Does Perimenopause Cause Anxiety?
What are Symptoms and Triggers of Perimenopause Anxiety?
Yes—perimenopause can cause anxiety even if you’ve never experienced it before. Welcome back to my blog series on all things perimenopause! This is the third post of the series where we’ll explore all things anxiety, panic, and perimenopause. In case you missed the first fews posts:
Mental Health Changes During Perimenopause
Does Perimenopause cause mood changes or depression?
And next up in the series:
WOMEN, PERIMENOPAUSE AND ADHD: WHY SYMPTOMS OFTEN GET WORSE?
How psychotherapy can help your mental health during perimenopause
But first, Hi, I’m Nikki! A therapist and licensed clinical social worker (LCSW) with nearly 20 years of experience. In my online therapy practice, I support women struggling with perimenopause and everything that comes with it: anxiety and stress, ADHD and inattention, depression, grief and those unexpected life events that throw you off course.
Ok, let’s get back to the question at hand. Yes—perimenopause can cause anxiety even if you’ve never experienced it before But realistically, you have experienced anxiety, we all have at some point. Anxiety is defined as feelings of worry, nervousness, unease, apprehension, edginess, or irritability. Sound familiar to anyone?
But maybe you’ve never experienced anxiety to the degree that it starts to interfere with your functioning- the tipping point where anxiety becomes pathological or diagnosable by a mental health professional.
Hormonal fluctuations during the perimenopause transition (which can begin as early as 35 and last 7-10 years before the onset of menopause) affect brain chemistry and the body’s stress response, making anxiety symptoms common even in women with no prior history of an anxiety disorder (e.g. generalized anxiety disorder, social anxiety disorder, or panic disorder). And it probably goes without saying that perimenopause can worsen those pre-existing anxiety conditions.
This informed guide explains why it happens, what symptoms look like, what helps, and when to seek professional care. But first:
Why does Perimenopause Cause Anxiety?
Perimenopause can cause or worsen anxiety due to fluctuating hormone levels: primarily estrogen and progesterone, but also testosterone, DHEA, and FSH. These hormones interact with neurotransmitters like serotonin, dopamine, and GABA that regulate mood and calmness. As levels rise and fall unpredictably during perimenopause, the brain’s ability to manage stress can be disrupted—leading to new or intensified anxiety symptoms.
How Fluctuating Hormones Affect the Stress Response
Hormones play a direct role in how the brain processes stress. In simple terms, estrogen can enhance synthesis of serotonin (a natural mood booster) and dopamine (our pleasure neurotransmitter, among other functions). When we’re happy and can easily derive pleasure from our activities, we’re generally less stressed. But when estrogen is low, we may notice fluctuations in our mood and ability to feel pleasure, which makes us more sensitive to stressors.
Progesterone can enhance GABA transmission and induce feelings of calm, also sleepiness. When progesterone levels are higher, we tend to feel calmer. And we tend to sleep better. And when we sleep better, we’re less anxious or irritable. Add together low progesterone levels and poor sleep, and you’re more likely to feel anxious the next day.
During perimenopause, inconsistent and fluctuating hormone levels coupled with the stress of every day life (any combination of attending to your self-care while maintaining a household, romantic relationship, raising children, working full time, climbing the corporate ladder, oh and trying to have a social life) can overstimulate the nervous system, making the body feel “on edge” even without an obvious trigger. This is a biological stress response—not a personal failure. What you need is a little self-compassion and coping strategies, not self-judgment or criticism.
Common Anxiety Symptoms During Perimenopause
Anxiety during perimenopause can be experienced as cognitive (thoughts), emotional (feelings), behavioral (how we act, react), or physical (how we feel in our body), or any combination. Anxiety is not just in your head. It’s in your body, too.
Cognitive symptoms of perimenopause anxiety can include:
Racing thoughts
Difficulty concentrating
Mind going blank
“Brain fog” associated with perimenopause
Emotional symptoms of perimenopause anxiety can include:
Feeling nervous, anxious, or worried
Experiencing worry that can be difficult to control
Increased irritability
Behavioral symptoms of perimenopause anxiety can include:
Sleep disturbances or insomnia… 3am wake-ups anyone?
Unable to sit still or difficulty relaxing
Snapping or overreacting, having a shorter fuse
Physical symptoms of perimenopause anxiety can include:
Feeling tense, restless, or on edge
Muscle tension, especially in the head, neck, and shoulders
Changes in heart rate, heart palpitations
Shortness of breath, sighing
Digestive changes (nausea, appetite changes, constipation)
This is not an exhaustive list, but some of the most common symptoms. Symptoms may fluctuate throughout the menstrual cycle or appear unexpectedly.
