If you’ve noticed yourself feeling more anxious, restless, or “on edge” lately, you’re not imagining it — and you’re not alone.
Many women describe perimenopause as a time of emotional turbulence: one day feeling calm and capable, the next gripped by racing thoughts or an unfamiliar sense of worry.

Perimenopause is a time of hormonal recalibration — a transition that affects not only the body but also the brain and nervous system. Understanding what’s happening beneath the surface can be deeply reassuring. Anxiety in this phase is common, real, and very treatable once you understand its roots.

What is Perimenopause?

Perimenopause is the transition phase leading up to menopause, when the ovaries gradually begin to produce less estrogen and progesterone. It typically begins in a woman’s 40s (sometimes earlier) and lasts about five to seven years, ending one year after your final period (1).

During this time, your hormones don’t decline in a smooth, linear way — they fluctuate wildly. One week your estrogen may surge, the next it plummets. These hormonal shifts affect the brain’s chemistry, particularly the neurotransmitters serotonin, dopamine, and GABA, which regulate mood, focus, and calm (2).

Because hormones influence everything from sleep and metabolism to immune and nervous system balance, these fluctuations can leave many women feeling emotionally fragile, even if life is otherwise stable.

How Common is Anxiety During Perimenopause?

Anxiety is one of the most frequently reported emotional symptoms of perimenopause. Research shows that up to two-thirds of women experience new or worsening anxiety symptoms during this transition (3), and around 13–24% may meet criteria for an anxiety disorder such as generalized anxiety or panic disorder (4).

Interestingly, these symptoms can appear even in women who have never struggled with anxiety before. For those with a prior history, perimenopause can act as a “perfect storm,” amplifying previous patterns (5).

Knowing that these experiences are both normal and physiological can be the first step toward relief.

What Perimenopausal Anxiety Can Feel Like

Anxiety at this stage doesn’t always look like worry or fear. Sometimes it’s more of an internal restlessness — an uneasy feeling that something isn’t quite right.

Emotional and Cognitive Symptoms

• Persistent worry or racing thoughts

• Feeling tense, restless, or irritable

• Difficulty concentrating (“brain fog”)

• Sudden overwhelm or panic attacks

Physical Symptoms

• Heart palpitations or fluttering sensations

• Shortness of breath

• Trembling, sweating, or dizziness

• Fatigue or muscle tension

• Nausea or digestive upset

Many women describe it as:

“Like my body is buzzing on the inside.”
“I feel wired, but I’m exhausted.”
“It’s as if my nerves are turned up too high.”

These sensations are signs that your stress system — known as the HPA axis — is being triggered more easily, often due to hormonal fluctuations.

Why Does Anxiety Happen in Perimenopause?

1. Hormonal Fluctuations

Estrogen supports serotonin and GABA — the brain’s natural “calm” chemicals. When estrogen dips suddenly, those calming effects weaken, and anxiety can surge (6).

Progesterone also plays a soothing role through its metabolite, allopregnanolone, which acts on GABA receptors to reduce anxiety (7). As progesterone declines, that natural sense of ease is lost, leaving the nervous system more reactive.

Together, these hormonal shifts can temporarily destabilise the stress-response system (HPA axis), increasing cortisol levels and making the body feel “stuck in fight or flight” (8).

2. Sleep and Circadian Disruption

Hot flushes, night sweats, and disrupted sleep are hallmarks of perimenopause. Even a few nights of poor sleep can increase cortisol, amplify stress perception, and reduce emotional resilience (9). Quality sleep is one of the most powerful tools for restoring balance.

3. Physical Sensations that Trigger Fear

Symptoms such as heart palpitations or chest tightness can mimic panic. Even when medical tests are normal, these sensations can understandably cause concern, creating a feedback loop of worry (10).

4. Life and Emotional Factors

Perimenopause often coincides with midlife pressures — caring for children or aging parents, managing careers, or navigating changing relationships. These stressors can magnify underlying anxiety.

For some women, past trauma may resurface during this period, as the same neurobiological systems that regulate hormones also process emotional memory (11). This isn’t regression — it’s the brain’s way of seeking healing during a major life transition.

Who is More at Risk?

You may be more likely to experience anxiety during perimenopause if you:

• Have a history of anxiety or depression

• Experience frequent hot flushes or poor sleep

• Are under chronic stress or financial strain

• Have unresolved trauma

• Lack social or partner support

• Have poor general health or limited physical activity (12)

Supporting Your Mental Health During Perimenopause

The most effective care combines biological, psychological, and social approaches — in other words, a mind-body-environment perspective.

1. Lifestyle Foundations

Move Often:
Exercise is medicine. Regular aerobic or strength exercise helps lower cortisol, improve sleep, and boost serotonin (13). You don’t need a gym — a brisk walk, yoga session, or some resistance training at home all count.

Eat to Nourish:
Balanced meals rich in protein, fiber, healthy fats, and colorful plants stabilize blood sugar and support brain chemistry. A Mediterranean-style diet — rich in vegetables, olive oil, and fish — has been linked to lower rates of anxiety and depression (14).

Watch Your Caffeine:
During perimenopause, the nervous system is more sensitive to stimulants. Reducing coffee or switching to green tea can ease jitteriness (15).

Prioritize Sleep:
Protect your sleep like medicine. Keep your bedroom cool and dark, avoid screens before bed, and consider natural supports like magnesium, tart cherry, or melatonin. For many women, micronised progesterone (utrogestan) improves both sleep and anxiety (16).

Calm Your Nervous System:
Mindfulness, deep breathing, journaling, gentle yoga, or time in nature all help reset the body’s stress response. Even 10 minutes of slow breathing can lower heart rate and cortisol (17).

2. Medical and Therapeutic Options

Hormone Therapy (HRT):
For some women, replacing estrogen and progesterone can stabilise fluctuations that drive anxiety. Transdermal estrogen combined with oral micronised progesterone is considered the gold standard and is available in body-identical forms in New Zealand (18).

Cognitive Behavioural Therapy (CBT):
CBT teaches practical strategies to identify unhelpful thought patterns and reduce panic or worry. It’s one of the most effective psychological treatments for perimenopausal anxiety (19).

Acceptance and Commitment Therapy (ACT):
ACT helps women accept their internal experiences rather than fight them, while focusing on living in alignment with values and purpose (20).

Medication:
When symptoms are severe, antidepressants (SSRIs/SNRIs) or beta-blockers may be prescribed alongside lifestyle and hormone therapy (21).

3. Social Support and Connection

Humans are wired for connection. Talking openly with trusted friends or joining a menopause support group can provide relief and perspective. Studies show that women who feel socially supported experience lower stress hormone levels and better emotional health (22).

When to Reach Out for Help

If anxiety or panic begins to affect your work, relationships, or daily function, reach out for support. A menopause-informed GP or specialist can help assess hormonal factors, sleep patterns, and overall wellbeing.

There is no shame in seeking help — this is a biological transition, not a personal failing. The right support can bring enormous relief.

The Takeaway

Perimenopause is a powerful recalibration of your body and mind. Anxiety during this time doesn’t mean you’re weak — it means your system is adapting.

With the right combination of lifestyle support, medical care, and emotional connection, it’s entirely possible to restore calm, confidence, and clarity.

Menopause is not the end of vitality — it’s the beginning of a wiser, more balanced chapter.

References

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