Perimenopause, the transitional time before menopause when reproductive hormones are shifting, can make women more vulnerable to anxiety. This is common, and help is available.

Who may experience anxiety during perimenopause?

It’s common for women to experience some mood changes during perimenopause and menopause. In fact, about 4 in 10 women experience mood symptoms similar to premenstrual syndrome, or PMS, during perimenopause. During perimenopause, PMS symptoms may come at times unrelated to your menstrual cycle.

Women who have a previous diagnosis of anxiety are at greater risk during the perimenopausal time.

What causes anxiety during perimenopause?

Hormonal Factors

When estrogen and progesterone hormone levels drop during perimenopause, serotonin levels also fall, contributing to increased irritability, nervousness and anxiety. Higher levels of cortisol, the “stress hormone” that increases with age, can also create feelings of anxiety.

Physical Factors

Hot flashes, night sweats and sleep disturbances, while all normal symptoms of perimenopause, can contribute to feelings of anxiety and unease.

What are symptoms of anxiety during perimenopause?

Emotional Symptoms

During menopause, it is normal to experience heightened anxiety, become more easily nervous and have frequent mood fluctuations. Your family or friends may notice these symptoms before you do.

Although women are encouraged to always discuss their anxiety and perimenopause-related concerns with a medical professional, the following symptoms require more urgent evaluation from a doctor or other health care provider:

• Anxiety that makes it difficult to perform your daily routine of hygiene, eating and going to work.
• Suicidal thoughts and feeling of hopelessness.

Physical Symptoms

• You may experience a faster heartbeat, increased sweating, shaking or digestive problems.
• Your sleep pattern may be disrupted.

Cognitive Symptoms

• It might be harder to focus or remember things.

Diagnosis for Anxiety During Perimenopause

If you suspect perimenopause-related anxiety, talk to your primary doctor or gynecologist. They can provide a diagnosis and treatment plan, or may refer you to a mental health expert for treatment. Some tests might be conducted to evaluate for other conditions that could be causing your symptoms, such as thyroid disorders.

Treatment for Anxiety During Perimenopause

• Regular exercise, a healthy diet, enough sleep and stress management techniques like yoga or meditation can boost your mood and help ease anxiety symptoms.
• Talk therapy, especially cognitive behavioral therapy, can be effective in handling anxiety by addressing negative thought patterns and developing coping tools. It can also be helpful in addressing nighttime anxiety that can lead to insomnia.
• In some cases, anti-anxiety or sleep-promoting medications may be prescribed to manage symptoms.

Recovering from Anxiety During Menopause

Once perimenopause is complete and hormone levels stabilize, many women experience a decrease in anxiety. This varies greatly from person to person. If you have anxiety that persists after menopause, talk to your doctor about treatment options.