How to Handle Anxiety During Perimenopause

Micah Abraham, BSc

Written by

Micah Abraham, BSc

Last updated October 10, 2020

How to Handle Anxiety During Perimenopause

Menopause is a time of significant transition in a woman's life. But prior to menopause, there is another (much longer) transitional period known as "perimenopause."

Menopause is not an event that typically comes out of the blue. Perimenopause occurs before a woman enters menopause, and is when a woman experiences a change in her menstrual cycle, with her periods becoming irregular, less frequent, and often lighter in flow. These changes occur due to the hormonal shifts that begin to take place during the perimenopause period.

Perimenopause can be a stressful time, and one of the most difficult side effects for many women is the increased levels of anxiety.

Complex Causes of Perimenopausal Anxiety

Women report experiencing mood changes during perimenopause, including an increase in anxiety. Anxiety is extremely common during this time, and while some of the anxiety may be due to the changing hormones, there are other reasons as well.


Many believe hormones are solely to blame for the increased anxiety during perimenopause, and while this is not true, they certainly do play a role.

Hormones have a direct link to the production and management of neurotransmitters in the brain, including those that regulate anxiety levels. When the levels of neurotransmitters shift in the brain during perimenopause, it can lead to a considerable amount of mental stress and trouble coping - emotional changes that "feel" completely normal but are nothing more than a response to inadequate regulation of these neurotransmitters.

Yet hormones are not the only factor in that anxiety.

Body Changes

Women going through perimenopause often report body changes. Some of these bodily changes take place due to the hormonal shifts that naturally occur during this time, but body changes can also occur for other reasons.

Regardless of why a woman’s body is changing during this period, it can bring about a significant amount of stress. The more stress a woman feels, the more susceptible she is to having anxiety. Unfortunately, because of the strong mind/body connection (which has been substantially researched), the stress and anxiety a woman feels can actually trigger more changes in the body. This can become a vicious cycle.

Fear of the Changes

Perimenopause is a complex time for most women. And while a great deal of anxiety comes from the hormonal or body changes, much anxiety also comes from the fear of those (or other) changes, such as getting older. Perimenopause and menopause are substantial life events. All of the changes women go through during perimenopause can contribute to reflecting on the past, thinking about the future, and for some, trying to come to terms with mortality.

Perimenopause often begins between the ages of 30 and 40 when women have decades upon decades of life left. But it is often one of the first indicators or changes a woman goes through that is connected to getting older. This means can force women to consider their age, perhaps more than they had previously, and think more about their past and future. That causes a great deal anxiety.

Combine those feelings with the overall fear of eventually getting anxiety, and it's easy to see why this period can be so stressful.

Hot Flashes and Symptom Stress

Perimenopause symptoms, which of course can look a bit different for each woman, are, overall, quite stressful. One of the most commonly discussed are hot flashes. Hot flashes are sudden periods of intense heat that may occur at any time, but often occur at night. Hot flashes can make it difficult to sleep and cause considerable stress while awake.

Many women have to drastically alter their life to adjust for hot flashes, and often find that the adjustments they make are insufficient to reduce the stress that those hot flashes cause. In this sense, the hot flashes themselves start to cause ongoing distress, which can develop into anxiety. Additionally, when many women experience hot flashes, they fear more hot flashes occurring, which further contributes to anxiety.

Anxiety Increasing Perimenopausal Symptoms

Similarly, studies have shown that menopausal symptoms (and presumably perimenopausal symptoms as well) are made worse by stress and anxiety. For many women, the core issue may not be attributed solely to the perimenopause itself. Instead, the problem may be the stress, which then can cause perimenopausal symptoms to be worse, and in turn causes an increase in anxiety.

Finally, perimenopause tends to come at a time when there are other stressors in a woman’s life. Between the late 30's and early 50's, many women struggle with a variety of life issues, and what is sometimes blamed on perimenopause may be nothing more than life stress that happens to coincide with a very similar time. For example, many women going through perimenopause have children, and being a parent is a big contributor to stress in adults.

These are a variety of potential issues that can create some form of anxiety. And, most likely, the anxiety a woman feels during perimenopause is the result of an interaction of a combination of life stressors, and not quite as simple as saying "it is hormones.”

How to Curb Perimenopausal Anxiety

Anxiety, regardless of the cause, is hugely distressing. Whether a woman is struggling from anxiety as a result of perimenopause or otherwise, there are ways to manage and curb that anxiety through the use of effective anxiety reduction strategies.

One of the best things a woman can do is talk to a medical professional about the symptoms of her perimenopause, including the stress and anxiety. Asking questions about how to better manage the anxiety and whether or not there are any things to consider in terms of improving one’s physical or mental health can be a great place to start.

Other helpful ways to manage anxiety might including joining a support group, which can provide a safe space to talk with other women about the experience of perimenopause and resulting symptoms. Support groups can help a person feel more connected, and gain additional insights or thoughts on how to cope with the perimenopausal experience.

There are also natural supplements that can help decrease anxiety, including Kava. Kava is an herbal supplement that research shows effectiveness in perimenopausal women. Kava is one of the few herbs that has actually been researched for anxiety, and the effects tend to be strong with minimal (if any) side effects. There were fears that kava could lead to liver issues, but most new studies show that it is likely safe in the recommended doses. Just to be safe, of course, always talk to your doctor before starting any herbal or non-herbal medicine.

Questions? Comments?

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Where can I go to learn more about Jacobson’s relaxation technique and other similar methods?

– Anonymous patient


You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process.

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