Perimenopause and Anxiety? Why it happens and what you can do!

December 21, 2019.

As this is probably one of the most crippling symptoms of perimenopause, we partnered with Dr. Kim Langdon M.D. to have a closer look at perimenopause & anxiety. 

Perimenopause and Anxiety

Even though anxiety disorders are the most common type of psychiatric disorders, according to the American Psychiatric Society, perimenopausal anxiety may be the first and only manifestation of the condition. Perimenopause starts in the early to mid-forties for most women, while some do not transition until their late forties.

Approximately 90% of women seek treatment for the symptoms of perimenopause and menopause, primarily due to the physical symptoms such as hot flashes and insomnia. Like the postpartum period, perimenopause is a time of fluctuating hormone levels as menopause approaches. When the menstrual periods space out during the perimenopause, the symptoms of anxiety tend to increase.

Women with a pre-existing mood disorder such as depression or anxiety may experience a worsening of the symptoms in perimenopause. For example, panic attacks are very common manifestations of anxiety in this transitional period.

In one study completed in 2013, women with high anxiety before perimenopause continued to have high levels of anxiety throughout the menopausal transition, but those with low levels of anxiety were more likely to become highly anxious as they progressed through menopause.

What is Anxiety?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety disorders include disorders with features of excessive fear, anxiety, nervousness, intense worry, restlessness, muscle tension, and difficulty concentrating. Types of anxiety disorders are separation anxiety disorder, specific phobias, social anxiety disorder (social phobia), panic disorder, agoraphobia (fear of open places),  generalized anxiety disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition such as excess thyroid hormone.

The brain or central nervous system (CNS) is the underlying source of the symptoms of anxiety disorders because levels of norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) can widely fluctuate. In perimenopause, these neurotransmitters depend on and interact with the hormones, estrogen, and progesterone.

Perimenopausal Anxiety and Insomnia

Insomnia occurs in 40–50% of women during the perimenopausal period, and this translates into an increase in mood disorders. Problems with sleep are often connected to mood disorders.  Women with insomnia are more likely to experience problems such as anxiety, stress, tension, and depressive symptoms.

Sleep disorders are related to estrogen, progesterone deficiencies, and elevated luteinizing hormone (LH) levels, both of which are implicated in affecting the thermoregulatory process and elevating the body temperature. Progesterone has a known calming or sedating effect, and with lower levels, the onset of sleep can be delayed.

Night sweats occur more frequently in some women in perimenopause. Unfortunately, nighttime awakenings can disrupt your overall sleep quality.  

Treatment for Perimenopausal Anxiety 

One approach for managing anxiety during perimenopause is to use hormones such as estrogen and progesterone in the form of oral contraceptives. Oral contraceptives are safe and effective at managing abnormal or irregular bleeding, protecting against pregnancy, and normalizing estrogen and progesterone levels, which may help relieve the symptoms of anxiety. In more severe cases of anxiety, selective-serotonin reuptake inhibitors (SSRIs) may be useful in the short term or until menopause arrives.

Supplements for Perimenopausal Anxiety

 Besides vitamins, other possible naturally occurring substances in supplements that help anxious symptoms include the following:

  • Magnesium
  • L-threonine
  • Fish oil
  • 5-HTP
  • Bacopa
  • Ashwagandha
  • Lavender
  • Chamomile
  • Lemon balm
  • Valerian
  • Passionflower

How Long Does Perimenopause Anxiety Last?

Most of the anxious symptoms of perimenopause lessen or disappear a few years into menopause. This is especially true if symptoms were not present during the premenopausal years. However, if an anxiety disorder predates perimenopause, it will likely worsen until stabilizing in the years after menopause.


Meet the Author: 

Kimberly Langdon M.D. is a retired, board-certified obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine, earning Honors in many rotations. She then completed her OB/GYN residency program at The Ohio State University Medical Center, earning first-place for her senior research project and placed in the 98th percentile on the national exam for OB/GYN residents in the U.S. 

Besides obstetrics, she specialized in gynecologic medicine such as menopause, bioidentical hormones, osteoporosis, sexual dysfunction, menstrual disorders, vaginitis, infertility, contraception, pelvic pain, sexually transmitted infections, polycystic ovarian syndrome, endometriosis, and minimally-invasive surgeries. She is a national expert in vaginal infections.

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. 

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Julia Walker
perry expert Julia (RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations. She specializes in helping women optimize their health during perimenopause and beyond.

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