Panic Attacks vs. Hormonal Anxiety in Perimenopause
Did you know? Seven of the 34 known symptoms- that’s 20% of the known and documented symptoms- of perimenopause (anxiety, difficulty concentrating, dizzy spells, fatigue, irritability, memory lapses, and panic attacks) can be attributed to anxiety!
Hormonal anxiety:
Builds gradually or fluctuates (while a panic attack comes on abruptly)
Linked to menstrual cycle changes, which come with changes in hormone levels
Can be caused by sleep disruption, especially when progesterone is lower in the first half of your cycle
May improve as hormones stabilize throughout the cycle
Can perimenopause cause panic attacks?
Panic attacks are one of the 34 documented symptoms of perimenopause. Experiencing a panic attack does not mean you have a mental health disorder, or more specifically, Panic Disorder. Panic attacks, also called “anxiety attacks,” can happen out of the blue or be brought on by a stressor or trigger.
A panic attack is an abrupt surge of at least four of the following symptoms all at once causing of intense fear or discomfort, in the mind and body. While a panic attack can feel like it lasts for hours, realistically symptoms peak within minutes then dissipate. If you have experienced any combination of at least 4 of the symptoms below simultaneously, you were probably experiencing a panic attack, you were not “going crazy,” and it was not “all in your head.”
Palpitations, pounding, heart, or accelerated heart rate
Chest pain or discomfort
Sweating, chills or heat sensations
Trembling or shaking in the hands or the whole body
Sensations of shortness of breath or smothering
Feelings of choking
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint- dizzy spells are also a documented symptom of perimenopause sepearate from panic attacks
Numbness or tingling sensations, especially in fingers or toes (paresthesias)
Derealization: feelings of unreality, or depersonalization: being detached from oneself
Fear of losing control or going crazy
By the way, how can a panic attack be “all in your head” when the majority of symptoms above are experienced in the body, not the mind?
What Helps Reduce Anxiety Symptoms and Panic Attacks During Perimenopause
Managing anxiety during perimenopause often requires a multi-pronged approach. What changes can you make in your routine and lifestyle to reduce stress, and in turn anxiety? What can you do to prioritize sleep?
Lifestyle and Nervous-System Support:
Practice meditation, mindfulness activities, and breathing exercises
When I suggest meditation, I’m not suggesting you spend an hour meditating each day. Even 5-10 minutes can help! Meditation can look like doing a few yoga poses, a full body stretch routine, paired muscle relaxation, or a guided meditation on one of the many apps out there (aura, calm, insight timer).
Paired muscle relaxation can help you relieve stress by pairing breathing with muscle tension, then release. Start by clenching the muscles in your hands and arms while breathing in, hold for 5 seconds, then release the muscles and exhale. Repeat with clenching the rest of your big muscle groups one by one, breathing in as you clench, then breathing out as you release. Your core, then your glutes, then your thighs, then your calves.
Mindfulness is being present in any given moment. Whether that is exercise, time in nature, yoga, meditation, cooking, or creative outlets. Whatever promotes mindfulness for you, incorporate that into your routine.
One of my favorite breathing rituals when I’m stressed is paced breathing. Inhale for a count of 4, hold your breath for a count of 4, breathe out slowly through your mouth for a count of 8, then repeat this five times.
Prioritize consistent, quality sleep
Establish a pre-sleep routine, not just a sleep routine. A pre-sleep routine includes the activities that you do to wind down in the 1-2 hours before bed. During this time, limit screen time (our primitive brain codes bright lights of screens as daylight, which can disrupt melatonin production) and stimulating activities.
The bedroom is for sleep and sex, not watching TV or working from home. Don’t confuse your brain by making associations between your bed and productivity. If you’re having trouble sleeping (difficulty falling asleep, staying asleep, or having restless sleep), here are a few things to try:
Do your best to be consistent by going to bed and waking up at the same time daily
Assess your sleep environment- is your room dark enough? Is it the right temperature for you? Are your bed, pillows, and sheets comfortable? If not, what changes can you make?
Limit caffeine in the afternoon (my personal rule is NO caffeine after 2:00 pm) and eliminate it in the evening as it can contribute to sleep difficulties
Limit or eliminate alcohol consumption as it can contribute to sleep difficulties, not to mention rebound anxiety or “hang-xiety” the next day.
