Perimenopause and Sex: What’s Actually Happening and What Helps
Perimenopause doesn’t just lower libido — it exposes the whole architecture of desire, intimacy, and who you’ve quietly become inside your relationship. This post explores what’s actually happening neurobiologically and relationally when sex changes during perimenopause, and what genuinely helps — beyond the prescriptions and the platitudes — for driven women ready to look at it honestly.
- The Dinner Table, and the Chasm No One Names
- What Is Responsive Desire? What Is the Dual Control Model?
- The Neurobiology of Desire in Perimenopause
- How It Shows Up in Driven Women
- The Erotic-Domestic Split: Why Long Marriages Attenuate Desire
- Both/And: Your Body Is Changing and Your Psychology Is Telling the Truth
- The Systemic Lens: The Cultural Script That Women’s Desire Must Serve the Relationship
- The Work of Rediscovering Desire
- Frequently Asked Questions
The Dinner Table, and the Chasm No One Names
It’s 7:15 p.m. Elena sits across from her husband at their regular corner booth, the restaurant noise a soft hum around them. Candlelight flickers on the silverware. His mouth is moving — he’s talking about his day, a project, something at the office — but she hears the words from a slight remove, as if through glass.
What she’s actually attending to is the widening space between them. Not the physical space across the table. The other kind. The kind that’s been growing for nearly a year, quietly and without announcement, since she stopped wanting him. Nine months, she’s counted. Nine months since desire stirred, since the familiar heat of anticipation colored her thoughts or woke her in the night with something other than a hot flash.
Now there is only a quiet exhaustion. A numbness that makes her wonder if desire is simply gone — not temporarily absent but structurally dismantled, as if perimenopause took something from her that she hasn’t found a name for yet. It’s not just sex. It’s the intimacy, the wordless knowing that used to live between them. The marriage, once a sanctuary, now feels like a ledger of unmet needs and unspoken truths, and Elena doesn’t know how to begin.
This is the real moment of reckoning. Perimenopause hasn’t just lowered her libido. It’s exposed the architecture of desire itself — and with it, a marriage that was built on accommodation, performance, and assumptions that were never examined because there was never a reason to.
In my work with driven, ambitious women, this reckoning is far more common than anyone acknowledges. The loss of desire during perimenopause is one of the most quietly devastating experiences women describe in my office — because it touches identity, partnership, and the fundamental question of what they actually want. This post is for women who are ready to look at that question honestly.
What Is Responsive Desire? What Is the Dual Control Model?
Before we can understand what perimenopause does to desire, we need to understand what desire actually is — because the model most women have been given is too narrow and too male-centric to explain what they’re experiencing.
Responsive desire is a concept articulated by Rosemary Basson, MD, clinical professor of obstetrics and gynecology at the University of British Columbia and a pioneer in women’s sexual health research. Contrary to the traditional model that views desire as spontaneous and internally generated — an urge that arises without external prompts — Basson’s responsive desire model recognizes that many women experience desire as a response to sexual stimuli, emotional closeness, or relational context rather than as an initial, internally driven urge. For many women, particularly during and after perimenopause, responsive desire is the dominant pattern, not a dysfunction.
In plain terms: You might not wake up craving sex. But when you feel close, safe, touched in the right way, or emotionally seen, desire can grow and follow. This isn’t a deficiency — it’s simply how many women’s desire actually works, especially in midlife.
The dual control model, developed by Emily Nagoski, PhD, sex educator and researcher, and author of Come As You Are, conceptualizes sexual response as a balance between two neurobiological systems: the sexual excitation system (the accelerator) and the sexual inhibition system (the brakes). Both systems are modulated by individual differences, history, and contextual factors. Excitation involves the brain and body’s responsiveness to sexual cues; inhibition suppresses or limits arousal in response to stress, mood, physical discomfort, relational tension, or perceived threat.
In plain terms: Your brain has an accelerator and a brake when it comes to sex. Perimenopause often turns down the accelerator and turns up the brake simultaneously — through hormonal changes, sleep deprivation, stress, and relationship tension. The capacity for pleasure can remain even when desire feels inaccessible.
These models shift the conversation about libido loss from “What’s wrong with me?” to a more accurate and compassionate question: “What conditions does my desire actually need in order to emerge?” For driven women who’ve spent years performing desire rather than inhabiting it, that question can feel radical — and deeply necessary.
