Anxiety can ramp up as estrogen production fluctuates in perimenopause. You can take steps to lower stress and increase calm during this important transition.

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Perimenopause is a natural period of transition when your body’s reproductive hormone levels fluctuate before menopause when your menstrual periods stop.

For some women, perimenopause brings on extra anxiety. This article describes what that anxiety can feel like and offers you some insight into what can be done to lower it.

Learn more about premenopause, perimenopause, and menopause.

Some symptoms of perimenopause are physical. Some are mental or emotional. Here’s a quick rundown:

Perimenopausal anxiety symptoms may include:

  • feeling nervous, irritable, or restless
  • having trouble relaxing
  • worrying more than usual
  • having trouble concentrating and remembering things
  • tensing muscles throughout your body
  • sweating
  • having trouble falling asleep or staying asleep

For some, perimenopausal anxiety can lead to panic attacks with dizziness, chest pain, fast heartbeat, fear, and other symptoms.

Language Matters

You’ll notice we use the binary terms “man” and “women” in this article. While we realize this term may not match your gender experience, it’s the term used by the researchers whose data was cited. We try to be as specific as possible when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data for or may not have had participants who are transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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A lot is going on in your body during perimenopause, and there may also be a lot going on in the rest of your life as well. In one study involving Chinese women ages 40–60 years, 11.4% had anxiety during the reproductive phase of their lives. That percentage jumped to 18% during perimenopause.

Declining Estrogen

As mentioned in a 2022 review, animal studies have shown that sharp fluctuations in estrogen levels change the structure and function of the brain. These changes can increase anxiety symptoms and raise the risk for anxiety and other mood disorders.

More research is needed to understand exactly how a drop in estrogen could directly affect anxiety in perimenopausal people.

Physical Symptoms

The physical symptoms of perimenopause can lead to anxiety. As estrogen levels change, you’re likely to start noticing symptoms such as:

Part of the anxiety comes from the sheer unpredictability of these symptoms. It’s hard to know when a hot flash is going to hit. Or if sex is going to be uncomfortable. Or if you’ll get a good night’s sleep before an important event. Or when your period is going to start or if it will even start again.

If you have anxiety sensitivity, which is when anxiety symptoms cause you to feel fear, these symptoms can be even more distressing. And if you’re part of a minoritized group, your experience with perimenopausal healthcare may be adding to your stress.

Mid-Life Challenges

Perimenopause happens at a time in life when lots of other changes are happening. If you have children, they may be reaching their teen years or heading off to college and career. If you want to have children but haven’t yet, you may feel pressure, depression, or even grief. If you’re childfree by choice, menopause may represent a freedom from birth control. It may also prompt emotions surrounding the finality of your choices.

You may have a few health challenges on your hands. Your financial needs and resources may have changed, possibly because of a major career shift. Or you may be one of a growing group of people who divorce later in adulthood, a phenomenon sometimes called “gray divorce.”

All these mid-life experiences are associated with anxiety, so it can be hard to determine exactly what’s causing the extra stress.

You may be able to reduce anxiety during perimenopause by working with a healthcare professional and taking some practical steps on your own. Here’s a look at a few treatments that may help anxiety symptoms:

  • Sound sleep measures: Protecting your sleep is so important during perimenopause. That’s because the relationship between sleep and anxiety is a two-way street. Anxiety can interfere with sleep, and the lack of sleep can increase anxiety. Practice good sleep hygiene, and avoid caffeine and alcohol later in the day or before bed.
  • Hormone replacement therapy (HRT): Though not a first line treatment for anxiety, HRT may be helpful with VMS and sleep disturbances associated with perimenopause, and these improvements may help some people with some anxiety symptoms.
  • Exercise: Aerobic exercise (activity that raises your heart rate), such as dancing, brisk walking, or jogging, has been shown to improve anxiety in perimenopausal people, whether you do it on your own or in a group.
  • Mindfulness-based stress reduction: Research has shown that mindfulness-based stress reduction techniques help people feel less anxiety. Additionally, they may also help with some other hormone-related perimenopause symptoms.

There’s no single test to determine whether you have anxiety during this transition, but there are validated screening tests for anxiety, such as the GAD7 that mental health professionals may use to better understand your symptoms. A health professional can ask you questions about your symptoms, when they started, and what makes them better or worse.

If your anxiety symptoms are keeping you from carrying out your daily activities, you may be diagnosed with an anxiety disorder.

The uncertainties of perimenopause — and the anxiety they bring — will eventually ease. Exactly how long perimenopause lasts will be different for each individual. Health experts say that for most people, perimenopause lasts several months but can be as long as 14 years.

It’s important to note that some people report panic disorders in perimenopause. It’s also important to note that sleep disorders can lead to depression and other long-term health problems if left untreated.

Possibly. If you have anxiety about what this transition will be like, you may be able to reduce some of that stress by having conversations with people you trust. That could be a friend who is in the same boat, an older relative who has already experienced perimenopause, or a health professional with whom you can speak openly.

Some medications may be able to reduce stressful perimenopause symptoms, saving you that anxiety. And some changes to your sleep and exercise routines could keep you from experiencing too much anxiety.

You can’t prevent all the changes perimenopause brings, but you may be able to lessen the grip of anxiety as you transition.

What about depression? Can you experience depression during perimenopause?

Yes. For some, depression symptoms go hand in hand with anxiety and perimenopause.

I’m worrying a lot about the changes in my body shape. Can perimenopause lead to an eating disorder?

About 3.5% of women have an eating disorder at mid-life, studies show. Researchers say that 29.3% of women in perimenopause are unsatisfied with their weight or body shape. If you think you might have an eating disorder, the National Eating Disorder Association offers resources to help.

Will a glass of wine take the edge off this anxiety?

Health experts recommend no more than one drink a day. More could interfere with sleep, increase hot flashes, and raise your risk of other health conditions like heart disease. Researchers note that people often change how much they drink during perimenopause — for better or worse.

During perimenopause, your body slows its production of estrogen, which leads to the end of your periods. It can also lead to anxiety. The changes in your body and brain can bring on symptoms like sleep problems, sweating, trouble concentrating, irritability, and more.

While you can’t always control the way perimenopause affects your body, if you are experiencing anxiety during perimenopause, there are things you can try, like mindfulness, exercise, anti depressant medication, and others. If anxiety is making perimenopause harder, reach out to people you trust, including health professionals who can help you find treatments that work for you.