If you’ve never been an anxious person and suddenly feel on edge, wake with a racing heart or worry about things that never bothered you before, you’re not imagining it. Anxiety is a common, and often overlooked, symptom of perimenopause.
In short: falling and fluctuating hormones can affect the brain chemicals that regulate mood. Simple daily habits like slow breathing, exercise, good sleep and less caffeine and alcohol can help, and so can treatment. Talk to your doctor if anxiety is affecting your life.
Why perimenopause can cause anxiety
During perimenopause, oestrogen and progesterone rise and fall unpredictably. These hormones influence brain chemicals such as serotonin and GABA, which help keep your mood steady and calm. When they fluctuate, many women feel more anxious, irritable or low.
Other perimenopause symptoms can add to it: poor sleep, hot flashes, night sweats and a busy midlife full of work, family and caring responsibilities.
Signs it might be perimenopause anxiety
- New or stronger feelings of worry or dread, often without a clear reason
- A racing or pounding heart
- Feeling irritable, tense or on edge
- Trouble switching off at night, or waking at 3 or 4am with your mind racing
- Anxiety that gets worse before your period
- Changes in your cycle at the same time
Always get new heart palpitations or chest symptoms checked by a doctor, to rule out other causes.
7 things that help
1. Slow, deep breathing
When anxiety rises, breathe in slowly through your nose for 4 counts and out for 6. A few minutes can calm your nervous system and ease a racing heart.
2. Move every day
Regular exercise is one of the best natural mood lifters. A brisk daily walk is a great start. Try our 30-day walking plan.
3. Strength training
Lifting weights two or three times a week supports your mood, sleep and confidence, as well as your muscles and bones. Our 4-week weight training plan keeps it simple.
4. Cut back on caffeine
Caffeine can trigger a racing heart and jittery feelings, especially when hormones are fluctuating. Try switching to decaf after your first cup and avoid caffeine after midday.
5. Go easy on alcohol
A glass of wine may feel relaxing, but alcohol can worsen anxiety the next day and disrupt sleep.
6. Protect your sleep
Poor sleep and anxiety feed each other. A cool bedroom, a regular bedtime and a wind-down routine can help. Read our guide to sleeping better in menopause.
7. Talk to your doctor
You don’t have to cope alone. Treatment options include HRT, which can help mood symptoms in perimenopause for some women, cognitive behavioural therapy (CBT) and other medicines. Your doctor can help you decide what’s right for you.
Eat to support your mood
Regular meals with protein, fibre and healthy fats help keep your blood sugar, and your energy, steady. Skipping meals can make anxiety worse. Our menopause diet guide shows you how.
When to get help urgently
If you feel overwhelmed, can’t cope with daily life, or have thoughts of harming yourself, please reach out for help straight away. Contact your doctor, call your local emergency number, or contact a crisis line: in the US, call or text 988; in the UK, call Samaritans on 116 123.
Frequently asked questions
Can perimenopause cause anxiety even if I’ve never had it before?
Yes. Many women experience anxiety for the first time in their 40s, and hormonal changes are often part of the reason.
Does perimenopause anxiety go away?
For many women it eases after menopause, when hormones settle. In the meantime, lifestyle changes and treatment can make a big difference.
Can HRT help with anxiety?
It can help some women with mood symptoms during perimenopause, especially when they come with hot flashes and poor sleep. Talk through the options with your doctor.
The bottom line
Perimenopause anxiety is real, common and treatable. Be gentle with yourself, build small calming habits into your day and don’t hesitate to ask for support. For simple daily habits, download our free Fit After 40 Starter Kit.
This article is for general information only and isn’t medical advice. Please speak to your doctor about your symptoms.
