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.

Get Your Expert Essentials
Which perimenopause topic are you interested in?
(we won’t annoy you – promised!)
Wonderful and welcome to the perry community!

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.


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). 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

  • Menopause Destroyed My Marriage: How Relationships Change

    Menopause Destroyed My Marriage: How Relationships Change

    If only our vows went like this: “In sickness and in health, for richer or poorer, in good times and in bad, and in menopause…” The reality is, divorce rates are rising in the United States, and there are so many different factors that cause couples to go their separate ways. But many women wonder,…

    Find out more

  • 5 Key Interventions for Better Sleep During Perimenopause

    5 Key Interventions for Better Sleep During Perimenopause

    Medically reviewed by Patricia Shelton, MD Many women find that their sleep suffers during perimenopause. When you’re not sleeping well, it can affect every other aspect of your life, from your mood and energy levels to your ability to think clearly and remember things. Not getting enough high-quality sleep can have a huge negative impact…

    Find out more

  • Vaginal Estrogen Cream – What You Need To Know

    Vaginal Estrogen Cream – What You Need To Know

    Medically Reviewed by Dr. Patricia Shelton, MD During perimenopause and after menopause, many women experience symptoms like vaginal dryness and pain during intercourse. These are symptoms of vaginal atrophy, which affects around half of all postmenopausal women. This condition occurs because when the body’s estrogen levels drop, the tissues of the vagina become thinner. What…

    Find out more

  • Spotting But No Period: What Does It Mean?

    Spotting But No Period: What Does It Mean?

    By Lemetria Whitehurst RN Periods. Let’s admit we have a love/hate relationship with them. For some it is a good reassurance that everything is according to plan. For others an unnecessary visitor every month. With perimenopause your period can become more irregular. It is actually one of the most telling sign and symptoms. Spotting but…

    Find out more

  • The Best Way to Manage Itching With Menopause

    The Best Way to Manage Itching With Menopause

    By Lemetria Whitehurst RN It’s hard enough to figure out what exactly is happening during menopause, let alone trying to make sense of weird symptoms like itching. This mysterious symptom can be highly uncomfortable and annoying whether you’re experiencing it on your skin, scalp, or even privates. In this blog post, we will explore why…

    Find out more

  • Postmenopausal: What it Means & What Changes

    Postmenopausal: What it Means & What Changes

    Postmenopause can be defined by dissecting the word itself. The Latin word “post” means “after”, thus it means literally “after menopause”.  It is not necessarily an event, but rather a time frame.  Being postmenopausal inhabits a block of time in menopause and marks the last chapter in the journey of passing our childbearing years. Briefly,…

    Find out more

  • What Are The 34 Symptoms Of Menopause?

    What Are The 34 Symptoms Of Menopause?

    Many realize they are in perimenopause when they become bombarded with new, often unpleasant symptoms that affect their day-to-day. We are all unique in how we experience perimenopause, but there are 34 symptoms of menopause that women in this transition can experience. Read on to gain a deeper understanding of each of these symptoms that you may…

    Find out more

  • Are Internal Vibrations A Sign Of Perimenopause?

    Are Internal Vibrations A Sign Of Perimenopause?

    Internal vibrations or tremors can be a disconcerting symptom. They are talked about in our perry community very often. Unlike external tremors, internal tremors are unseen and cannot be felt on the outside of your body. These invisible sensations are often felt in your trunk, arms, and legs. Some people also feel them in their…

    Find out more

  • Most Important Supplements During Perimenopause

    Most Important Supplements During Perimenopause

    In our expert Q&A  with Suzie Welsh – founder of Binto and a women’s health and fertility nurse – we finally get the answers to our most pressing supplements questions. 1. What are the most important supplements during perimenopause? The most important supplements I recommend taking for perimenopause and menopause support are the ones that…

    Find out more

  • Will I Ever Feel Normal And Healthy Again?

    Will I Ever Feel Normal And Healthy Again?

    Because the symptoms in perimenopause can be so nebulous, women can feel unwell during their menopause journey. Often, women even feel sickly because of the nature of the symptoms they endure. But keep in mind there are so many factors that contribute to the way you feel during your menopause years. From work and family…

    Find out more

  • Why Do I Have Sore Nipples in Perimenopause?!

    Why Do I Have Sore Nipples in Perimenopause?!

    It is not a clean, easy split when we say goodbye to our ovarian function. Most of us struggle physically, mentally, and emotionally in the years before we can officially say the final goodbye to our menstrual period. And, this separation is often met with a slew of emotions. Some women are thrilled to see…

    Find out more

  • What You Should Know About Antidepressants & Perimenopause

    What You Should Know About Antidepressants & Perimenopause

    Depression is a common symptom experienced by women in perimenopause. And while there is little scientific evidence suggesting that perimenopause causes depression, doctors and scientists alike are well-aware that hormonal imbalance can cause depression in women. Even though depression is one of the symptoms of perimenopause, it does not mean that you have to suffer through…

    Find out more

  • The 4-1-1 on Perimenopause Symptoms

    The 4-1-1 on Perimenopause Symptoms

    Women go through different stages as they progress through their menopausal years. There are four different stages: premenopause, perimenopause, menopause, and postmenopause. Perimenopause can feel like a rocky road to menopause because it is met with some intense perimenopause symptoms. Typically, women are more prepared for menopause because it is talked about more openly compared […]

    Find out more

  • Why Do My Legs Feel Heavy During Perimenopause?

    Why Do My Legs Feel Heavy During Perimenopause?

    medically reviewed by Patricia Shelton, MD WHAT YOU WILL LEARN IN THIS ARTICLE Why do our legs feel heavy in perimenopause? How do I manage heavy legs? When should I go to the doctor? One of our sisters on the perry platform shared recently:  “Are extremely heavy legs normal in perimenopause? My legs feel like…

    Find out more

  • Managing migraines in perimenopause

    Managing migraines in perimenopause

    Medically reviewed by Patricia Shelton, MD Recently posted in our perry community: Hi does anyone get frequent migraines in perimenopause the week after their period. I always get migraines when i have first day of my period but a week later more migraines? I just turned 49. My doctor advised i come off my BCP.…

    Find out more

  • Digestive issues during perimenopause

    Digestive issues during perimenopause

    Medically reviewed by Patricia Shelton, MD What you will learn in this article Hormones and gut function Factors affecting digestion Is this bloating normal? Most women expect to experience symptoms like hot flashes during peri, but many aren’t expecting indigestion, gassiness, and bloating. However, it turns out that digestive issues during perimenopause are actually very…

    Find out more

Was this post helpful?

Patricia Shelton

Community Favorites:

Related Posts:

Related Posts

From the Community

Was this post helpful?

Let us know if you liked the post. That’s the only way we can improve.


Join for free

perry is the #1 perimenopause community.
Join us in our FREE app.