MENOPAUSE MENTAL HEALTH: ANXIETY IN PERIMENOPAUSE
If you're going through perimenopause or menopause and you're suddenly experiencing anxiety, or if anxiety you've managed for years has suddenly gotten worse - you're not imagining it.
And you're not alone.
Anxiety is one of the most common, and most under-discussed, symptoms of perimenopause. Many women experience it for the first time in their 30s. Others find that anxiety they had under control suddenly feels unmanageable.
Either way, it's real. It's valid. And it's connected to what's happening in your body.
Let me explain.
What Is Perimenopause Anxiety?
Perimenopause anxiety can show up in many forms:
A constant sense of worry or dread
Panic attacks (even if you've never had them before)
Feeling on edge, irritable, or overwhelmed
Racing thoughts, especially at night
Physical symptoms like heart palpitations, shortness of breath, or chest tightness
A feeling that something is wrong, but you can't name what
For some women, anxiety is mild and manageable. For others, it's debilitating — affecting work, relationships, sleep, and daily life.
And here's what makes it even harder: many women don't realise it's connected to perimenopause. They think they're "losing it" or that something is fundamentally wrong with them.
But the truth is, perimenopause anxiety is a hormonal symptom — just like hot flushes or irregular periods.
Why Does Perimenopause Cause Anxiety?
During perimenopause, your oestrogen and progesterone levels fluctuate — sometimes dramatically. These hormones don't just regulate your menstrual cycle. They also play a major role in regulating mood, stress response, and emotional resilience.
Here's how it works:
Oestrogen affects serotonin and dopamine
These are the "feel-good" neurotransmitters in your brain. When oestrogen drops, so do serotonin and dopamine levels - which can lead to low mood, anxiety, and irritability.
Progesterone has a calming effect
Progesterone supports GABA, a neurotransmitter that helps you feel calm and relaxed. When progesterone declines, you lose that natural calming buffer, which can make you feel more anxious, on edge, or unable to wind down.
Cortisol (your stress hormone) becomes harder to regulate
When your sex hormones are unstable, your body's ability to manage stress becomes less effective. This means everyday stressors that you used to handle with ease now feel overwhelming.
The result? Your nervous system is more reactive. Your emotional resilience is lower. And anxiety, whether it's new or returning, can take hold.
How to Tell If Your Anxiety Is Related to Perimenopause
Here are some signs that your anxiety might be linked to hormonal changes:
It started or worsened in your late 30s
It coincides with other perimenopause symptoms (irregular periods, brain fog, sleep issues, hot flushes)
It fluctuates with your cycle (worse in the week or two before your period)
It feels different from anxiety you've experienced before — more physical, more intense, or more unpredictable
Traditional anxiety management strategies (therapy, mindfulness, exercise) aren't working as well as they used to
If this sounds like you, it's worth exploring whether perimenopause is playing a role.
What You Can Do About Perimenopause Anxiety
The good news? Perimenopause anxiety is treatable. Here are some steps you can take:
1. Talk to your GP about HRT
Hormone Replacement Therapy (HRT) can stabilise oestrogen and progesterone levels, which often reduces anxiety significantly. Not all GPs are well-versed in menopause care, so don't be afraid to ask for a referral to a menopause specialist if needed.
2. Consider therapy
Cognitive Behavioural Therapy (CBT) is one of the most effective treatments for anxiety, including perimenopause-related anxiety. A therapist can help you develop coping strategies, challenge anxious thoughts, and regulate your nervous system.
3. Support your nervous system
Practices like breathwork, mindfulness, gentle movement (yoga, walking), and grounding techniques can help calm your nervous system and reduce anxiety in the moment.
4. Prioritise sleep
Lack of sleep makes anxiety worse. If perimenopause is disrupting your sleep (and for many women, it does), addressing sleep issues can have a huge impact on anxiety levels.
5. Reduce caffeine and alcohol
Both can exacerbate anxiety, especially when your nervous system is already dysregulated. If you're struggling with anxiety, try cutting back and notice if it helps.
6. Connect with other women
Isolation makes anxiety worse. Talking to other women who understand what you're going through can be incredibly validating and calming.
That's why I started the Menopause Café in Reading — a free, safe space where women can share their experiences without judgement. We meet on the 1st and 3rd Friday of each month at the local library. There's no agenda, no pressure — just honest conversation and peer support.
7. Seek professional support
If anxiety is significantly affecting your life, don't wait. Reach out to a GP, therapist, or menopause coach who can help you navigate this.
I offer a complimentary 30-minute conversation each month where we can explore what's happening for you and discuss ways to support your mental and emotional wellbeing during perimenopause.
https://www.nhs.uk/conditions/menopause/symptoms/
https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/menopause-and-mental-health/
https://thebms.org.uk/publications/tools-for-clinicians/patient-information/
You're Not Losing Your Mind
If you're experiencing anxiety in perimenopause, please know this:
You're not weak. You're not overreacting. You're not losing your mind.
Your body is going through a profound hormonal transition, and anxiety is a common, valid, and treatable response to that transition.
You don't have to suffer in silence. You don't have to push through alone.
There is support available — medically, therapeutically, and in community.
If you're in Reading, Berkshire, or the Thames Valley area and you're struggling with perimenopause anxiety, reach out. Join us at the Menopause Café. Book a complimentary conversation. You don't have to navigate this alone.
ABOUT JOAN ST CLAIR
Joan St Clair is The Sensuality In Menopause Coach, a Mental Health First Aider, Community Researcher, and founder of the Menopause Café in Reading, Berkshire. She supports women navigating the mental, emotional, and physical challenges of perimenopause and menopause with compassion, evidence-based guidance, and community connection.