Perimenopause is a natural phase in a woman's life, characterised by hormonal changes that lead to the end of monthly periods. After 12 consecutive months without a period, a woman is considered to have reached menopause. Along with physical symptoms, some women experience emotional changes, including anxiety during this transition.
For some people, hormonal fluctuations, particularly a decline in oestrogen levels, can contribute to mood swings and heightened anxiety. This is common in people who have suffered from low-level symptoms in the past, but it can also develop out of the blue. You might find yourself having panic attacks in response to tasks that you may have found straightforward in the past, such as driving. Understandably, this can be alarming and unpleasant, so it's important to learn how to deal with these symptoms.
Can perimenopause cause anxiety?
During perimenopause, fluctuations of hormones (predominantly oestrogen and progesterone) occur, which cause physical symptoms such as irregular periods, heavier or lighter periods and vaginal dryness. However, these hormone changes can also influence your mood, and lead to emotional and mental symptoms, including anxiety.
There isn’t a wealth of studies about anxiety and perimenopause, although some women report symptoms of anxiety at this time in their livers. A study of Women's Health Across the Nation (SWAN) found that overall, women had high anxiety symptoms at 21% of early perimenopause doctor visits and 20% of late perimenopause visits, compared to 18% of postmenopausal visits and 16% of postmenopausal visits when using hormone replacement therapy.
Several factors may contribute to anxiety during perimenopause:
Hormonal fluctuations and the brain
Oestrogen influences important chemicals in the brain like serotonin and dopamine, which are both crucial for mood regulation. When oestrogen levels decline, it can reduce serotonin production, potentially lowering mood, increasing irritability and making you more prone to anxiety. Hormonal fluctuations can also make emotions feel more intense and reactive, leading to heightened anxiety during perimenopause.
Sleep disturbances
40-60% of women experience sleep disruption during the menopause transition. This can be due to a variety of factors including the direct impact of hormonal changes but also due to symptoms such as hot flushes, night sweats and needing to pass urine at night. Disrupted sleep can impact upon the body’s ability to manage stress and emotions leading to reduced tolerance and brain fog, which can intensify feelings of anxiety.
Hot flushes and night sweats
Hot flushes and night sweats can induce feelings of anxiety as the physical symptoms they trigger such as reddening of the face, sweating and a racing heart beat are similar to those experienced by people suffering with anxiety. Because they can be so troubling, the anticipation of a hot flush can become anxiety-inducing in itself, especially when in public or professional settings where these symptoms may feel more challenging to manage.
Women are often woken up by night sweats so their impact on sleep can be profound. It is not uncommon for women to wake up following a night sweat and lie away for hours struggling with anxious thoughts which limit her ability to return to sleep afterwards. This then results in further anxiety as a result of poor sleep, the following day.
Life stage transitions
Perimenopause often coincides with other life changes, such as children leaving home, career adjustments or caring for ageing parents. These changes can add stress and contribute to anxiety.
Symptoms of perimenopause anxiety
There are numerous perimenopause and menopause symptoms, of which anxiety is one. Anxiety can leave you feeling stressed, fearful or tense and get in the way of your day-to-day life. Symptoms of perimenopause anxiety can be both emotional and physical and can result in the following:
- Excessive worry
- Restlessness and difficulty relaxing
- Irritability
- Sleep disturbances or trouble falling asleep
- Difficulty concentrating
- Palpitations
- Shaking
- Sweating
- Nausea
- Breathlessness
- Muscle tension
- Panic attacks
Occasionally feelings of anxiety can become so overwhelming that it leads people to think about self harm or even suicide. If this is something that you are experiencing, please seek urgent help from your local GP practice, Emergency Department, by calling 999 or by contacting the Samaritans on 166 123. These feelings do improve with treatment but at the time they can feel completely overwhelming.
Simple strategies for managing perimenopausal anxiety
The severity and duration of perimenopausal anxiety is different for everyone. Some women will find it improves after the menopause whilst for others it may continue. Lifestyle is particularly important in helping to manage anxiety and making a few changes can have a significant impact on symptoms:
Regular exercise
Physical activity can have positive effects on mood and overall health. One study found that exercise is 1.5 times more likely to reduce mild to moderate symptoms of anxiety than medication or cognitive behavioural therapy while another established that those who undertook regular vigorous exercise were 25% less likely to develop depression or anxiety over the next five years.
Sleep hygiene
Having a regular bedtime routine and ensuring enough sleep every night can make a big difference to anxiety symptoms in the perimenopause. However, anxiety itself can lead to sleep issues, so it can become a vicious cycle.
