Morning Anxiety During Perimenopause

August 07, 2023.

medically reviewed by Patricia Shelton, MD

What causes it and what can you do?

Anxiety during the menopausal transition is a fairly common experience. In fact, studies have found that more than half of women experience symptoms of anxiety during the menopausal transition. Interestingly, it’s not just women who have previously experienced anxiety who are vulnerable to experiencing anxiety during peri. In fact, some studies have actually shown that those who had the lowest levels of anxiety before menopause are actually at a greater risk for experiencing high anxiety during perimenopause.

Many women in peri find that their anxiety is particularly bad in the morning. What makes morning anxiety such a common experience during the menopausal transition? More importantly, what can you do if you’re experiencing this?

Related: Find out how more than 15.000 women navigate their menopause transition in our free app

Hormonal shifts lead to morning anxiety

There are a variety of reasons why anxiety may occur in perimenopause. However, one major reason is the balance between estrogen and cortisol. Cortisol is one of your body’s primary stress hormones. Having high levels of cortisol tends to stimulate your brain’s stress response, and many people feel anxious when their cortisol levels are up. 

Estrogen reduces your body’s production of cortisol. However, during the menopausal transition, levels of estrogen drop rapidly. This can lead to increased cortisol production, which can cause anxiety. Women who have more vasomotor symptoms (like hot flashes and night sweats) are more likely to experience anxiety, probably because both of these symptoms are related to the rapid drop in estrogen.

Cortisol levels are naturally highest in the morning, peaking around when you wake up. Without the balancing effects of estrogen and progesterone, the morning peak in cortisol may be even higher. This tends to lead to feelings of anxiety during this morning period. 

In addition, both estrogen and progesterone help to regulate the brain’s production of various chemicals that influence mood, such as serotonin and dopamine. When the levels of these hormones drop rapidly, this can shift the brain’s production of these chemicals, which can lead to increased anxiety.

Anxiety can cause a variety of symptoms, including:

  • Feeling nervous, restless, jittery, or frustrated
  • An inability to sleep
  • A sense of impending doom
  • Rapid heartbeat
  • Rapid breathing
  • Headache
  • Nausea or other discomfort in the stomach
  • Feeling lightheaded
  • Trembling, tension, or weakness in the muscles

What can you do to reduce morning anxiety during perimenopause?

Just knowing that your symptoms of morning anxiety are related to hormone levels may be helpful. It can sometimes be easier to deal with anxiety when you know that it has a physiological cause. Studies have shown that, for women who experience anxiety during the menopausal transition, the symptoms will usually get better after menopause is complete.

However, anxiety can be a very uncomfortable experience, and many women are looking for a way to reduce it. There are a few different options you can try:

  • Hormone replacement therapy (HRT). Because anxiety in peri is believed to be related to hormone levels, hormone replacement may be helpful for some women. Research has not been consistent regarding the effects of HRT on anxiety, but some women may find it helpful. It’s definitely been shown to help with symptoms like hot flashes, which many women with anxiety are also experiencing.
  • Exercise in the morning. Getting some exercise as soon as you wake up can help to relieve feelings of restlessness, and may help to burn off excess energy. It can also help to stabilize your mood.
  • Breathing techniques. There are various breathing techniques that can be used to help calm anxiety when it arises. These generally involve breathing slowly and deeply. Learning these techniques may be helpful, so that you can use them when you start to feel overwhelmed. 
  • Reducing caffeine. Caffeine increases cortisol levels, which can make morning anxiety worse. If you’re experiencing anxiety, you may want to consider skipping your morning coffee, or delaying it until later in the morning when your cortisol levels have started to drop.
  • Therapy. You don’t have to deal with anxiety alone. Therapy can be very helpful for many people who experience anxiety. Your therapist will help you to learn techniques for dealing with anxiety, as well as uncovering unhealthy thought patterns that may be making you more anxious.

Although anxiety during peri is very common, it can sometimes be an indication of a serious mental health problem. If your anxiety is severe or if you’re experiencing panic attacks, please reach out to your doctor right away to talk about this. People of any age can develop an anxiety disorder, including women in perimenopause. It’s important to take mental health seriously, and to reach out for help when you need it.

 
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Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.

Sources

Jaeger MB, Mina CS, et al. Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause. Braz J Psychiatry. 2021 May-Jun; 43(3): 277–284. doi: 10.1590/1516-4446-2020-0871

Bromberger JT, Kravitz HM, et al. Does Risk for Anxiety Increase During the Menopausal Transition? Study of Women’s Health Across the Nation (SWAN). Menopause. 2013 May; 20(5): 488–495. doi: 10.1097/GME.0b013e3182730599

Walf AA, Frye CA. Effects of Two Estradiol Regimens on Anxiety and Depressive Behaviors and Trophic Effects in Peripheral Tissues in a Rodent Model. Gend Med. 2009 Apr; 6(1): 300–311. doi: 10.1016/j.genm.2009.04.004

Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. Focus (Am Psychiatr Publ). 2017 Spring;15(2):162-172. doi: 10.1176/appi.focus.20160042

Anxiety. StatPearls (National Library of Medicine). https://www.ncbi.nlm.nih.gov/books/NBK470361/. Accessed 30 July 2023.

Sharma A, Davies R, et al. The effect of hormone replacement therapy on cognition and mood. Clin Endocrinol (Oxf). 2023 Mar;98(3):285-295. doi: 10.1111/cen.14856

Fincham GW, Strauss C, et al. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci Rep. 2023 Jan 9;13(1):432. doi: 10.1038/s41598-022-27247-y

Carpenter JK, Andrews LA, et al. Cognitive Behavioral Therapy for Anxiety and Related Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials. Depress Anxiety. 2018 Jun; 35(6): 502–514. doi: 10.1002/da.22728

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