Why does perimenopause cause anxiety? Signs and solutions
Hormonal Changes in Menopause: Causes & Solutions
The period leading up to the menopause, known as the perimenopause, is often characterised by a series of symptoms which can affect women to varying degrees. These symptoms are caused by sudden fluctuations in hormone levels in your body and, in particular, the decline of hormones that play a vital role in reproductive health..
During the perimenopause, a woman’s body undergoes significant physical and emotional changes, the effects of which can, understandably, contribute to the mental health issues.
How Reproductive Hormones Can Impact Your Mental Health
The main hormones associated with the perimenopause are oestrogen and progesterone, but it’s important to understand that all hormones in our body are part of an ecosystem, with most hormones influencing or stimulating the production of others.
This is the case for oestrogen and progesterone. They aren’t simply hormones that govern the reproductive system, there are oestrogen and progesterone receptors throughout your body. When levels of these hormones start to decline sharply during the perimenopause, every system that houses any receptors, including your brain, registers these changes.
As the hormone receptors in your brain start to dip, this disrupts the delicate chain of biochemical activity, which, in turn, impacts the production of mood-regulating hormones, like serotonin and dopamine. Accordingly, you may experience changes in your mental health, with an increase in symptoms of anxiety during the perimenopause (1).
It’s important to note that while it can be normal to experience symptoms of anxiety — such as irritability, nervousness or tension, feeling fearful for no reason, and a racing heart — during the perimenopause, but that frequent high anxiety or panic attacks can be a sign of something more serious, and should be addressed by a medical professional.
How Other Menopause Symptoms Can Cause Anxiety
Just as oestrogen and progesterone play an important role in your reproductive organs and brain, they also play a part in regulating your body temperature. Declining levels of these hormones commonly manifest themselves as hot flushes, which is an intense feeling of heat spreading across your body and face.
Hot Flushes and Night Sweats
Research has found there could be a significant link between perimenopausal hot flashes and anxiety (2, 3, 4). Not only can experiencing a hot flush at an inappropriate time be stressful, but there is also evidence that suggests that anxiety can increase the risk of hot flashes (2).
Why Does Menopause Cause Sleep Problems?
When hot flushes occur at night, they are referred to as night sweats. Night sweats often lead to fragmented sleep and next-day fatigue. Before a hot flush, your body temperature rises and, consequently, wakes you up. Most hot flushes last around three minutes, resulting in decreased overall sleep efficiency.
But quality sleep is essential for emotional stability. Inadequate rest can pave the way for anxiety and vice versa. Together, anxiety and sleeplessness intensify the effects of each other, creating a negative feedback loop.
According to the sleep expert, Matthew Walker, the brain reverts to its primitive pattern of uncontrolled reactivity when sleep-deprived, which explains why anxiety is more likely after a night of broken sleep (5).
Sometimes the feelings that precede a hot flush can imitate or trigger a panic attack. The symptoms of a panic attack include chest pain, dizziness, heart palpitations, shortness of breath and feeling ‘disconnected’ from reality, and many women report similar feelings before a hot flash.
Perimenopause Anxiety in the Morning
Experiencing anxiety in the morning is another common symptom of the perimenopause. Generally speaking, levels of cortisol, your stress hormone, are higher in the morning to rouse you from sleep. Before the perimenopause, oestrogen helped to control this spike in cortisol.
As you enter the perimenopause, however, lower levels of oestrogen mean that there is more cortisol to overwhelm your nervous system in the morning. This surge in cortisol explains why you may feel more anxious as soon as you wake up.
How Long Does Perimenopause Anxiety Last?
Most perimenopausal symptoms last around four years on average, but this can differ from woman to woman. The symptoms will pass, however, as your hormone levels rebalance themselves (1).
It’s important to acknowledge that the perimenopause is a time of significant changes, both to your body and your life, so it’s normal to feel out of control. You may find your behaviour changes during this time, but remind yourself you are OK, and this is a natural reaction to hormonal fluctuations and challenging symptoms.
To manage perimenopause anxiety, you could benefit from the following interventions.
Use relaxation techniques: meditation, yin yoga, deep belly breathing, and regular exercise are helpful ways to relax your nervous system and offset anxiety. Make relaxation a non-negotiable part of your daily life.
Minimise morning stress: try exercising first thing in the morning to burn off excess cortisol. Avoid having any caffeine as this may intensify anxiety.
Consider supplementation: St John’s Wort, magnesium, and theanine & lemon balm are known to contribute to normal psychological function and support the reduction of anxiety. Valerian is traditionally used for the relief of night-time disturbances and may aid sleep.
Get help if you need it: don’t be afraid to seek out support if anxiety and panic become too challenging. Talking to your GP or finding a suitable therapist can be a helpful place to start.
While the menopause and its associated symptoms can be difficult to navigate, understanding what’s happening is a big step in being able to manage this period of your life effectively. If you found this article useful, please browse the rest of our Menopause hub to learn more about managing the menopause.
Bromberger JT. et al., Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause. 2013;20:488-495.
Freeman. EW., Sammel MD., Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort. Menopause. 2016;23:942-949.
Hanisch LJ. et al., Hot flashes and panic attacks: a comparison of symptomatology, neurobiology, treatment, and a role for cognition. Psychol Bull. 2008;134:247-269.
Juang K-D. et al., Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas. 2005;52:119-126.
Connell, M. (2019). Why We Sleep by Matthew Walker review – how more sleep can save your life. Available online: https://www.theguardian.com/books/2017/sep/21/why-we-sleep-by-matthew-walker-.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Olivia Salter has always been an avid health nut. After graduating from the University of Bristol, she began working for a nutritional consultancy where she discovered her passion for all things wellness-related. There, she executed much of the company’s content marketing strategy and found her niche in health writing, publishing articles in Women’s Health, Mind Body Green, Thrive and Psychologies.