Managing Menopause Anxiety

Anxiety is one of the most common experiences women report during perimenopause, writes Dr Shabnam Hariri, and it can show up well before the “classic” symptoms like hot flushes or night sweats. For many women, anxiety is the first sign that something is shifting. It can feel as though your mind has become noisier overnight, and you’re suddenly worrying about everything, even when life on the outside looks much the same.

What’s tricky is that a lot of women don’t immediately connect anxiety with perimenopause. They tend to assume they’re “just stressed” or “not coping as well as they used to,” and it can feel confusing or even a bit frightening when this doesn’t match how you normally see yourself. And if you’ve always been someone who manages well, it can be especially unsettling to notice your nervous system feeling more reactive than usual.

Women are generally more likely than men to experience anxiety, and hormonal change is one of the reasons the perimenopause can intensify that vulnerability. As hormones fluctuate, your stress system can become easier to trigger, and anxiety symptoms can become more frequent or more intense. Sometimes perimenopause also acts like a spotlight. It doesn’t create all the struggles out of nowhere, but it can bring to the surface pressures, unfinished emotional knots, or long-standing patterns of over-responsibility and over-thinking that you’ve been carrying for years.

Anxiety can happen at any point in perimenopause, including the early stage when your periods haven’t changed much at all. It can start subtly, almost like a background hum: a bit more tension, a bit more irritability, a sense of being “on edge,” or finding that your thoughts loop more than they used to. Because it creeps in gradually, you might not immediately realise it’s linked to perimenopause.

There’s also a very real layering effect. Perimenopause can bring disrupted sleep, changes in energy, and shifts in how your body feels day to day. When sleep quality drops, everything becomes harder: your tolerance narrows, your emotions sit closer to the surface, and your brain becomes more likely to interpret things as urgent or threatening. If you’re also dealing with gut symptoms, immune changes, or ongoing life stress, your system can start to feel overloaded, and anxiety can take hold more easily.

If you’re experiencing this, you really aren’t alone. And it doesn’t mean you’re “failing,” “weak,” or “going backwards.” Anxiety can happen to anyone, including women who have never had any mental health difficulties before. Perimenopause is a major transition, and it often requires a new way of understanding yourself and caring for your mind and body.

Some physical symptoms of perimenopausal anxiety can include a fast heart rate or palpitations, nausea or a churning stomach, shaking, sweating, a dry mouth, chest tightness or pain, headaches, faster breathing, panic attacks, sleep disruption, and feeling more irritable or snappy than usual. When these sensations arrive, it can be easy to misread them as a sign that something is seriously wrong, which can then feed the anxiety further.

So what causes perimenopause-related anxiety? During perimenopause and menopause, many changes can be happening at the same time, so it isn’t always possible to point to one single cause. Anxiety can sometimes sit alongside low mood or depression, and both can be influenced by falling oestrogen levels. Oestrogen also interacts with cortisol, which is one of the body’s key stress hormones. When oestrogen drops, cortisol can rise, and that can make your stress response feel more activated. There are likely other hormonal and brain-chemical factors involved too, and it often becomes a “perfect storm” of biology, life stress, sleep disruption, and emotional load.

The good news is that anxiety is treatable, and you don’t have to white-knuckle your way through this. Cognitive Behavioural Therapy (CBT) is an evidence-based therapy used by clinical psychologists to help you understand how anxiety works in your mind and body, and to develop steadier, healthier ways of responding to it. CBT helps you change unhelpful thinking patterns, reduce the behaviours that unintentionally keep anxiety going, and build practical strategies so you can feel more grounded and more like yourself again.

CBT is also recommended by NICE for anxiety and depression, including in the context of perimenopause. Many women describe being caught in a vicious cycle during this stage: anxiety leads to poor sleep and fatigue, fatigue lowers resilience and mood, and then everything feels harder to cope with. CBT works with that cycle directly, helpin

g you interrupt it gently but effectively.

A clinical psychologist can use CBT to target the specific ways perimenopause is showing up for you, whether that’s anger and mood swings, insomnia, intrusive or overwhelming thoughts, low self-esteem, or a sense that you’re constantly “not quite on top of things.” It can also support you in changing coping strategies that may have crept in during this time, such as drinking more than you want to, comfort eating, binge eating, or withdrawing from people.

Research also suggests that perimenopausal symptoms like hot flushes, night sweats, and anxiety can be triggered or worsened by life stressors. When you learn to manage stress differently, your nervous system often becomes less reactive, and symptoms can reduce in frequency or intensity. The aim isn’t to pretend this is easy, or to minimise what your body is doing, but to help you feel steadier, safer inside yourself while you move through it.

Perimenopause is serious and it can be genuinely challenging. It can last several years, and for some women symptoms continue after periods stop entirely. That’s why it matters that you feel properly supported, not brushed off, not told you’re overreacting, and not left to figure it out alone. Therapy should feel like a place where you can exhale, make sense of what’s happening, and be met with calm, evidence-based guidance.

Talk therapy with a clinical psychologist can offer a confidential and supportive space where you can process what’s going on, feel heard and understood, and make sense of the emotional and identity shifts that can come with perimenopause. It can help you learn practical strategies for handling stress, anxious thinking, and low mood, and also give you space to troubleshoot the real-life pressures that often collide at this stage, such as family dynamics, relationship strain, work stress, health worries, changing roles, and a shifting sense of who you are. And it can help you set new goals for this next chapter, with steady support to actually bring them into being.