, yet rarely acknowledged, transformation that occurs when a
woman becomes a mother. Coined by anthropologist Dana Raphael, matrescence
describes the emotional, psychological, and social shifts that accompany
motherhood, akin to an identity rebirth.
Pregnancy is often portrayed as a time of joy and fulfillment, yet beneath the surface,
many women wrestle with anxiety, fear, and an unexpected sense of loss. Grief,
because stepping into motherhood also means leaving behind a past self, a familiar
body, and sometimes, a way of life once deeply cherished.
A woman about to give birth may find herself standing in front of the mirror, staring at
a version of herself that she will never fully return to. The body that has been hers
alone will soon belong, in some ways, to another. The freedoms she took for
granted—the ability to move through the world unburdened—will shift into something
else entirely. It is a beginning, but it is also an ending. And like all endings, it comes
with mourning.
The mental health implications of this shift are significant:
Perinatal Anxiety and Depression – Up to 20% of pregnant women
experience perinatal depression or anxiety, though many hesitate to speak
about it, fearing they will be seen as ungrateful or unfit for motherhood.
Identity Crisis and Existential Angst – Who am I beyond this role? Will I
ever feel whole outside of motherhood? These are questions many mothers
ask in the quiet hours, often too afraid to voice them.
Interpersonal Strain – Relationships shift. Partners may not fully understand
the magnitude of this transformation, friendships may dissolve as priorities
change, and family expectations can feel suffocating.
Counselling offers a space where these feelings can be explored rather than
suppressed. Through therapy, women can process their fears, acknowledge their
grief, and build a version of motherhood that feels authentic to them—not just one
that has been prescribed by society.
Infertility and the Psychological Toll on Women’s Well-Being
Not all women who long for children are able to have them. Infertility is a grief that
exists in the shadows—a loss that is not just one event but a cycle of hope and
devastation, repeated over and over.
A woman trying to conceive may walk through the world differently, measuring time
not in months but in ovulation cycles. Every pregnancy announcement from a friend
may feel like a reminder of what her body will not give her. She might find herself
avoiding baby showers, dreading family gatherings where the inevitable "When are
you having kids?" will come. Unlike other losses, there is no funeral for the child that
never came. No rituals. No roadmap for mourning something that was never
tangible.
The mental health toll is profound:
Complicated Grief – The loss of an imagined future, repeated with every
unsuccessful attempt.
Identity and Self-Worth – The internalised belief that fertility is a measure of
femininity, leaving many women feeling broken.
Social and Emotional Isolation – The well-meaning but painful
reassurances (“You can always adopt”) that fail to acknowledge the depth of
loss.
Therapy offers a space to sit with this grief and cycles of disappointment, to
acknowledge it as real and valid. It helps women reclaim an identity that is not solely
tethered to fertility, to find meaning beyond the narrow expectations of womanhood
that have been imposed upon them.
Childlessness and the Emotional Impact of Circumstance
Not every woman without children arrived there by choice. Some actively chose a
child-free life, while others had the desire but lacked the circumstances—whether
due to career trade-offs, financial constraints, or the absence of a partner with whom
to build a family.
A woman who chooses to be child-free often finds herself interrogated. Why not?
Won’t you regret it? Her decision is treated as a temporary state, something she will
grow out of, rather than a fully formed choice.
And then there are the women who did want children, but life had other plans.
Some delayed motherhood for their careers, only to realise that biology is less
forgiving than ambition. Others spent years searching for the right partner, but the
right partner never came. Some simply ran out of time, caught in the strange and
sudden realisation that what once felt like a distant possibility was now slipping out of
reach.
For these women, the grief is often unspoken. Unlike infertility, there is no diagnosis,
no medical intervention. Just time, passing. Therapy helps women process this silent
loss, to reframe what fulfilment and legacy can look like beyond motherhood.
Menopause and Mental Health in Midlife Transitions
Menopause is often treated as the end of fertility, but its emotional impact goes far
beyond biology. Women entering perimenopause experience:
Mood Disorders and Emotional Instability – The decline in oestrogen
affects serotonin and dopamine, leading to increased vulnerability to
depression and anxiety.
Cognitive Fog and Self-Doubt – Forgetfulness and mental fatigue can
trigger imposter syndrome, particularly for women in demanding careers.
Existential Reflection – Who am I beyond motherhood, beyond my youthful
body, beyond my reproductive function? This stage forces a confrontation with
mortality but also offers an opportunity for renewal.
Therapy provides tools for processing this transition—not as a loss, but as an
evolution. Many women find strength in this period of reinvention, reclaiming their
time, ambition, and identity in ways they couldn’t before.
Uncovering the Complex Layers of Female Mental Health
For too long, womanhood has been reduced to a series of biological
chapters—puberty, fertility, childbirth, menopause—while the full narrative remains
unwritten. A greater understanding to the complexity of women’s mental health is
needed that science and research is coming to grips with. From the impact of
neurodiversity to the processing of trauma and stress, and the integration of mental
health into broader healthcare frameworks. Pain brushed off as stress, mood swings,
or overreaction. The quiet grief of infertility or childlessness left unspoken. The
reckoning of menopause dismissed as just another phase to endure. Too often,
women seeking support are met with prescriptions before they’re asked what they
have lost, what they are carrying, or who they are becoming.
But womanhood is not just about sacrifice, endurance, or fulfilling gender normative
expectations. It is ambition, creativity, deep friendships, chosen families, legacies
shaped in boardrooms, classrooms, and communities.
A woman is not a ticking clock or an expiration date. She is not just someone’s
daughter, mother, or wife. She is a force, a story in motion, an evolving self—one
that unfolds on her own terms.
Restoring Peace is a private mental health centre which provides counselling and psychotherapy services for children, adolescents, youths, adult individuals, couples and groups with anxiety, depression, trauma, grief and various mental health and relationship challenges. For more information, please visit www.restoringpeace.com.sg or WhatsApp at +65 8889 1848. For periodic updates, we invite you to join our telegram group: https://t.me/restoringpeace.
References
Zhao, Y., Li, J., Sun, Y., Zhao, L., Sun, H., Wang, F., & Zhang, S. (2024). The impact of reproductive
health events on women's mental health: A systematic review and meta-analysis. International
Journal of Environmental Research and Public Health, 21(2), 123-145.
Rosenthal, M. (2023, May 5). Recognizing the psychological toll of infertility. Anxiety and Depression
Association of America (ADAA). https://adaa.org/learn-from-us/from-the-experts/blog-
posts/professional/recognizing-psychological-toll-infertility
Panagiotopoulou, A., & Gari, A. (2022). Exploring psychological distress in infertile women
undergoing assisted reproduction treatment. Frontiers in Psychology, 13, 1093459.
Garofola, L. (2025, February 4). Who am I now? Coping with postpartum identity loss. Psychology
coping-with-postpartum-identity-loss
DePaulo, B. (2021, June 21). The psychology of feeling sad about not having children. Psychology
about-not-having-children
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