Many women discover in therapy that they’ve spent years operating on accommodating desire rather than authentic desire: showing up, performing enthusiasm, keeping the peace. Perimenopause removes the hormonal scaffolding that made that accommodation feel manageable, and what’s left underneath is often the truth about what was there all along. That’s not a tragedy — though it often feels like one at first. It’s an invitation.
The Neurobiology of Desire in Perimenopause
From a neurobiological standpoint, perimenopause challenges the systems that regulate desire and arousal in specific, measurable ways. Estrogen and testosterone — the primary sex hormones — play distinct but overlapping roles in modulating sexual response.
Estrogen, which declines unevenly through the perimenopausal years, supports genital blood flow, vaginal lubrication, and sensitivity. It also influences brain regions involved in mood and reward processing, including the hypothalamus and limbic system. When estrogen fluctuates unpredictably, the neurological foundation of desire becomes less reliable — not because the woman is broken, but because the biological substrate supporting it is unstable.
Genitopelvic pain or penetration disorder, along with vaginal atrophy (also called genitourinary syndrome of menopause, or GSM), refers to the thinning, drying, and inflammation of vaginal tissues that occurs as estrogen declines in perimenopause and menopause. These changes can cause pain during intercourse, reduced lubrication, and decreased physical sensitivity. Rosemary Basson, MD, clinical professor and leading researcher in women’s sexual health at the University of British Columbia, has extensively documented how these physical changes interact with psychological factors to reduce both desire and sexual satisfaction in perimenopausal women.
In plain terms: As estrogen drops, vaginal tissues can become drier and more sensitive in ways that make sex uncomfortable or painful. This isn’t a character flaw or a sign of aging poorly — it’s a biological reality that’s both common and highly treatable with the right medical care.
Emily Nagoski, PhD, highlights that the brain’s sexual inhibitory system often becomes more sensitive during stressful life phases — and perimenopause is no exception. The combined effects of fluctuating hormones, sleep disruption, midlife stress, and the relentless demands placed on driven women can amplify the “brakes” on sexual desire, making the experience of libido loss multifactorial. It’s not merely a hormonal deficiency. It’s a complex interaction of biology, psychology, relationship quality, and nervous system state.
What I see consistently in clinical work is that the neurobiological shifts expose what was previously hidden beneath the surface. The hormonal scaffolding that made accommodating desire feel manageable is gone. And what’s left requires a different kind of attention — one that goes beyond prescription pads and into the actual texture of a woman’s interior life and relational reality.
If you’re navigating the intersection of perimenopause and trauma reactivation, this layer is often particularly pronounced: old relational wounds around safety, autonomy, and embodiment can surface with new intensity when the hormonal cushion is removed.
How It Shows Up in Driven Women
Maya is a 47-year-old nonprofit CEO. She’s built her organization from the ground up in a male-dominated sector, managing boards, budgets, and the particular exhaustion of caring deeply about everything while appearing to be unflappable. Her days are packed with high-stakes decisions. Her marriage — once a sanctuary from all of that — now feels like one more thing that requires her to perform.
One evening, after a particularly tense board meeting, Maya’s husband reaches for her hand on the couch. Tentative. The unspoken expectation hovers between them like weather.
“I don’t want to,” she says quietly. “I haven’t wanted you in nine months. I don’t know if I ever will again.”
His face tightens with a complicated combination of hurt and confusion. Maya feels the weight of their shared history: the years of sex out of obligation, the times she performed enthusiasm to keep the peace, the resentments that grew slowly in the space between who she actually was and who she was showing up as. It dawns on her, sitting there on that couch, that for two decades she’d equated sex with love rather than with desire. She’d shown up and accommodated, believing her compliance was genuine want.
Stripped now of hormonal support and flooded with midlife exhaustion, the truth is unavoidable: her desire had been responsive at best, accommodating by default. And now even the accommodation has run dry.
This realization is both liberating and devastating. It demands a reckoning — not only with her body but with the marriage itself. And it’s a reckoning that no hormone patch or lubricant will resolve on its own.
What I see consistently in driven women navigating this terrain: perimenopause doesn’t create these patterns. It reveals them. The years of professional overextension, the relational accommodations, the deferred desires — perimenopause simply removes the hormonal buffer that made all of that feel manageable. What’s left is the actual truth about what was always there.
