Anxiety and the Perimenopause: Why does it happen?
Perimenopause is a natural transition, but for many women, it arrives with something unexpected and unsettling, something many women have never experienced in their lives before that can be scary and unsettling: anxiety.
Not just the occasional worry, but a kind of emotional pressure that can feel intense, persistent and sometimes completely out of the blue, and frequently about totally random and apparently silly things that previously wouldn’t bother you.
Women often tell me, “I’ve never been an anxious person… why now?”
The truth is, perimenopausal anxiety isn’t a personal flaw or a sign that you’re “not coping”.
It’s a physiological, hormonal and neurological response – that means it’s a normal response to the changes in your body and your mind in response to the changes in your hormones.
Once you understand what’s happening, it becomes much easier to manage, cope and navigate your way through this period of your life.
Let’s explore why anxiety levels rise during perimenopause, what’s actually happening in the brain, and what you can do to reclaim calm, clarity and balance during this transition.
Your Hormones Are Sending Mixed Messages to the Brain
During perimenopause, hormones don’t simply decline in a straight line. They rise, crash, spike and drop unpredictably — sometimes day to day.
Two hormones in particular play a significant role in anxiety:
Oestrogen
Oestrogen supports serotonin, dopamine and other neurotransmitters – the Happy Hormones we need to help us think and behave in a mentally healthy way.
These happy hormones are linked to our mood, confidence, motivation and emotional regulation.
When oestrogen suddenly dips, you may struggle to regulate stress and stay grounded. You might feel more worried, overwhelmed, reactive, or tearful, and this can often happen without knowing why.
Progesterone
Progesterone has a naturally calming, soothing effect on the brain. It supports GABA, which acts like the body’s “slow down, you’re safe” signal. When progesterone becomes erratic or drops significantly, that calming influence fades, leaving the brain feeling more alert, jumpy and sensitive to stress.
This combination — less soothing, less stability, more unpredictability — can make everyday challenges feel heavier, louder and harder to navigate.
Your Brain’s Threat System Becomes More Sensitive
During perimenopause, fluctuating hormones affect your Amygdala (Your Amygdala is like a Health and Safety Officer, detecting threats)
Your Health and Safety Officer’s (That Amygdala) job is to keep you safe, not happy, so even when life hasn’t changed dramatically, the Health and Safety Officer may:
- Misread everyday events as danger
- Trigger a stronger stress response
- Send signals of panic or urgency
- Heighten physical sensations like a racing heart, a tight chest or restlessness
This feeling is why many women say things like:
- “I feel on edge for no reason.”
- “I wake up anxious even when nothing is wrong.”
- “My heart races, but I don’t know why.”
It’s not imagined.
It’s the brain reacting to hormonal disruption, not to real danger.
Sleep Disruption Adds Fuel to the Fire
Perimenopause commonly affects sleep through:
- Night sweats
- Waking multiple times
- Lighter, more restless sleep
- Difficulty falling back asleep
When the brain is tired, its ability to regulate emotions drops dramatically. The prefrontal cortex (the rational, logical part of the brain) struggles to stay in control, while the Health and Safety Officer becomes more reactive.
Lack of sleep doesn’t just make you tired. It makes you more sensitive, overwhelmed and anxious. It’s like walking through the world without emotional cushioning.
Stress Hormones Can Rise During Hormonal Change
Cortisol, the body’s stress hormone, naturally increases during hormonal fluctuations. For some women, perimenopause triggers:
- Higher baseline cortisol
- Faster stress responses
- Difficulty calming down after stress
- A constant “wired but tired” feeling
High cortisol can cause symptoms like:
- Worry
- Racing thoughts
- Irritability
- Digestive changes like IBS symptoms
- Restlessness
- Feeling overwhelmed by small things
This isn’t a weakness; it’s a biological change.
Life Load and Emotional Pressure Peak at the Same Time
Perimenopause often arrives during one of the busiest, most emotionally demanding phases of life:
- Work responsibilities
- Parenting teenagers
- Supporting ageing parents
- Relationship pressures
- Household management
- Societal expectations to “hold everything together”
Many women are stretched thin long before hormones begin to shift. When hormonal instability is added to the mix, the emotional load can become too heavy for the nervous system.
This isn’t “just hormones”. It’s hormones interacting with real-life demands.
The Loss of “Old You” Can Trigger Worry
Many women say they no longer feel like themselves.
It’s one of the most common things women say during this time (I have even said it myself), and that can be frightening.
Changes in confidence, energy levels, memory, focus, motivation and mood can make you question:
- Am I coping?
- Why can’t I manage as I used to?
- Is something wrong with me?
This inner uncertainty can spiral into anxiety, even when nothing dangerous is happening.
The good news? These changes are reversible with the proper support.
How Hypnotherapy Helps Calm Perimenopausal Anxiety
Solution-Focused Hypnotherapy works by:
- Reducing the brain’s threat response
- Helping the nervous system settle into safety
- Supporting deeper, more restorative sleep
- Rebuilding confidence and emotional resilience
- Helping women focus on their strengths, resources and preferred future
It also helps you understand what’s happening in your brain so that you feel empowered rather than overwhelmed.
Women often describe sessions as calming, grounding and “like pressing reset on the mind”.
You’re Not Losing Control: Your Brain Is Asking for Support
Perimenopausal anxiety is common, natural and treatable.
You’re not “going backwards”.
You’re not becoming someone you don’t recognise.
Your brain is adapting, recalibrating, and adjusting to a new hormonal landscape — and with gentle, consistent support, you can feel like YOU again.
If you’re struggling with anxiety, overwhelm or sleep during perimenopause, you don’t have to manage it alone.
Support is available, and relief is absolutely possible: Get in touch here
