Perimenopause anxiety: why it happens, how it feels and what actually helps

The short answer: perimenopause can cause anxiety. The NHS lists anxiety among the common symptoms of perimenopause and menopause, and a large US study found women with low anxiety before the transition were more likely to report high anxiety during and after it. Swinging estrogen, hot flashes, poor sleep and life stress all play a part. CBT, exercise, better sleep and treatment from a doctor can help.

For the full picture of the transition, see perimenopause symptoms.

Can perimenopause cause anxiety?

Yes. The NHS says mood swings, low mood and anxiety are common around perimenopause and menopause, and the US Office on Women’s Health lists anxiety as a menopause symptom.

The best long-term data come from the Study of Women’s Health Across the Nation (SWAN), which followed 2,956 women for 10 years. Women who started with low anxiety had about 1.6 times the odds of reporting high anxiety in early or late perimenopause, or after menopause, compared with before the transition. That held even after allowing for stressful life events, money strain and hot flashes.

Cleveland Clinic and ACOG both note there are only a few studies on anxiety in perimenopause specifically. Depression has been studied more, and most studies agree its risk rises during the transition.

Why does perimenopause cause anxiety?

No one knows the exact mechanism, but hormone swings, symptoms and life pressure seem to add up. The Menopause Society says estrogen receptors are spread through the brain, including areas that regulate mood. Here is what the sources point to:

What does perimenopause anxiety feel like?

It usually feels like constant worry that gets in the way of your day, often with physical signs such as sweating, nausea or tight muscles. That’s how Cleveland Clinic and ACOG describe it. The NHS adds restlessness, irritability, trouble concentrating and a more noticeable heartbeat as common signs of anxiety.

ACOG says about 4 in 10 women have PMS-like mood symptoms in perimenopause: irritability, low energy, tearfulness and trouble concentrating. Unlike PMS, they can show up at any point in your cycle. If you’re also drained all the time, read why you might always feel tired too.

Can perimenopause cause anxiety and heart palpitations?

Yes, both can happen, and they can feed each other. The NHS lists palpitations (a faster, slower or more noticeable heartbeat) as a menopause symptom and says hot flashes can cause palpitations or anxiety. The Menopause Society says some women feel a rapid heartbeat during a hot flash. Anxiety itself is also a common cause of palpitations, according to MedlinePlus.

Most palpitations are harmless, but don’t assume yours are hormonal. The NHS says to see a doctor about them, since caffeine, an overactive thyroid, anemia or a heart rhythm problem can also cause them.

Don’t drive yourself to the hospital. The NHS says to ask someone to drive you or call an ambulance. MedlinePlus notes that heart attack symptoms in women can differ, and women are more likely to feel tired for no reason.

Is perimenopause anxiety worse at night?

It can be, because night sweats and broken sleep make anxiety harder to manage. The NHS says sleep problems can leave you stressed and anxious, and they may be worse if you also have night sweats. The Office on Women’s Health adds that night sweats, bladder symptoms and mood changes can all disrupt sleep.

ACOG’s sleep advice for perimenopause:

• Keep the same bedtime and wake time every day.
• Put screens away for the hour before bed.
• Skip caffeine in the afternoon. ACOG says it can affect you for up to 8 hours.
• Keep your bedroom quiet, cool and dark, with a fan if it helps.

If night sweats are what wake you, how to stop hot flashes covers what works.

How do you deal with perimenopause anxiety naturally?

The self-help steps with the most support are talking therapy skills, regular exercise, better sleep and calm breathing. The NHS suggests these for anxiety:

• Breathe slowly. The NHS breathing exercise: let your breath flow deep into your belly, in through your nose and out through your mouth, counting 1 to 5 on each breath if that helps. Keep going for at least 5 minutes. It works best done daily.
• Move regularly. Walking, swimming, running and yoga can reduce anxiety and stress and help you sleep, says the NHS. Cleveland Clinic says calm movement like yoga can help mood and relieve anxiety.
• Cut back on coffee, tea, cola and energy drinks. Caffeine can disrupt sleep and make anxiety harder to control.
• Don’t lean on alcohol or cigarettes to calm down. The NHS says they can add to poor mental health.
• Eat regular meals to keep your energy steady.
• Talk to someone, or try self-help CBT books and courses.

Be careful with supplements. The NHS says remedies sold for menopause, such as black cohosh and red clover, have very little evidence on how well they work or how safe they are, and some can interact with other medicines.