Research by Rosemary Basson, MD, and Emily Nagoski, PhD, underscores that sexual desire problems in midlife are rarely purely biological. They intersect with mood, relationship quality, stress, and the accumulated history of how a woman has — or hasn’t — inhabited her own desire. For driven women who’ve spent decades prioritizing performance over presence, that intersection is particularly charged.
The Erotic-Domestic Split: Why Long Marriages Attenuate Desire
Leila sits across from her husband in their favorite Italian restaurant, candlelight flickering between them. His mouth moves — an account of the day’s meetings — but her mind drifts toward the ache in her chest that’s been there for months. She knows she hasn’t wanted him. Not really. Not the way she used to. It’s not just hormones. It’s something deeper, something that no prescription can fix.
What Leila’s experiencing is the collision of two worlds: the erotic and the domestic. Esther Perel, psychotherapist and author of Mating in Captivity, articulated this concept with precision: the erotic realm thrives on mystery, distance, novelty, and the unknown. The domestic realm demands familiarity, safety, and predictability — qualities essential for partnership and family life, but that paradoxically dampen erotic energy over time.
Perel argues that desire requires a paradoxical space: the closeness of intimacy paired with a degree of separateness, of otherness, of not-yet-fully-known. Over years of partnership, the domestic calcifies into routine, and erotic tension quietly drains away. This isn’t a moral failure or a sign of incompatibility. It’s the predictable result of two people becoming too familiar with each other — too merged to feel the aliveness that desire requires.
“Eroticism in the home requires active engagement and willful intent. It is an ongoing resistance to the message that marriage is serious, more serious than pleasure.”
Esther Perel, psychotherapist and author of Mating in Captivity
In my work with driven women like Leila, this split often becomes visible precisely when perimenopause removes the hormonal scaffolding that made accommodating desire feel manageable. The combination of declining estrogen and the erosion of erotic charge in a long marriage creates a double exposure — two separate forces making desire feel increasingly remote.
What’s crucial to understand is that the erosion of erotic charge in marriage isn’t evidence that love is gone, or that the relationship has failed, or that the woman is broken. It’s a signal that the old patterns no longer hold — and that something new needs to be constructed. Perel’s work invites couples to hold the tension between comfort and aliveness, not as a problem to solve but as a creative edge to inhabit. That’s a different kind of work than most driven women have been taught to do.
The question shifts from “How do we get back to what we had?” to “What might we create now, with who we’ve actually become?” That’s a much more honest — and ultimately more generative — question.
Both/And: Your Body Is Changing and Your Psychology Is Telling the Truth
Elena — the same Elena from the dinner table at the beginning of this post — lies awake at 2 a.m., unable to sleep. She’s consumed by a tangle of feelings: frustration at her dwindling libido, confusion about what she actually wants now, and an aching loneliness she doesn’t know how to name inside a marriage that looks fine from the outside.
For two decades, Elena’s sex life was reliable, if sometimes perfunctory. She showed up. She was a good partner. She never complained. Now, stripped of hormonal certainty and facing the truth of her interior life, she’s forced to confront something she’d managed to defer: what she wants, what she’s been giving, and whether those two things are the same.
This is the Both/And truth of perimenopause and sex: your body is changing — and your psychology is telling the truth about what was always there.
Emily Nagoski, PhD, offers the dual control model as a framework for holding this complexity. Sexual desire is governed by two systems: the sexual excitation system (the accelerator) and the sexual inhibition system (the brakes). In perimenopause, the biological shifts can reduce excitation by declining estrogen and testosterone — but the brakes may also tighten through fear, stress, relational discord, accumulated resentments, and the fatigue of a driven woman who’s been giving more than she’s been receiving for years. Longstanding relationship dynamics, cultural scripts about women’s sexuality, and internalized beliefs about desirability amplify these effects.
What’s more, research by Lisa Mosconi, PhD, neuroscientist at Weill Cornell Medicine and director of the Women’s Brain Initiative, has shown that brain estrogen receptor density declines in perimenopause — affecting areas critical to motivation and reward, which directly impacts the neurological architecture of desire. This neurobiological change is real and profound. And the psychological truth Elena is confronting is equally real.
