Is perimenopause behind your anxiety?

Perimenopause — literally meaning “around menopause” — describes the years leading up to menopause. People often talk about how difficult menopause is, but perimenopause can be just as challenging. For many people, perimenopause and anxiety come together in a way that makes life feel more stressful. In one study, over half of perimenopausal women experienced anxiety.

You may be at especially high risk for developing anxiety during your perimenopause years if you don’t usually live with symptoms of anxiety. This can be a confusing and even frightening experience, but it should go away with time. Therapy and, sometimes, medication can help you get through the worst of it and stay grounded during your perimenopause years.

What perimenopausal anxiety feels like

Anxiety during perimenopause can be distressing, overwhelming, and even frightening. Especially if you’re not somebody who typically feels anxious, these new feelings can be confusing to deal with. It’s hard to know what symptoms and experiences are “normal” parts of perimenopause and what might be signs of a deeper underlying condition.

Common anxiety experiences and symptoms that people report during perimenopause include:

• Nighttime anxiety and insomnia: You might find yourself lying awake for hours, unable to turn off your thoughts. Even if you fall asleep, you may wake up in the middle of the night with your heart pounding for no particular reason.
• Morning anxiety: You might wake up with a pit in your stomach, like something bad is about to happen or you’re forgetting something crucial — even if there’s nothing specific causing it. That sense of dread can make it hard to start your day.
• Social anxiety: You might feel nervous about being around people, even with close friends or in situations that used to feel easy. Things like small talk, social events, or even texting someone back might feel oddly overwhelming or emotionally draining.
• Excessive worrying: You might feel like your mind is constantly racing and jumping from one worry to the next. You might overthink your decisions, replay conversations repeatedly, or feel like you’re waiting for something bad to happen — even if everything seems fine on the surface.
• Anxiety or panic attacks: You might experience sudden waves of anxiety that come on without warning. These can include chest tightness, difficulty breathing, dizziness, or a feeling like you’re losing control or even about to die.
• Physical symptoms: Perimenopausal anxiety doesn’t only affect how you think or feel — it can show up in your body too. Some common physical symptoms include muscle tension, jaw clenching, rapid heartbeat, headaches, digestive issues, and even feeling shaky or lightheaded.

The care you need, when you need it

Learn how Rula can support your mental health journey

Subscribe

I agree to receive emails from Rula and accept the terms outlined in Client Email Consent and Privacy Policy.

Why perimenopause symptoms cause anxiety

Mental health challenges are a common part of perimenopause. This includes anxiety, as well as other mental health symptoms, like depression and mood swings.

Not everyone experiences increased anxiety during perimenopause. One review found that women who had lower levels of anxiety before menopause were most likely to experience heightened anxiety during perimenopause. 

On the other hand, women who already had higher levels of anxiety before perimenopause weren’t as likely to experience a dramatic shift. Their anxiety levels stayed chronically high. (This particular study — as well as most others on this topic — unfortunately only included women, not other people assigned female at birth. We need more research to understand how perimenopause affects people of different genders, including trans men and nonbinary people assigned female at birth.)

There are a few different reasons, both biological and environmental, why anxiety might get higher during perimenopause. These include:

Hormonal changes

One of the main changes that happens in your body as you enter perimenopause is fluctuations in estrogen levels. It’s unclear how dropping estrogen levels directly cause anxiety, but unstable estrogen can affect your body’s ability to manage cortisol — a stress hormone. This can physically increase the sensation of anxiety and tension that you feel.

Life changes and challenges

Perimenopause also often comes at a time when other life changes are happening. For example, children may reach adulthood and “leave the nest.” Parents may start needing more care, which leads to additional caregiving duties.

Approaching menopause can also be a period of loss and emotional adjustment. You may need to grieve the fact that you’re no longer in your childbearing years. Some women feel less attractive or feminine during perimenopause.

All of these factors can contribute to anxiety during this time of life.

Other physical symptoms of menopause

On top of the hormonal changes, you may also experience other uncomfortable physical symptoms during perimenopause. These can include:

• Hot flashes
• Vaginal dryness
• Weight gain
• Sleep difficulties

These symptoms can be uncomfortable and stressful to live with, which can put you at higher risk for anxiety.

How to cope with anxiety during perimenopause

For many people, perimenopausal anxiety goes away once they reach full menopause (typically defined as 12 months without a period). But many people go through the hormonal changes of perimenopause for years before reaching menopause. And if other factors — like life challenges — are contributing to your anxiety, or if you’ve developed an anxiety disorder, these feelings may not go away on their own.

You don’t need to suffer through perimenopausal anxiety without support. There are many things you can do to cope with these feelings now, whether or not they go away with time.

1. Practice relaxation techniques

It’s important to be able to calm your body’s stress response and activate your parasympathetic nervous system. This can counter the physical effects of anxiety and let your body know you’re not in danger.

There are evidence-based ways you can do this. For example, progressive muscle relaxation is a technique that involves tensing and releasing your muscles one group at a time. This can help reduce physical tension and send calming signals to your brain. Deep breathing, grounding exercises, and guided imagery can also help regulate your nervous system when anxiety feels overwhelming.

2. Focus on a healthy lifestyle

You don’t need to do a total overhaul of your life to support your mental health during perimenopause. Small changes can still make a big difference. Focus on living an overall healthy lifestyle that supports both your physical and mental well-being. Daily habits like moving your body, cutting back on caffeine and alcohol, and eating nourishing foods can all help stabilize your mood and energy levels. 

Sleep is especially important. Trouble sleeping is common during perimenopause, and it can feed into anxiety. Try to create a calming nighttime routine and avoid stimulating activities before bed. 

3. Connect with others

Social anxiety, in particular, can make it hard to reach out to your friends and loved ones. But maintaining connection is one of the most important things you can do for your mental health. Connecting with others can also remind you that you’re not alone in what you’re going through. Other people in your life may be experiencing similar hormonal or emotional changes and can relate in ways that feel comforting and normalizing.

Even if it feels hard to do so, try to reach out to supportive people. This might mean spending time with trusted friends, joining a support group for people going through perimenopause, or simply talking with someone who listens without judgment. 

4. Practice self-reflection

Especially when anxiety is new or unfamiliar, it’s natural to feel like something is “wrong” with you. But anxiety is often your body’s way of responding to stress, grief, or change. Self-reflection can help you figure out what you’re really feeling beneath the surface.

Taking time to reflect on the meaning behind your emotions can be powerful and healing. You can do this through journaling, talking to a therapist, or just giving yourself time and space to be honest with yourself. Naming what’s going on doesn’t always make it go away, but it can reduce the power it has over you.

5. Get treatment for anxiety

If your anxiety is persistent, interfering with your daily life, or making it hard to cope, it’s time to get professional support. There’s no shame in this, regardless of whether your anxiety is a temporary part of perimenopause or if it’s developed into something more long lasting.

Therapy is one of the most effective ways to treat anxiety. For example, cognitive behavioral therapy (CBT) can help you identify unhelpful thought patterns and change the behaviors that keep you stuck in anxiety. Other types of talk therapy, like acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), are also effective options. Some people also benefit from medication to help manage symptoms while they work through the root causes of their anxiety symptoms.

Find care with Rula

Perimenopause can bring many changes, and it’s normal to feel a bit overwhelmed at times. Adding anxiety into the mix can make things challenging, but you don’t have to wait until it feels like too much. Reaching out for support early can help you regain your balance and feel more confident during this transition.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

Find a provider with Rula