Why Anxiety Can Spike in Perimenopause — Even If You’ve Never Been Anxious Before

“I just don’t recognize myself anymore.”

For many women, anxiety is one of the most surprising symptoms of perimenopause. You may never have considered yourself an anxious person before, and then suddenly you feel more worried, irritable, overwhelmed or emotionally reactive than you used to.

One day you feel like yourself. The next, your patience is gone. Small things feel enormous. Anxiety appears seemingly out of nowhere.

In this Perry Short, created in collaboration with Bonafide Health, Perry Community Manager Kristin Cohen sits down with board-certified OB-GYN and Bonafide Health Chief Medical Officer Dr. Alyssa Dweck to talk about one of the most prominent topics in the Perry community: anxiety during perimenopause.

Is Anxiety Really a Symptom of Perimenopause?

Yes.

Dr. Dweck describes anxiety and mood changes as some of the most commonly reported symptoms during perimenopause.

For some women, anxiety was already present before perimenopause and becomes more intense during this stage of life. For others, anxiety appears for the first time.

In her practice, Dr. Dweck often hears women say they simply don’t feel like themselves anymore.

That change can show up as irritability, impatience, sadness, anger or even rage. And just as suddenly as those feelings appear, a woman may feel completely like herself again.

That unpredictability can be particularly unsettling when you don’t understand why it’s happening.

What Do Hormones Have to Do With Anxiety?

Quite a lot.

Perimenopause isn’t simply a period when estrogen steadily declines. Hormones can fluctuate significantly, and Dr. Dweck explains that this volatility and variability in estrogen may contribute to feelings of anxiety and angst.

Progesterone matters too.

Progesterone has a calming effect, and progesterone levels decline during perimenopause. As Dr. Dweck puts it: less progesterone can mean less calming.

Estrogen is also associated with neurotransmitters involved in mood, including serotonin, dopamine and melatonin. When estrogen levels become volatile, those systems can be affected as well.

This helps explain why emotional changes can feel so sudden during perimenopause.

What Can You Do About Perimenopause Anxiety?

Dr. Dweck’s first recommendation is deceptively simple: get educated.

Understanding that anxiety and mood changes can occur during perimenopause can itself be reassuring.

You aren’t the only woman suddenly wondering why you feel different.

From there, Dr. Dweck recommends seeking support when needed. That could include working with a therapist, accessing therapy online or exploring stress-management and relaxation strategies.

She specifically discusses cognitive behavioral therapy (CBT), exercise, box breathing, paced respiration and practices such as Tai Chi as potential tools for managing stress and anxiety.

The right approach will be different for every woman.

Don’t Automatically Assume It’s Perimenopause

This is an important part of the conversation.

Anxiety may be common during perimenopause, but not every feeling of anxiety, panic or unease should automatically be attributed to hormones.

Some medical conditions can produce similar symptoms.

Dr. Dweck specifically points to hyperthyroidism, or an overactive thyroid, as one example. Certain cardiovascular issues can also present with sensations that may feel like anxiety or panic.

Those conditions require different evaluation and treatment.

If anxiety is new, unusual or concerning, it’s worth discussing with a healthcare professional rather than simply assuming perimenopause is responsible.

Why Can Anxiety Get Worse Before Your Period?

If you notice that anxiety suddenly intensifies before your period, you’re not imagining the pattern.

Dr. Dweck discusses both premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD).

These can include mood changes alongside physical symptoms before menstruation. One important characteristic is that symptoms typically resolve with the onset of menstrual flow.

The extreme hormonal fluctuations in estrogen and progesterone before menstruation may contribute to these changes, particularly because of the relationship between these hormones and neurotransmitters involved in mood.

During perimenopause, when hormonal patterns are already becoming more volatile and cycles may become less predictable, those changes can become particularly noticeable.

Start Looking for Your Personal Anxiety Triggers

One practical step Dr. Dweck recommends is identifying the things that may make your anxiety worse.

Caffeine is one potential trigger.

Diet can play a role too. Dr. Dweck discusses artificial sweeteners, very high-sugar meals and large amounts of ultra-processed foods as examples of things that some people may find affect their mood or feelings of anxiety.

