Anxiety in Perimenopausal Women: Understanding the Struggle and How to Cope 

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If you’ve been feeling overwhelmed, suddenly gripped by anxiety, or finding yourself trapped in a cycle of overthinking, trust me, you’re not alone. Many women in their 40s, including myself, and especially during perimenopause, start noticing that anxiety seems to show up more often, and sometimes out of nowhere. You may even be wondering: Why is this happening? 

I get it. In my early 40s, anxiety began to creep up more frequently. By 47, I’d feel the tight grip of worry at the oddest times—like when everything seemed just fine on the surface, or when I had a thought about something I needed to get done, or even when a memory popped up and I began to overthink. It was frustrating. If this sounds familiar to you, know that it’s common and you are not alone. And it’s okay to ask for help. 

How Does Anxiety Show Up During Perimenopause? 

For many women, perimenopause brings a whirlwind of changes. It’s not just about hot flashes and sleep disruptions. Along with the myriad of other perimenopausal symptoms, anxiety can often sneak in during this time. But how does it look for other women, and how can you spot it? 

• Sudden, Unexplained Worry: You’re just sitting there, doing your thing, and suddenly your mind starts racing with “what ifs.” The future feels uncertain and overwhelming. You may start to catastrophize, imagining the worst possible outcome. It’s like your brain goes into overdrive, thinking about everything all at once. 

• Physical Symptoms: Anxiety can show up physically too—heart palpitations, sweaty palms, trouble breathing, or feeling a bit dizzy. I know for me, it felt like my body was reacting faster than my mind could catch up during intense episodes of anxiety. 

• Sleep Disruptions: Waking up in the middle of the night with your mind buzzing, your thoughts racing, unable to calm down or feeling restless in the morning. It’s exhausting. A lack of quality sleep only makes anxiety worse, creating a frustrating cycle. 

• Irritability and Mood Swings: Ever feel like you’re on an emotional rollercoaster? One minute, you’re fine. The next minute, you’re ready to snap. Your patience is thin, and things that never used to bother you suddenly feel intolerable. For me, this contributes to my anxiety. I aim to feel balanced most of the time. It brings me stability and peace within myself. Mood swings and irritability crank up my anxiety. Why can’t I get this under control? 

• Loss of Confidence: It’s normal to feel unsure about things in life. But with anxiety, it can feel like a sudden loss of self-assurance—questioning your abilities, decisions, and even relationships. 

Why Is This Happening? A Hormonal Rollercoaster 

As our bodies go through perimenopause, the hormonal shifts are not just physical—they’re emotional too. When estrogen and progesterone fluctuate, they affect neurotransmitters like serotonin, which play a key role in mood regulation. This imbalance can make anxiety feel more intense or frequent. 

And let’s not forget about cortisol, the stress hormone. Perimenopause can cause cortisol levels to rise unpredictably, leading to feelings of anxiety, restlessness, and fatigue. The result? Your body’s response to stress may be amplified during this time. 

Cortisol. Huh. So, I did some research… 

When you’re under stress, your body triggers the “fight-or-flight” response, a survival mechanism. This involves a cascade of events, including the release of cortisol to help you deal with the stressor. For instance, cortisol helps provide energy by releasing glucose and fatty acids into the bloodstream to fuel your muscles and brain for quick action. 

However, when you’re constantly under stress—whether it’s from work, personal life, or even hormonal changes like perimenopause—cortisol can stay elevated for longer than it should. This can lead to a range of issues, including anxiety. 

Here’s how cortisol relates to anxiety: 

1. Elevated Cortisol = Heightened Anxiety: When cortisol levels stay high, it can contribute to feelings of anxiety. The body’s “fight-or-flight” response is triggered more easily, even when there’s no immediate threat. You might feel like your body is constantly on alert, which can lead to anxiety and restlessness. 

2. Disrupted Sleep: Cortisol naturally follows a daily rhythm—it’s highest in the morning to help you wake up and lowest at night to allow restful sleep. But when cortisol is chronically elevated (due to stress or hormonal fluctuations), it can interfere with sleep, making it harder to relax and fall asleep. Lack of sleep, in turn, worsens anxiety. 

3. Hormonal Fluctuations in Perimenopause: As you approach perimenopause, your estrogen and progesterone levels fluctuate, which can also affect cortisol regulation. In some women, perimenopausal hormonal shifts can lead to an exaggerated cortisol response, making anxiety more pronounced. 