For years, she’s engaged in sex out of love, obligation, or performance. The hormonal shift removes the buffer that made that accommodation feel sustainable. What’s exposed is the gap between accommodating desire and authentic desire — and that gap, when finally seen, demands a reckoning. Not with shame, but with honesty.
Holding the paradox — both body and mind are shifting, and both deserve attention — allows for compassionate inquiry rather than self-judgment. It reframes desire loss not as failure but as revelation. That’s the Both/And this transition is offering, if you can bear to receive it.
The Systemic Lens: The Cultural Script That Women’s Desire Must Serve the Relationship
We can’t understand perimenopause and desire without examining the cultural context in which women’s sexuality exists. The myth that women’s desire is primarily relational — that it exists to serve partnership, family, or a male partner’s needs — is deeply ingrained in most women’s psyches, often invisibly.
This script places women in a double bind: their desire is expected to be spontaneous, responsive, and always available, yet also accommodating and self-sacrificing. When desire wanes, the common narrative pathologizes the woman as “broken,” “unloving,” or “not trying hard enough” — as if desire were a performance she should be able to maintain regardless of what’s happening in her body, her nervous system, or her relationship.
Rosemary Basson, MD, clinical professor of obstetrics and gynecology at the University of British Columbia and a leading researcher in women’s sexual health, critiques this narrow framing directly. Her responsive desire model highlights that women’s desire often arises in response to intimacy, context, and emotional connection — not as an innate, context-free urge. The insistence that desire must be spontaneous to count as real has caused enormous unnecessary shame for women whose desire doesn’t work that way.
This cultural conditioning is compounded by healthcare systems that treat perimenopause primarily as a hormonal problem to be fixed, rather than a complex biopsychosocial transition deserving integrated attention. Women are offered HRT and lubricant, but rarely the space to explore what their desire actually is, what it’s been based on, and what it might become when freed from the scripts they’ve been handed.
Female sexual interest/arousal disorder refers to a persistent or recurrent absence or reduction in sexual interest, arousal, or pleasure that causes significant personal distress. Rosemary Basson, MD, clinical professor and researcher at the University of British Columbia, has contributed substantially to refining this diagnosis to account for the complexity of women’s desire — emphasizing that context, relationship quality, and psychological safety are essential components of female sexual response, not peripheral factors. The diagnosis is not appropriate when the absence of desire is attributable to relationship discord or life stressors without personal distress.
In plain terms: FSIAD is the clinical term for persistent desire loss that causes genuine distress — and it’s important to note that “not wanting sex in the context of a difficult relationship” doesn’t qualify. Context matters enormously in women’s sexual health, and the medical system is slowly catching up to that reality.
The systemic script also ignores the accumulated exhaustion carried by driven women — the relentless demands of careers, caregiving, social expectations, and the particular burden of feeling responsible for everyone else’s emotional worlds. Rebecca Thurston, PhD, professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh and director of the Women’s Biobehavioral Health Research Center, has found that trauma history significantly increases risk for sexual dysfunction during the menopause transition — highlighting that a woman’s sexual present is always in conversation with her relational past.
What this means practically is that many driven women enter perimenopause carrying unacknowledged grief, shame, and disconnection — both from their own bodies and from authentic desire. The cultural silence around these realities renders perimenopause and sex a lonely, bewildering terrain. You’re not broken for finding yourself here. The system failed to prepare you.
The Work of Rediscovering Desire
Healing desire in perimenopause is neither quick nor simple. It requires a multi-dimensional approach that addresses biology, psychology, and relationship — and probably in that order, though all three need eventual attention.
First, the physical reality must be addressed with medical support. Vaginal estrogen therapy, prescribed by a menopause-certified physician (MSCP or NCMP), can alleviate vaginal dryness and pain, restore lubrication, and improve the physiological capacity for pleasure — without the systemic effects of full HRT. Testosterone therapy may be appropriate for some women, but it requires thorough clinical evaluation and doesn’t address the psychological and relational dimensions that are often equally important.
Second, individual therapy is critical for exploring the psychological landscape of desire loss. Trauma-informed approaches can help women access and integrate the internal parts that hold fear, shame, or grief around sexuality. This is where the work of disentangling accommodating desire from authentic desire happens — where women begin to ask what they actually want, what they’ve been giving, and what they’re allowed to ask for. If you’re considering one-on-one therapeutic support, you’re welcome to learn more about working with Annie directly.