Rather than trying to remember how you felt several weeks ago, consider tracking it.

If you’re still menstruating, an app or calendar can help you look for patterns between your cycle, mood and potential triggers.

Perimenopause can make this more difficult because cycles themselves can become erratic. But tracking may still help you connect dots you otherwise wouldn’t notice.

Why Hormonal Volatility Matters

It isn’t necessarily only declining hormones that matter during perimenopause.

The rapid changes themselves may be important.

Dr. Dweck explains that hormone volatility — the rapid and sometimes abrupt fluctuations that characterize perimenopause — appears to play an important role in triggering symptoms.

This may help explain something women frequently describe: feeling perfectly fine one day and completely unlike themselves the next.

Perimenopause doesn’t always follow a neat, linear path.

And neither do its symptoms.

When Should You Seek Medical Help for Anxiety?

You don’t need to wait until anxiety becomes unbearable before talking to someone.

Dr. Dweck recommends seeking medical help when symptoms feel strange or unusual, particularly when they first appear, so other potential medical causes can be considered.

And if anxiety or panic begins interfering with your work, relationships, daily activities or overall quality of life, it should absolutely be addressed.

Depending on the individual, treatment might involve therapy, medication, lifestyle changes or a combination of approaches.

The important point is that significant anxiety isn’t something women should simply be expected to tolerate because they’re in perimenopause.

What About the Viral Antihistamine Trend?

Social media has introduced another conversation into the perimenopause and PMS space: taking combinations of over-the-counter antihistamines for mood symptoms.

Dr. Dweck addresses the trend directly.

She notes that some women report using combinations of H1- and H2-blocking antihistamines to manage PMS or PMDD symptoms. However, she also emphasizes that she is not aware of evidence-based studies demonstrating that this approach effectively manages these symptoms.

While there are hypotheses around histamine activation and mood symptoms, Dr. Dweck says she isn’t currently recommending the approach to her patients.

It’s an important reminder that a treatment going viral on social media is not the same thing as a treatment being supported by clinical evidence.

Real women’s experiences matter. So does rigorous research.

We need both.

Can You Prepare for Perimenopause Anxiety?

You can’t necessarily predict exactly how perimenopause will affect you.

But awareness can make a difference.

Dr. Dweck recommends education and, where useful, tracking symptoms through a calendar, app or wearable.

If you’re already tracking your menstrual cycle, you may begin noticing when mood changes tend to occur. Perimenopause can make these patterns harder to predict as cycles become increasingly erratic, but recognizing that mood changes and perimenopause can be connected is itself valuable.

Because when anxiety appears suddenly, knowing that hormonal changes may be part of the picture can give you a starting point for asking the right questions.

The Biggest Takeaway: Recognize It and Be Proactive

If Dr. Dweck could leave women with one message about anxiety during perimenopause, it would be to look at lifestyle strategies that may help prevent or reduce symptoms and learn to recognize what’s happening.

That might mean adjusting your diet, exercising, identifying personal triggers or using stress-reduction techniques.

For healthcare professionals, there is an equally important message: continue learning.

Perimenopause is an evolving field, and clinicians need to remain curious and open-minded about the many ways this transition can affect women.

Anxiety shouldn’t automatically be dismissed as “just stress.”

And it shouldn’t automatically be attributed to perimenopause either.

Women deserve clinicians who are willing to consider the whole picture, rule out other potential causes and recognize that hormonal changes can have very real effects on mood and mental wellbeing.

Watch the full Perry Short above for the complete conversation between Kristin Cohen and Dr. Alyssa Dweck about anxiety, hormones, triggers and navigating mood changes during perimenopause.

Medical Disclaimer

This content is for educational and informational purposes only and is not intended as medical advice, diagnosis or treatment. Anxiety and mood changes can have many causes, and individual health needs vary. Always consult a qualified healthcare professional about new, persistent, worsening or concerning symptoms and before starting, stopping or changing any medication, supplement or treatment. If anxiety or other mental health symptoms are significantly affecting your daily life or safety, seek professional medical or mental health support.