There are various things you can do to support restful sleep which are known as sleep hygiene measures. These include:
- Following a regular bedtime and waking up time every day
- Avoiding screens before bed
- Keeping your bedroom cool, dark and quiet
- Ensuring you spend time outside during the daylight hours as this helps to set sleep patterns
- Avoiding caffeine, alcohol, large meals and drinking too much before sleep
- Enjoying something relaxing such as reading or listening to gentle music before falling asleep
- Regular exercise
- If you struggle to fall asleep, try to avoid staying in bed - instead, leave the bedroom and do something calm and relaxing such as reading a book until you feel sleepy
Healthy diet
Your perimenopause and menopause diet can have a big impact on how you feel, not just physically but mentally too. Eating a well balanced, varied diet rich in vitamins and minerals is a great place to start.
These are some specific foods and diet suggestions which may help with anxiety symptoms:
- Leafy greens, legumes, nuts, seeds and whole grains are high in magnesium, which can make you feel calmer.
- Zinc-rich foods such as cashews, liver, beef and egg yolks have been linked to lower anxiety.
- Research also indicates that omega-3 fatty acids can improve symptoms. Good sources of omega-3 include oily fish, nuts and seeds, and plant oils.
- Probiotic-rich foods, like kefir and sauerkraut, have been linked to lower levels of social anxiety so they may help if your perimenopausal anxiety makes social situations more challenging.
- B vitamins, particularly B6, have been shown to significantly reduce feelings of stress, anxiety and depression. B6 is found in many foods including organ meats, some fish, starchy vegetables, fortified cereals and non-citrus fruits.
- Caffeine and alcohol can aggravate symptoms of anxiety so cutting down or avoiding them altogether can be beneficial.
Supportive relationships
You might find it helpful to share your experiences with friends, family or a support group. Talking about your feelings can provide emotional support, and sometimes, just knowing other people are feeling the same way can be a relief.
Relaxation techniques
Practices such as mindfulness, meditation, deep breathing exercises and menopause yoga can help you manage stress and anxiety by calming both your body and mind.
These practices encourage present-moment awareness, helping you to break the cycle of anxious thoughts and reduce emotional reactivity which is often heightened by hormonal fluctuations during perimenopause.
Techniques such as deep breathing and meditation activate the parasympathetic nervous system, which counteracts the body’s stress response, lowering cortisol levels and promoting a sense of calm.
Yoga adds an extra layer of benefit by releasing physical tension stored in muscles, supporting better sleep, and enhancing overall emotional resilience.
Treatments for perimenopausal anxiety
It’s true that, while important, tackling the root cause of anxiety can take some time. If you’d like to address the symptoms through treatment to make life more comfortable in the meantime, there are a range of options:
Hormone replacement therapy (HRT)
HRT is an effective treatment for the symptoms of perimenopause and menopause in many women. When it comes to HRT and anxiety, oestrogen can help improve your mental well-being by balancing hormones, impacting neurotransmitter activity and reducing other physical symptoms, such as night sweats and hot flushes, that can affect your mood, sleep and usual routine.
Psychological therapies
Psychological therapies can be effective tools for managing anxiety in all people, so can also be effective during perimenopause. They encompass a range of therapies including cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), group therapy and counselling.
CBT for menopause and perimenopause can not only help you to reframe your thoughts and modify negative behaviours but in turn, can also help alleviate physical symptoms such as hot flushes.
Medication to manage specific symptoms
Beta-blockers, such as Propranolol, can help to manage the physical symptoms of anxiety including a racing heart beat, flushing and shaking. They do this by blocking the chemicals noradrenaline and adrenaline, which your brain makes more of when you’re anxious.
Antidepressants
Medications such as selective serotonin reuptake inhibitors (SSRIs), or other antidepressants including serotonin and norepinephrine reuptake inhibitors (SNRIs) can be helpful in controlling symptoms of anxiety. They work by increasing the levels of ‘happy’ hormones (like serotonin and dopamine) in the brain. Examples of these include:
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
Supplements
Some people find that herbal remedies help to reduce their symptoms of anxiety, although evidence of their efficacy is often limited. Read our guide to herbal remedies for menopause for more information.
If you find that your anxiety symptoms are significantly impacting your daily life, it's important to seek professional help. While anxiety during perimenopause is common, it is manageable with the right strategies and support. By adopting a holistic approach that includes lifestyle changes, social support, and, where appropriate, hormone replacement therapy, you can navigate this phase with ease.
Menopause Care can help you. You can have an in-depth discussion about your medical history and lifestyle with one of our experienced professionals, who’ll help to develop a plan of action you are happy with and understand.
When appropriate, we will arrange blood tests to rule out other causes for your symptoms and to check your hormone levels, and we’ll liaise with your GP and, when needed, other specialists involved in your care.
If you decide HRT is the right treatment for you, we can optimise your regimen to eliminate symptoms as quickly as possible and we have an in-house CBT specialist who can provide additional support for managing anxiety. To get started, book a consultation with a menopause doctor.
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