Third, couples therapy grounded in emotionally focused approaches offers a pathway to repair the attachment wounds that often underlie desire loss in long-term relationships. The goal isn’t to restore the desire of early partnership — it’s to create sufficient emotional safety that responsive desire has something to respond to. Without that safety, no amount of hormonal treatment or novelty will sustainably restore erotic charge.
Finally, the longer, quieter work of discovering what your desire actually is — now, in this body, in this season of life — unfolds over time. It requires curiosity, patience, and a willingness to release the should’s that have governed your sexuality. Desire may look different than it did in your 30s. It may be quieter, slower, more specific. It may require saying no to performance and yes to honesty. That’s not loss. That’s the beginning of something more real.
For driven women who want to begin exploring this territory on their own terms, Fixing the Foundations offers a self-paced entry point into the relational patterns that shape every dimension of intimacy. And if perimenopause has surfaced questions about who you’re becoming — not just in your relationship but in your own identity — the perimenopause identity crisis addresses that directly.
What I witness consistently in this work: when driven women give themselves permission to stop performing desire and start exploring it — when they bring the same intelligence and courage to their inner life that they bring to everything else — something shifts. Not immediately, not without grief. But the destination is a desire that’s actually theirs. And that matters far more than getting back to something that never quite belonged to them in the first place.
You don’t have to figure this out alone. You don’t have to have the language for it yet. You just have to be willing to look honestly at what’s actually here — and that’s already more courage than most people manage. If you’re ready to take a next step, I’d encourage you to explore what one-on-one support could look like through a free consultation.
PERIMENOPAUSE LIBRARY
This is one piece of a larger conversation. Browse Annie’s complete perimenopause library — 42 articles organized by symptom, identity, relationships, profession, and treatment.
Q: Will testosterone fix my low libido during perimenopause?
A: Testosterone therapy can modestly improve sexual desire in some women, particularly those with very low androgen levels or surgical menopause — but it’s not a universal solution and doesn’t address the psychological and relational dimensions of desire loss that are often equally important. What I see consistently in practice is that libido loss during perimenopause is not merely a hormonal deficit. It’s also a profound psychological and relational shift — the collapse of accommodating desire leaving an emptiness that a hormone patch can’t fill. Testosterone might help with physical arousal or energy. It won’t answer the question of what your authentic desire actually is or what conditions it needs.
Q: Is my marriage over if my desire has disappeared?
A: No — though the fear that it might be is one of the most common things women bring to my office during this period. Desire’s absence is often a signal, not a death sentence. Esther Perel, psychotherapist and author of Mating in Captivity, describes how erotic desire and domestic intimacy frequently fall out of sync over time — not because love has disappeared, but because the conditions desire requires (novelty, mystery, a sense of separateness) have been eroded by the demands of long partnership. Couples who do the work — through emotionally focused therapy, honest communication, or individual therapeutic work — often discover new ways of relating that honor the shifts in desire without condemning the relationship. What’s needed isn’t restoration of what was. It’s the construction of something more honest.
Q: Can desire come back after it’s been absent for months?
A: Yes — though it rarely looks exactly like it did before. According to Rosemary Basson, MD, clinical professor and researcher in women’s sexual health at the University of British Columbia, desire in women often operates via a responsive model rather than a spontaneous one. This means desire often follows emotional intimacy, safety, and contextual cues rather than arising from nowhere. The perimenopausal brain and body are recalibrating. The kind of desire that emerges may be quieter, more specific, and more honest than what came before. In therapy, we work on helping women listen to their body’s new language — to recognize what genuinely sparks curiosity and longing rather than what their desire used to look like. The return of desire is a process of rediscovery, not a switch to flip back on.
Q: What if I find myself attracted to someone outside my marriage?
A: Attraction outside your primary relationship is common, particularly during perimenopause when your interior experience of desire is shifting. This can feel confusing, disloyal, or frightening. From a clinical perspective, it’s often a signal that something vital is missing in your current emotional or erotic life — not necessarily a signal that the relationship needs to end. It’s important to hold this experience without acting from reactivity and to explore what it reveals about your needs, longings, and the state of your primary relationship. These conversations, when held with a skilled therapist, can become a portal to deeper understanding and renewed connection. Attraction is information. What you do with it requires discernment.
