Oct 11, 2022
Perimenopause anxiety symptoms can include feeling on edge, racing thoughts, disrupted sleep, irritability and difficulty concentrating. Anxiety and mood changes can occur during perimenopause, and some people notice new or worsening symptoms during the transition. Hormonal changes may contribute, but anxiety can have several causes. If these changes are affecting your daily life, speaking to your GP and getting emotional support can help you understand what may be happening.
It is 3am and you are wide awake. You have a full day of work ahead, the children will be up in a few hours and your partner is asleep beside you, but your mind is already racing through everything that needs to be done tomorrow. Worries that would barely register during the day suddenly feel enormous. Your heart is pounding, your thoughts will not slow down and there is a heavy sense of dread that you cannot quite explain.
You reach for your phone and see someone describing waking at the same time with sudden anxiety. Another person mentions brain fog and irritability. Someone else says they no longer feel able to cope with things that used to be easy. You begin to wonder whether perimenopause could be part of the explanation.
If you are in your late 30s or early 40s, perimenopause may not be something you have considered. You may have assumed that you are stressed, exhausted or struggling with the demands of family and work. If you have noticed several physical, emotional or menstrual changes that do not feel like you, it is worth discussing them with your GP.
Perimenopause is the transition leading up to menopause. Hormone levels change during this time, periods may become irregular and physical or emotional symptoms can occur. Menopause is reached when you have gone 12 consecutive months without a period, provided you are not using hormonal contraception that affects your bleeding pattern.
The transition often begins in the 40s, but symptoms can start earlier. If you are under 40 and think you may be experiencing perimenopause, speak to your GP. Other causes may need to be considered, and possible premature ovarian insufficiency may require assessment.
A change in periods is usually one of the first signs. You might also notice night sweats, disturbed sleep, palpitations, headaches, joint pain, changes in mood or greater difficulty concentrating. None of these symptoms proves that you are experiencing perimenopause, but a combination of changes is worth discussing with your GP.
There is no single pattern. For some people, anxiety feels familiar but suddenly becomes stronger. For others, it seems to appear without an obvious reason. You may worry about things that would not normally bother you, feel unable to relax or wake during the night with an immediate sense that something is wrong.
Possible experiences include:
Chest pain or tightness should not automatically be attributed to anxiety or perimenopause. Ask for medical advice if symptoms are new, persistent or concerning. NHS chest-pain guidance says to call 999 for sudden chest pain or discomfort that does not go away, pain that spreads, or chest pain accompanied by sweating, nausea, light-headedness or breathlessness.
Disrupted sleep can make everything else feel harder. You wake in the middle of the night and immediately begin worrying about why you are awake, how tired you will be tomorrow and everything you have not managed to do. The longer you are awake, the more you worry about not sleeping.
By morning, you are exhausted before the day has properly begun. Tiredness can make stress and emotions harder to manage, leaving you more irritable, tearful or anxious. That anxiety can then make it harder to switch off the following night.
Sleep problems are recognised during perimenopause, and poor sleep can increase stress and anxiety. The NHS menopause symptoms guide explains that sleep, mood and concentration can affect one another. Struggling when you are exhausted is not a personal failing.
Conversations about perimenopause often focus on hot flushes and changes to periods, but symptoms can be wider than that. The NHS also recognises anxiety, low mood, mood swings, sleep problems, memory difficulties and problems with concentration.
You may still be doing everything you normally do. You get the children where they need to be, turn up for work and keep the household moving, but it all feels harder than it once did. One of the most unsettling experiences can be the sense that you no longer feel like yourself.
Hormonal change may be one part of the picture, while sleep, physical symptoms and circumstances can also influence how you feel. Perimenopause may coincide with parenting, career pressure, caring responsibilities, relationship changes or financial worries. These factors can overlap rather than having one simple cause.
For example, changing symptoms may disturb sleep. Exhaustion can make everyday stress harder to manage, which can increase anxiety. Anxiety may then make it harder to sleep. This does not mean that symptoms are all in your head, and it does not mean that every anxious moment is caused by perimenopause.
If you have noticed persistent physical or emotional changes, speaking to your GP is a sensible place to start. A simple symptom record can help you explain what has been happening. You might note changes to your periods, sleep, mood and anxiety alongside physical symptoms such as hot flushes, night sweats, headaches, palpitations or joint pain.
You do not need to identify the cause by yourself. A GP can consider menopause and other possible explanations. You can also get support for anxiety or low mood while you explore the physical changes.
No single lifestyle change will remove the transition, but practical routines may help you manage some symptoms. Useful steps can include keeping sleeping and waking times reasonably consistent, taking regular exercise, eating a balanced diet and noticing whether caffeine or alcohol makes sleep, hot flushes or anxiety worse.
It can also help to talk to somebody you trust. Social media may help you recognise an experience or find questions to ask, but TikTok and Instagram are not diagnostic tools. A video that feels familiar cannot tell you what is causing your symptoms.
Try to respond to yourself with the same patience you would offer someone else. If you are exhausted, anxious and struggling to concentrate, expecting yourself to function exactly as usual may add more pressure.
Talking therapy is not a hormonal treatment and does not replace medical assessment or treatment for perimenopause. It may, however, help with anxiety, low mood, sleep difficulties and coping with change.
Therapy can give you space to understand why anxiety feels different, notice patterns in the things you worry about and develop ways of responding when thoughts become particularly loud. It can also provide room to explore confidence or identity when symptoms have affected how capable or familiar you feel to yourself.
Head Agenda offers anxiety therapy in Leeds and online for people whose worries, physical anxiety symptoms or sleep difficulties are affecting daily life. You do not need to wait until you are at breaking point before asking for support.
Cognitive behavioural therapy can help you understand the relationship between thoughts, feelings and behaviour. It may support you to question unhelpful thought patterns and change habits that keep anxiety or sleep difficulties going.
NICE guidance recommends considering menopause-specific CBT as an option for sleep problems such as night-time awakening when they occur in association with vasomotor symptoms, including hot flushes and night sweats. It may be considered alongside other management, including HRT, or when other options are unsuitable or not preferred.
You do not need a confirmed diagnosis of perimenopause before seeking support for anxiety, low mood or sleep difficulties. Therapy and medical assessment can take place alongside each other. Your GP can explore the physical symptoms and treatment options, while a therapist can help you work through the emotional impact.
Speak to your GP if you have new or persistent symptoms that affect daily life, work or relationships, or if you have palpitations or changes in bleeding that concern you. Do not assume that every new symptom is caused by perimenopause, because other explanations may need to be considered.
If you need urgent help for your mental health, contact NHS 111 or ask for an urgent GP appointment. Call 999 or go to A&E if your life is at risk or you cannot keep yourself or somebody else safe. Current NHS urgent mental-health guidance explains the available routes.
If you have found yourself awake in the early hours, scrolling through social media and wondering why you suddenly feel anxious, you are not alone. Perimenopause may be part of the explanation, another factor may be contributing, or several things may be happening together.
Speaking to your GP can help you explore physical changes. Talking to a therapist can give you somewhere to work through the emotional impact, understand patterns and find practical ways forward.
If perimenopause anxiety symptoms are affecting your sleep, work, relationships or sense of yourself, you do not need to have every answer before starting a conversation. Contact Head Agenda to discuss support in Leeds or online.