4. Impact on the Brain: Cortisol has direct effects on the brain, especially the amygdala, which is responsible for processing emotions. Elevated cortisol levels can make the amygdala more sensitive, leading to exaggerated emotional responses to stressors and even causing anxiety to feel more intense or irrational. 

5. Increased Sensitivity to Stress: When cortisol is constantly elevated, your body becomes more sensitive to future stressors. What might have once seemed like a minor issue (e.g., a work deadline) may feel overwhelming, leading to anxious thoughts and physical symptoms like a racing heart. 

How Can You Alleviate Perimenopausal Anxiety? 

1. Movement: Exercise is a natural mood booster. Even a daily walk or some gentle yoga can make a huge difference in how you feel, helping to regulate both mood and sleep. 

2. Mindfulness and Meditation: Practicing mindfulness or meditation can help center your mind and calm those racing thoughts. It may feel strange at first, but it really works. One technique that works for me while meditating, especially to get me started, is ‘square breathing’. I take one big breath in through my nose on a count of 4, hold it for 4 seconds and let it out slowly on a count of 8, and lastly wait 4 more seconds before I take my next breath. This technique helps to slow my mind down and focus on the meditation. 

3. Sleep Hygiene: Creating a routine that promotes restful sleep can help keep emotions balanced. This means reducing screen time before bed, sticking to a sleep schedule, and avoiding caffeine late in the day. Self-care also fits well with a good sleep routine. Establishing a shower/facial care regime before bed can help with relaxation. Reading a good book, be it fiction, inspirational or self-help can help reduce stress and anxiety too. Repeating daily affirmations before bed can not only help with anxiety but also solidifies a sense of self-love over time. 

4. Balanced Nutrition: Eating a diet rich in nutrients and healthy fats can support overall health and help keep emotional dysregulation at bay. Avoiding excessive caffeine and sugar can also prevent spikes in hormone levels, such as cortisol, which contributes to higher levels of anxiety. 

5. Supplements & Herbal Remedies: I’ve found that magnesium and omega-3s help ease the anxiety rollercoaster for me. A great magnesium supplement Sylvie & Nat can recommend is CanPrev Pure Magnesium Bisglycinate 200g, which you can find on Amazon here. Some women take ashwagandha, but I haven’t given that one a try, so I can’t personally speak to its efficacy. Evening primrose oil is another suggested option for hormonal balance. Always check with your healthcare provider before trying new supplements. 

6. Therapy & Talking It Out: Cognitive Behavioral Therapy (CBT) can teach you to identify and change the negative thought patterns that fuel anxiety. Talking to a therapist can give you tools to better manage stress. One tip that came from my therapist was to identify with my 5 senses during a moment of high anxiety. What can I see? What can I hear? What can I smell? What can I taste? What can I feel? It really is helpful in bringing me back to the present moment and regulating my emotions. 

7. Consider Hormone Therapy: If your anxiety is overwhelming, it’s worth discussing hormone therapy or medications (like SSRIs) with your doctor. Sometimes a bit of extra support can make all the difference. 

8. Support Groups: You’re not alone in this. Sometimes, just talking to other women going through the same thing can be incredibly comforting and reassuring. Whether online or in person, connecting with others can make you feel less isolated. That’s the goal with Sylvie & Nat – building community together! 

Final Thoughts: You’re Not Alone 

Perimenopausal anxiety is real, and it’s okay to acknowledge it. By understanding the hormonal shifts happening in your body and recognizing the signs of anxiety, you can take steps to manage it effectively. Whether it’s making small lifestyle changes, seeking professional support, or simply giving yourself grace, there’s a path forward. 

Remember, this is just a phase—and with the right tools, you can get through it. If you’ve been feeling anxious lately, I hope this post helps you realize you’re not alone, and there’s support out there for you. If you’d like to read more on the topic of perimenopause/menopause, these two books we can personally recommend. 

Click on the titles below to find out more!

Share your experience! Let’s release the stigma of perimenopause and anxiety. Let’s talk about it! Comment below. 

📌Written by Sylvie 
💬 Sharing my journey to learn, laugh, and grow on Peri Lane. 

Loved this? You might also enjoy CanPrev Magnesium Bisglycinate 200mg Review: The Best Magnesium for Sleep & Stress?