The Truth About Anxiety in Perimenopause

If your moods are unpredictable, your thoughts feel scattered, and anxiety seems to have crept in out of nowhere, it might not just be everyday stress; it could be the start of something hormonal. Perimenopause and anxiety often appear together, and while no one sends a warning letter, your body is definitely trying to get your attention.

While hot flashes and irregular periods are often the most talked-about changes, perimenopause symptoms can go far beyond the physical. Emotional and mental changes, like mood swings, low confidence, and sudden anxiety, are just as real and just as valid. Understanding what’s going on in your body is the first step to feeling better. This blog will help you spot the signs, identify common triggers, and find calm, effective ways to cope with anxiety.

Why is anxiety during perimenopause so common?

Perimenopause, the stage leading up to menopause, often begins in a woman’s 40s, though it can start earlier for some. During this time, levels of oestrogen and progesterone begin to fluctuate significantly. These hormones not only regulate reproductive functions; they also influence brain chemicals like serotonin and cortisol, which play a key role in mood regulation.

When these hormones become imbalanced, it can affect the nervous system, potentially leading to symptoms of anxiety, including panic attacks, restlessness, irritability, and a sense of unease. Add to this the physical perimenopause symptoms, such as night sweats, hot flashes and disrupted sleep, and it’s quite evident to see why mental health may suffer.

Signs of perimenopause and anxiety symptoms to watch for

Not all anxiety is hormonal, but perimenopause can certainly exacerbate it. Recognising the signs is an important first step in managing both the mental and physical challenges that arise.

Common perimenopause symptoms of anxiety include:

• Racing thoughts or constant worry

• Difficulty concentrating (often referred to as 'brain fog')

• Irritability or mood swings

• Muscle tension or unexplained aches

• Sleep disturbances or insomnia

• Heart palpitations or chest tightness

• Panic attacks

Anxiety during perimenopause can appear suddenly, even in women with no history of the condition. The unpredictability of perimenopause can make these episodes feel even more unsettling.

How to tell if it’s perimenopause or generalised anxiety?

Telling the difference between perimenopause and anxiety linked to other causes, such as generalised anxiety disorder (GAD), can be challenging. During perimenopause, anxiety often comes in waves and may coincide with other hormonal symptoms like irregular periods, hot flashes night sweats, or changes in libido. These symptoms tend to fluctuate and may worsen at certain points in the menstrual cycle. 

In contrast, anxiety related to GAD is usually more persistent and less tied to hormonal shifts, often lasting for six months or more and significantly affecting daily life. If anxiety appears alongside other signs of perimenopause, it may be related to perimenopause rather than a separate anxiety disorder. 

Common perimenopause triggers that worsen anxiety

Perimenopause and anxiety often go hand in hand, with hormonal shifts making it harder for some women to manage stress and emotions. Certain triggers can make anxiety symptoms worse during this time.

Here are some common causes of anxiety during perimenopause:

• Hormonal fluctuations: Shifting levels of oestrogen and progesterone can directly affect mood and emotional regulation.

• Poor sleep: Night sweats, insomnia, or disrupted sleep patterns can leave you feeling more anxious and less able to cope.

• Caffeine and alcohol: These can worsen anxiety symptoms and interfere with sleep, making mood swings more severe.

• Life stressors: Pressure of daily life, such as work demands, caring for family, or relationship changes, can compound anxiety.

• Blood sugar imbalances: Skipping meals or eating highly processed foods can lead to energy crashes and irritability, causing anxiety during perimenopause. 

• Lack of exercise: Low physical activity levels can affect both physical and mental well-being, increasing anxiety levels and further complicating the relationship between perimenopause and anxiety. 

Natural ways to manage perimenopause anxiety

Navigating emotional changes during this transitioning phase of life can be overwhelming, but the right perimenopause anxiety treatment approach can offer relief. A mix of lifestyle changes and gentle support methods can help ease anxiety and bring a sense of calm back into daily life.

Here are some natural ways to cope with perimenopause anxiety:

• Exercise regularly

Moderate physical activity like walking, swimming, or yoga can reduce stress hormones and lift your mood. It also helps improve sleep, which is key to managing anxiety during menopause.

• Eat a balanced diet

A diet rich in whole grains, leafy greens, healthy fats, and lean proteins supports hormone balance and stabilises blood sugar, which can help improve mood.

• Cut back on caffeine and alcohol

Both can disrupt sleep and overstimulate the nervous system, making anxiety symptoms worse. Try herbal teas or non-alcoholic alternatives instead.

• Practice mindfulness or meditation

Simple daily practices like mindful breathing or guided meditations can bring awareness to the present moment and reduce spiralling thoughts. Just a few minutes a day can have a calming effect over time and help in coping with anxiety.

• Focus on quality sleep

Going to bed at the same time each night, dimming lights and avoiding screens before sleep can make it easier to fall asleep and stay asleep. Add calming rituals like herbal tea or a warm bath to signal to your body it's time to rest.

• Connect with others

Talking openly with trusted friends, partners, or support groups can lift emotional weight. Knowing others are going through similar experiences can be incredibly reassuring and help ease the isolation that sometimes comes with anxiety.

When to get help: Knowing if it’s more than just hormonal

If anxiety symptoms persist or worsen, it’s essential to seek professional help. While anxiety during perimenopause is common, it shouldn’t be dismissed or endured in silence. If your anxiety is affecting your work, relationships, or daily functioning or if you’re experiencing depression, thoughts of self-harm, or panic attacks, you must seek professional guidance.

It’s also worth speaking to your healthcare provider if you’re unsure whether your symptoms are related to perimenopause or another condition. A few medical tests, as recommended by the specialist, can help clarify the cause and guide appropriate treatment.

Finding your calm in the chaos

The mix of perimenopause and anxiety can feel like riding an emotional rollercoaster blindfolded. One moment you're fine, the next you're wide awake at 3 AM, worrying about things that never used to faze you. But it’s not all doom and gloom. Once you recognise the signs and understand your triggers, you can take practical steps to manage the chaos and anxiety during perimenopause​. Whether it’s through gentle lifestyle shifts, natural remedies, or seeking support, there are plenty of ways to steady the ship. You’re not broken; your body is simply adjusting, and with the right tools, you can feel like yourself again.

Frequently Asked Questions

1. What is perimenopause, and how does it relate to anxiety?

Perimenopause is the transition before menopause, where fluctuating hormones can cause mood changes, including anxiety.

2. Why does perimenopause trigger anxiety?

Hormonal shifts, especially changes in oestrogen and progesterone, affect brain chemicals that regulate mood and anxiety.

3. How can I tell if my anxiety is due to perimenopause or another cause?

If anxiety coincides with other perimenopause symptoms like irregular periods or hot flashes, hormones may be involved.