Engage in regular movement (walking, yoga, strength training)
The perimenopause phase of life may not be conducive to intense cardio sessions. Instead, especially when you’re already struggling with anxiety, focus on movement and exercise that is calmer to your system. Examples include walks, particularly in nature*, yoga, pilates, strength and resistance training.
*Research shows that time in nature can reduce anxiety symptoms
When Perimenopause Anxiety Requires Mental Health (or Medical) Treatment
I’m a huge fan of therapy, and think we can all benefit from it! Its a good idea to speak to a mental health professional if anxiety:
Interferes with your daily functioning
Persists most days for more than two weeks
Disrupts sleep, concentration, or your ability to get things done
Feels unmanageable or begins escalating
Appears suddenly without a clear cause
Early evaluation helps identify whether anxiety is hormonally driven, caused by an underlying anxiety disorder, or a combination—and allows for targeted treatment.
Emotional and Therapeutic Support:
Therapy is a wonderful tool when it feels like nothing else is working.
Cognitive Behavioral Therapy (CBT) and CBT for insomnia (CBT-i) are shorter-term appraoches that can help you identify how thoughts, feelings, and behavior impact each other
Distress tolerance skills drawn from Dialectical Behavioral Therapy (DBT) can help you manage intense anxiety symptoms
Motivational Interviewing can help when you’re feeling stuck but want to make healthy behavioral change
EMDR when traditional talk therapy is less effective for you. You can learn more about EMDR here.
There are countless different therapeutic approaches that can help you manage anxiety in perimenopause. When you reach out to a potential therapist, feel free to ask them how they support clients experiencing anxiety and how they support clients in perimenopause. You can learn more about finding a therapist who’s the right fit for you here.
FAQs About Perimenopause and Anxiety
Can perimenopause cause anxiety even if I’ve never had it before?
Yes, absolutely! Perimenopause can cause anxiety, panic, and other symptoms associated with anxiety like difficulty concentrating, dizzy spells, fatigue, irritability, memory lapses, and panic attacks.
Is anxiety one of the first signs of perimenopause?
Hard to say if its one of the first signs, but seven of the 34 known symptoms of perimenopause (anxiety, difficulty concentrating, dizzy spells, fatigue, irritability, memory lapses, and panic attacks) can be symptoms of anxiety disorders.
How do I know if my anxiety is hormonal or a true anxiety disorder?
This is also hard to answer, but a mental health professional can help determine if there is an underlying anxiety disorder or if anxiety is hormone-related. Whatever the answer, therapy can help you to feel better!
Does menopause make anxiety better or worse?
Perimenopause is the period of time (7-10 years) leading up to menopause (late 40s-early 50s)- when you no longer menstruate. In her book, The Menopause Brain, Dr. Lisa Mosconi shares that postmenopausal women are generally happier than younger ones—and also happier than they were, themselves, before menopause! But you don’t need to wait 7-10 years to feel better, therapy can help!
What is the best treatment for perimenopause-related anxiety?
Lifestyle and nervous-system support
Therapy and behavioral approaches
Hormonal vs. non-hormonal medical options
Should I see a gynecologist or a mental health provider for anxiety?
This is a great question and it depends on your goals. If you’re seeking strategies to manage anxiety, therapy is a great option. If you’re considering hormones or want lab work done to better understand where you are in your perimenopause journey, talk to your gynecologist. If you don’t have a gynecologist of if you don’t feel your provider is well versed in (peri)menopause, you can find a Certified Menopause Provider in your area here.
Takeaways related to Perimenopause and its relationship to Anxiety
Perimenopause can cause anxiety due to hormonal fluctuations that affect the brain’s stress and calming systems. In my clinical opinion, seven of the 34 known symptoms of perimenopause (anxiety, difficulty concentrating, dizzy spells, fatigue, irritability, memory lapses, and panic attacks) can be symptoms of anxiety disorders. And the best news is that these symptoms are common, medically recognized, and treatable with appropriate support.
Interested in online therapy for perimenopause anxiety?
Hi again, I’m Nikki! A therapist and licensed clinical social worker (LCSW) with nearly 20 years of experience. In my online therapy practice, I support women in midlife and the struggles that come with it- perimenopause, anxiety and stress, ADHD and inattention, depression, grief and loss, and those unexpected life events that throw you off course.
If you’re a woman looking for support in perimenopause, let’s connect for a FREE 15-minute call to talk through how I can support you! Located in Michgan and licensed to practice in CT, FL, IL, IN, MI, OH, SC, and WI.