I’ve never struggled with anxiety before. Why am I feeling it now?
First, I want you to know that I understand just how overwhelming anxiety can feel. Let’s begin here: anxiety is a completely normal human emotion that rises in response to uncertainty, challenge or potential threat, and usually settles once the situation has passed. But for many women, that pattern can shift during perimenopause, the years leading up to menopause when hormone levels fluctuate. Anxiety may become more frequent, more intense or appear for the first time.
Research shows women become more vulnerable to anxiety and mood changes during perimenopause
Research shows women become more vulnerable to anxiety and mood changes during this stage of life. The risk of depressive symptoms increases substantially, while the likelihood of experiencing significant anxiety symptoms or an anxiety disorder also rises compared with the pre-menopausal years. It’s not just about the midlife juggle or the mental load. Hormonal changes create genuine biological changes that can increase vulnerability to anxiety, while life stresses that often occur during midlife can add another layer of challenge.
Why is this happening?
A big part of the story is oestrogen. It’s not just a reproductive hormone; it plays a big role in the brain areas that regulate mood and stress. As oestrogen fluctuates unpredictably during perimenopause rather than declining steadily, it affects several of the brain’s systems that regulate mood, stress and emotional balance. That’s part of why this can feel less like a passing mood dip and more like an emotional rollercoaster with no obvious trigger.
A big part of the story is oestrogen... it plays a big role in the brain areas that regulate mood and stress
Do stress hormones play a role too?
Our stress response system also changes with age. Research suggests that recovery from stress can become less efficient, and some women show higher or more prolonged cortisol (stress hormone) responses to stress during midlife. Combined with fluctuating hormones, disrupted sleep and hot flushes, this can leave us feeling less resilient than we once did.
How do I know if my anxiety is related to my hormones, or something else?
If you’ve noticed a change in your anxiety, or anxiety is becoming problematic, it’s worth checking in with your GP. Some of the patterns you might notice include:
- Anxiety appearing for the first time in midlife
- Symptoms fluctuating unpredictably
- Anxiety flaring alongside hot flushes or night sweats
- Anxiety closely linked with poor sleep
- Symptoms occurring alongside changes to your menstrual cycle
Hot flushes, disrupted sleep and even ‘brain fog’ can also overlap with anxiety, making it difficult to know what’s driving what. Whatever the cause, don’t hesitate to seek help and get some answers. Support and treatment are available either way.
For many women, anxiety improves as hormone levels become more stable after menopause
Will this get better?
For many women, anxiety improves as hormone levels become more stable after menopause. For others, symptoms persist, particularly if anxiety has become established or other life or health factors are contributing. What matters most is recognising any anxiety you’re experiencing, chatting to your GP to work out what support you might need, and knowing that anxiety is treatable.
It can be so very hard, which is why, in the next articlen here, I dive into what genuinely helps, including one evidence-backed approach that might surprise you.
- Website: https://drjodirichardson.com/
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References
Bromberger, J. T., & Epperson, C. N. (2018). Depression during and after the perimenopause: impact of hormones, genetics, and environmental determinants of disease. Obstetrics and Gynecology Clinics of North America, 45(4), 663–678.
Gordon, J. L. (2020). Perimenopause and the psychiatric implications: A review. Annals of the New York Academy of Sciences, 1477(1), 21–32.
Gibson, C. J., Ajmera, M., O’Sullivan, F., Shiozawa, A., Lozano-Ortega, G., Badillo, E. C., Venkataraman, M., & Mancuso, S. (2025). A systematic review of anxiety and depressive symptoms among women experiencing vasomotor symptoms across reproductive stages in the US. International Journal of Women’s Health, 17, 537–552.
Bromberger, J. T., Kravitz, H. M., Chang, Y., Randolph, J. F., Jr., Avis, N. E., Gold, E. B., & Matthews, K. A. (2013). Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation. Menopause, 20(5), 488–495.
Australasian Menopause Society. (2023). Menopause and mental health. https://www.menopause.org.au/health-info/fact-sheets/menopause-and-mental-health