What is the best way to treat perimenopause anxiety?

CBT is usually the first treatment to try, and medicines are an option to discuss with your doctor. The NHS says a doctor will usually suggest talking therapy before prescribing medicine for anxiety. These are the options the sources describe:

Which fits depends on your health history, so talk the choices through with your doctor.

Can perimenopause cause anxiety and depression?

Yes, and the two often come together. The Menopause Society says women are especially vulnerable to depression during perimenopause and just after menopause. If you feel hopeless, lose interest in things you enjoyed, and struggle to sleep or concentrate most of the day, nearly every day, for at least 2 weeks, it says to see a healthcare professional.

If you’re having thoughts of harming yourself, get help now. In the US, call or text 988 to reach the 988 Suicide & Crisis Lifeline, free and open around the clock. Outside the US, call your local emergency number or a crisis line in your country. If your life is in danger right now, call 911 or your local emergency number.

Does perimenopause anxiety go away?

For many people it eases over time, though it can come and go for years. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer, and hot flashes may fade and be replaced by low mood and anxiety. Cleveland Clinic says most people’s symptoms ease after menopause. In SWAN, though, the higher risk carried on after menopause, so it’s worth treating now.

How do you manage perimenopause anxiety starting today?

Start with one step this week. Try the 5-minute breathing exercise each evening, and keep a short note of your anxious days, sleep, hot flashes and period dates. Bring it to your doctor and ask about CBT. Our menopause symptoms checklist gives you a printable list to fill in and questions to ask.

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Quick questions

Is menopause anxiety real?

Yes, menopause anxiety is real. The NHS and the US Office on Women’s Health both list anxiety as a symptom of perimenopause and menopause. In the SWAN study of 2,956 women, those with low anxiety before the transition had about 1.6 times the odds of reporting high anxiety during perimenopause or after menopause.

Can perimenopause cause anxiety attacks?

Perimenopause can bring on anxiety, and hot flashes can come with a racing heart and a rush of anxiety, says the NHS. A panic attack can cause chest pain, sweating, dizziness and a fast heartbeat. Because those overlap with heart problems, call 911 or your local emergency number if chest pain lasts or comes with breathlessness or fainting.

Does perimenopause anxiety come and go?

Yes, it often comes and goes. ACOG says perimenopause mood symptoms such as irritability and tearfulness can appear at any point in your cycle and continue for years with no clear pattern. The NHS says symptoms change over time, and anxiety can arrive as hot flashes fade.

Can HRT help with anxiety in perimenopause?

HRT might help some people, but it isn’t a standard anxiety treatment. ACOG says estrogen may help depression during perimenopause, while the NHS says people with anxiety caused by menopause may be offered antidepressants and CBT. Ask your doctor which option suits your symptoms and health history.

What helps perimenopause anxiety at night?

Cooler, calmer nights help most. ACOG suggests a fixed bedtime and wake time, no screens for an hour before bed, no caffeine in the afternoon and a cool, dark, quiet bedroom. The NHS breathing exercise, slow belly breaths for 5 minutes, can settle you if you wake up anxious.

Do supplements help perimenopause anxiety?

There’s little good evidence that they do. The NHS says herbal remedies sold for menopause, such as black cohosh and red clover, have very little evidence on how well they work or how safe they are, and some can cause serious side effects with other medicines. Talk to a doctor or pharmacist before trying one.

This article is general information, not medical advice. Anxiety, palpitations and chest symptoms can have many causes, so see a doctor to find yours. If you have chest pain or thoughts of harming yourself, call 911 or 988 in the US, or your local emergency number or a crisis line elsewhere.

Sources

• NHS. Symptoms of menopause and perimenopause
• NHS. Things you can do to help menopause and perimenopause symptoms
• NHS. Treatment for menopause and perimenopause
• NHS. Generalised anxiety disorder (GAD)
• NHS. Breathing exercises for stress
• NHS. Heart palpitations
• NHS. Chest pain
• MedlinePlus. Heart palpitations
• MedlinePlus. Heart attack
• The Menopause Society. Mental health
• The Menopause Society. Symptoms
• Cleveland Clinic. Perimenopause
• Cleveland Clinic. Menopause
• American College of Obstetricians and Gynecologists. Mood changes during perimenopause are real. Here’s what to know
• Office on Women’s Health. Menopause symptoms and relief
• Bromberger JT et al. Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation. Menopause, 2013
• 988 Suicide & Crisis Lifeline