Q: What’s the difference between responsive and spontaneous desire?
A: Spontaneous desire is the internal urge for sex that arises without external prompts — the model most people are familiar with and that’s often treated as the “normal” baseline. Responsive desire, articulated by Rosemary Basson, MD, and expanded by Emily Nagoski, PhD, is desire that emerges in response to sexual stimuli, emotional connection, or relational safety — rather than firing spontaneously from within. Many women, especially in perimenopause, experience responsive desire as their primary pattern. Recognizing this shifts the question from “Why don’t I want sex out of nowhere?” to “What conditions help my desire emerge?” That’s a far more generative — and accurate — question.
Q: What should I tell my partner about my changed desire?
A: Honesty paired with clear separation of desire from love is essential. Your partner needs to understand that desire’s shift isn’t about rejection — it’s about a complex internal change that has biological, psychological, and relational dimensions. A useful starting frame: “I want to be close to you, and my body isn’t responding the way it used to. This is confusing and hard for me too.” Invite curiosity about what intimacy might look like now, beyond the script you’ve both been operating from. Couples who approach this conversation with compassion and willingness to explore — rather than defend or accuse — often find their way to something more real than what they had before. If you need a structured container for that conversation, couples therapy can be invaluable.
Q: Is desire loss during perimenopause “all in my head”?
A: Not at all — though the dismissal that it might be is unfortunately common. Perimenopause triggers measurable neurobiological shifts: altered estrogen and testosterone levels, changes in brain receptor density, disrupted neurotransmitter function in areas governing motivation and reward. These are real biological processes. And the psychological and relational layers — years of accommodating desire, accumulated resentments, the particular exhaustion of driven women — are equally real and equally deserving of attention. It’s not “all in your head.” It’s deeply embodied, deeply relational, and entirely worthy of comprehensive support.
Q: Can mindfulness help with perimenopause low libido?
A: Yes — mindfulness-based approaches have genuine efficacy for sexual desire and satisfaction in midlife women. Research demonstrates that mindfulness practices help women tune into their body’s actual sensations, reduce performance anxiety around sex, and bridge the gap between physical arousal and subjective experience of desire. This isn’t a quick fix, but a way to cultivate presence with a body that’s changing — and to begin listening for what your desire actually responds to now, rather than what it used to. Mindfulness integrates well with other therapeutic and medical approaches as part of a comprehensive path forward.
Related Reading
Nagoski, Emily, PhD. Come As You Are: The Surprising New Science That Will Transform Your Sex Life. New York: Simon & Schuster, 2015.
Perel, Esther. Mating in Captivity: Unlocking Erotic Intelligence. New York: HarperCollins, 2006.
Basson, Rosemary, MD. “Women’s Sexual Desire: How Can We Help Women With Low Desire?” Journal of Sexual Medicine 17, no. 4 (2020): 701–708. https://doi.org/10.1016/j.jsxm.2020.01.005.
Brotto, Lori A., PhD, and Rosemary Basson, MD. “Mindfulness-Based Approaches to Women’s Sexual Health.” Journal of Sex Research 58, no. 8 (2021): 1012–1024. https://doi.org/10.1080/00224499.2021.1929057.
Mosconi, Lisa, PhD, et al. “Menopause Impacts Human Brain Structure, Connectivity, Energy Metabolism, and Amyloid-Beta Deposition.” Science Advances 7, no. 22 (2021): eabe6559. https://doi.org/10.1126/sciadv.abe6559. PMID: 34108259.
Thurston, Rebecca C., PhD. “Childhood Abuse and Vasomotor Symptoms Among Midlife Women.” Menopause 26, no. 10 (2019): 1093–1099. https://doi.org/10.1097/GME.0000000000001368. PMID: 31166306.
Johnson, Sue, EdD. Hold Me Tight: Seven Conversations for a Lifetime of Love. New York: Little, Brown and Company, 2008.
Maki, Pauline M., PhD, and N. G. Jaff. “Menopause and Brain Fog: How to Counsel and Treat Midlife Women.” Menopause 31, no. 7 (2024): 647–649. https://doi.org/10.1097/GME.0000000000002382.
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Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
