Perimenopause Anxiety and How to Treat It

The word "women" is used throughout this article to refer to people who identify as female and have the typical reproductive organs of a cisgender female. We recognize that some people who identify as female do not have the same anatomy as that depicted in this article.

Menopause occurs when a woman's menstrual cycle has stopped for 12 straight months, signaling the end of menstruation. The transitional period prior to menopause is referred to as perimenopause. During this time, a woman's menstrual cycle begins to change and become irregular. Some women even experience anxiety as a symptom, likely due to hormonal changes.

Read on to learn more about perimenopausal anxiety and how to cope.

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What Are the Symptoms of Perimenopause?

Many symptoms can arise during perimenopause. While not all symptoms will occur in everyone, every person that goes through perimenopause will experience some symptoms, such as:

Perimenopause can last for roughly three to four years prior to the onset of menopause. Menopause is preceded by irregular periods that continue to get less and less frequent, along with the other symptoms of perimenopause.

Why Does Anxiety Happen During Perimenopause?

Anxiety can occur during perimenopause for a variety of reasons. Physiologically, anxiety develops during perimenopause because of hormonal changes that occur in the body in women with brains sensitive to those changes.

During perimenopause, the sex hormones estrogen and progesterone begin to decrease. Changes in levels of estrogen, specifically, have been closely linked to feelings of anxiety.

Along with these hormonal changes are other symptoms of perimenopause that drive anxiety. Hot flashes and a lack of proper sleep can cause anxiety.

Anxiety during this period can also be due to midlife stressors or a fear of aging.

Why Is Anxiety Worse in the Morning?

Researchers believe that anxiety is worse in the morning because of the stress hormone cortisol. Levels of cortisol tend to be highest in the first four hours after waking.

Risk Factors for Perimenopausal Anxiety

According to one study, there are several risk factors associated with changes in anxiety during perimenopause. They include:

  • Higher stress levels in everyday life
  • More severe or frequent hot flashes and sleep disturbances
  • Financial problems
  • Poor health

Premenopausal Anxiety and Perimenopausal Anxiety

Researchers have investigated whether people with high levels of anxiety before starting perimenopause also have high levels of anxiety during the transitional period. They found that women with high perimenopausal anxiety are not at increased risk for high anxiety at specific stages of the menopausal transition, but women with low perimenopausal anxiety may be more susceptible to high anxiety during and after the menopausal transition than before.

Treating Perimenopausal Anxiety

There are various treatment options available for those who experience anxiety during perimenopause. They include:

  • Hormone replacement therapy (HRT): Hormone replacement therapy can help balance hormones and may relieve some of the symptoms associated with the changes, such as anxiety.
  • Antidepressants: Certain prescription medications and antidepressants, particularly those that impact serotonin, may be used to address anxiety, depressive symptoms, and sleep disturbances.
  • Psychotherapy: Psychotherapy has proven to be an effective tool for battling anxiety in all people, so it can also be effective during perimenopause.
  • Cognitive behavioral therapy (CBT): Cognitive behavioral therapy, in addition to addressing anxiety, can help with hot flashes. 
  • Mind-body and exercise techniques: Practicing meditation or implementing a regular exercise routine may help manage symptoms of perimenopause that can drive heightened anxiety.

What Are Mind-Body Techniques?

Mind-body interventions are designed to enhance the connection between the body and the mind to improve well-being. Some examples include:

  • Meditation
  • Biofeedback (a learned technique to control some body functions, such as heart rate)
  • Laughter yoga (combining laughter with yoga breathing techniques)
  • Hypnotherapy

Can You Prevent Perimenopausal Anxiety?

It can be difficult to prevent perimenopausal anxiety, because it is driven by so many possible factors.

You can prepare yourself for the onset of anxiety by practicing good coping skills. This could include getting acquainted with mind-body techniques that work for you, speaking with your healthcare provider, and taking care of your overall health as best you can prior to perimenopause.

When to See a Healthcare Provider

While not all anxiety warrants a trip to your healthcare provider's office, you should make an appointment if you experience anxiety that interferes with your day-to-day life or if you begin having panic attacks.

Your healthcare provider will help you determine the best course of treatment and possibly refer you to other therapies or specialists that can aid in the management of perimenopausal anxiety.

How to Identify a Panic Attack

Panic attacks come on suddenly and can cause you to feel debilitated, as if your entire life is in danger. During a panic attack you may:

  • Feel like you can't breathe
  • Feel your heart pounding
  • Have an intense fear that you are dying

If you are experiencing your first panic attack, you can contact your healthcare provider for an evaluation to rule out medical causes of your symptoms.


Anxiety can be a symptom of perimenopause, which is the period before menopause. This is likely due to hormonal changes—including declining sex hormones—that women experience during the transition, impacting the brain in those who are sensitive to these changes.

Perimenopausal anxiety can be treated with talk therapy, hormone replacement therapy, medication, and mind-body exercises. The anxiety likely can't be prevented, but people can prepare themselves for the possible onset.

A Word From Verywell

Coping with anxiety is difficult, but it can be especially so if you’re also dealing with all the other unwanted symptoms of perimenopause. The best thing for you to do is prepare yourself for the possibility of increased anxiety and speak to your healthcare provider about treatment options. Try to become well-versed in relaxation and anxiety-reducing techniques so that if the anxiety strikes, you’ll be ready to cope.

Frequently Asked Questions

  • How can you help someone who has perimenopausal anxiety?

    Helping someone with perimenopausal anxiety is the same as helping someone with other causes of anxiety. You can first start by validating their feelings. Asking them how you can help, allowing them to open up about their anxiety in a judgment-free zone, and assisting them in seeking help can all be beneficial.

  • When does menopause start?

    Menopause starts 12 months following a woman's last menstrual period. According to the National Institute on Aging, the transitional period that signals menopause typically begins between the ages of 45 and 55.

  • How long does perimenopause last?

    The duration of perimenopause varies significantly from person to person. Typically, it lasts around three to four years. However, it can sometimes last longer than four years and for as little as a few months.

  • What happens during menopause?

    When a person reaches menopause, their menstrual periods stop completely. Hormones drop significantly and lead to symptoms such as hot flashes and vaginal dryness.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.