Anxiety is common in the perimenopause and menopause. Anxiety is a normal human response; it is the way that the body prepares to deal with a threat and is designed to keep us safe.
However, it can become a problem when this becomes excessive. This can take the form of a severe response to a minor threat or we may experience anxiety in the absence of a threat.
Anxiety has both emotional and physical components. Fear, worry, recurring fearful thoughts occur alongside physical feelings of a fast heartbeat, dry mouth, sweating palms, shortness of breath, nausea and dizziness.
Some women have experienced anxiety in earlier life and can identify the symptoms. Many women experience anxiety for the first time in the perimenopause and can be very distressed by this. It can manifest as panic attacks and can lead to avoidance of social situations, driving on the motorway etc.
Common presentations in the perimenopause include:
- Health related anxiety
- Social anxiety – cancelling meetings with friends, dinner out (even after lockdown)
- A sense of feeling overwhelmed even by small things
- Feeling fearful
- Generalised anxiety – worrying about everything and anything
- Panic attacks
What can make it worse?
Symptoms can be made worse by lack of sleep and vice versa; sleep disturbance resulting from night sweats, vaginal irritation and the need to get up to pass urine can all contribute.
Many women find that their intake of alcohol increases in the perimenopause as they try to find something that will aid sleep. Alcohol disrupts the normal sleep cycle, acts as a depressant and exacerbates hot flushes and night sweats. It can also make you need to get up to pass urine in the night. The consequent non-restorative sleep leads to fatigue which contributes to the feelings of anxiety.
Caffeine acts as a stimulant to the cardiovascular system and can precipitate palpitations. It can also disrupt the normal sleep cycle and should be avoided after 6pm or midday in women who are very susceptible to the effects.
How can I help myself?
- Keep a mood diary. When do you experience symptoms? Is it throughout the month or only at certain times? What are your triggers?
- Talk to friends and family. This will facilitate better understanding and support.
- Go outside and sit with nature or walk and talk with friends
- Practice controlled breathing
- Keep a good sleep regime (see further information on Sleep)
- Put a notebook by your bed so that you can write down things that are worrying you if you waken in the night. You might find it helpful to put each worry on a strip of paper, write a time and date that you are going to think about it. Put the slips away and only look at them at the time and date you have written on the slip.
- Eat a healthy diet with complex carbohydrates and avoid high sugar content foods
- Spend time with people who bring you joy
- Exercise in the daytime to help reduce stress and improve physical health
- Find a focused activity that you enjoy – gardening, knitting, sewing, reading, singing etc
- Use a meditation App
- Take up Yoga
- Avoid over committing and set realistic short-term goals
- Focus on ACE activities that bring:
The NHS website, No Panic and Mind all have free resources available at:
What if I am still struggling?
The psychological symptoms of the perimenopause and menopause are less discussed than the physical symptoms but can be very debilitating. Insomnia, fatigue, irritability, anxiety, panic attacks and low mood can impact on quality of life, relationships and a woman’s ability to work. Use a Period Tracker so that you can identify any changes in your menstrual cycle – shorter or longer, lighter or heavier periods – this can alert you to the fact that your hormones may not be in balance. In these circumstances HRT can often help to relieve the symptoms.
Cognitive behavioural therapy is an evidence based talking therapy that can help with anxiety and depression. There is also evidence that CBT can help women to cope with hot flushes. In many areas CCGs have funded direct access to CBT so that you can self-refer without a letter from your GP. To see if this is available in your area search:
Alternatively, you can look for a private registered CBT therapist in your area by searching at:
For some women, anxiety can be particularly problematic, and medication may be indicated in the short term to facilitate engagement with CBT or in the long-term if required. Your GP will be able to assess which is the best medication for you depending on the balance of physical and psychological symptoms.
Dr Alice Duffy
Last updated May 2021