Many people notice new or worsening anxiety during perimenopause, sometimes before other symptoms. Fluctuating hormones, poor sleep and hot flashes can all contribute, alongside midlife stress. Anxiety can also have causes unrelated to menopause, such as thyroid problems. CBT, treatment for underlying menopause symptoms and, where needed, other anxiety treatments can all help.
Anxiety can show up in the mind and the body:
- Feeling on edge, worried or unable to relax
- Racing or intrusive thoughts, often at night
- Feeling overwhelmed by things you used to cope with easily
- A sense of dread, sometimes without a clear reason
- Physical symptoms, such as a racing heart, tight chest, shaking, nausea or dizziness
- Avoiding situations, such as meetings or social events, because of fear of symptoms
- Panic attacks: sudden, intense surges of fear with physical symptoms
Some people feel anxious just before or during a hot flash. Others describe it as a general loss of confidence.
Why does perimenopause cause anxiety?
Several factors can combine:
- Hormone fluctuations. Estrogen and progesterone affect brain chemicals involved in mood and stress, and during perimenopause they rise and fall unpredictably. See hormone changes during perimenopause.
- Hot flashes and night sweats. Hot flashes can trigger physical sensations similar to anxiety, and the unpredictability can make people anxious about having one in public.
- Poor sleep. Sleep deprivation makes anxiety worse, and anxiety makes sleep harder. See sleep problems.
- Midlife pressures. Work, caring for children or parents, relationship changes, and health worries often peak at the same time.
In the SWAN study, women who had more anxiety when hot flashes began tended to have hot flashes for longer. Anxiety was also linked with worse verbal memory. See brain fog.
How common is anxiety in perimenopause?
The NHS lists anxiety alongside low mood, mood swings and low self-esteem among common mental health symptoms of menopause and perimenopause. Research also suggests perimenopause is a time of higher risk for developing depression, which often overlaps with anxiety.
What else can cause anxiety-like symptoms?
It’s important not to put everything down to menopause. Other causes include:
- An overactive thyroid, which Mayo Clinic notes can cause anxiety, palpitations, hot flashes and insomnia in women of menopausal age
- Heart rhythm problems. See heart palpitations.
- Caffeine, alcohol and nicotine
- Some medicines, such as decongestants, some asthma medicines and stimulants
- Low blood sugar
- Anxiety disorders or panic disorder, which can start or return at any age
- Stressful life events
See perimenopause or something else.
What might make anxiety worse?
- Poor sleep and night sweats
- Caffeine, especially in the afternoon
- Alcohol, which can cause "rebound" anxiety the next day
- Skipping meals
- Low physical activity
- Worries about symptoms themselves, such as fearing a hot flash in a meeting
Tracking anxiety alongside your cycle, sleep and hot flashes can reveal patterns. Our private Symptom Explorer can help.
What will a clinician assess?
A clinician may ask:
- When the anxiety started, how it affects your life, and whether you have panic attacks
- About other menopause symptoms and changes in your periods
- About sleep, alcohol, caffeine and medicines
- About previous anxiety or depression, and any thoughts of self-harm
- About physical symptoms such as palpitations or weight loss
They may suggest blood tests, such as thyroid function, and sometimes a heart check if you have palpitations.
What treatments help?
Cognitive behavioral therapy (CBT)
NICE recommends considering CBT to relieve low mood or anxiety that arises as a result of menopause. Its 2024 update also recommends menopause-specific CBT for hot flashes, night sweats, sleep problems and depressive symptoms. CBT can be done face to face, online, in groups or through self-help programs.
Treating hot flashes and sleep problems
Because hot flashes and poor sleep feed anxiety, treating them can help. Options include:
- Hormone therapy, which the Menopause Society describes as the most effective treatment for hot flashes
- Non-hormonal medicines, such as fezolinetant or elinzanetant, where available
- CBT for hot flashes and sleep
NICE also recommends considering HRT for depressive symptoms that begin around the same time as other menopause symptoms.
Treatment for anxiety disorders
If you have an anxiety disorder or panic disorder, standard treatments apply. These include talking therapies and, where appropriate, medicines such as some antidepressants. NICE notes there’s no clear evidence that SSRIs or SNRIs help low mood in menopausal women who haven’t been diagnosed with depression. That’s why a proper assessment matters.
Practical steps that may help
- Slow your breathing when anxiety rises. Breathe in gently for around four counts and out for around six.
- Move every day. Regular exercise reduces anxiety and improves sleep.
- Cut back on caffeine and alcohol.
- Protect your sleep with a regular routine and a cool bedroom.
- Eat regularly to avoid blood sugar dips.
- Talk about it with a friend, partner, colleague or support group.
- Plan for hot flashes in stressful situations, with layers, water and a fan, to reduce anticipatory worry.
- Try mindfulness or relaxation apps if they suit you.
When should you get help?
Book an appointment if anxiety is affecting your daily life, work, relationships or sleep, or if you’re having panic attacks.
Get urgent help if you:
- Have thoughts of harming yourself or ending your life. Contact emergency services or a crisis line in your country straight away.
- Have chest pain, severe breathlessness or fainting. These need emergency assessment, even if you think it might be anxiety.
Breaking the hot flash and anxiety cycle
Hot flashes and anxiety can feed each other. A hot flash brings a racing heart and heat, which can feel like panic. Worrying about the next hot flash then makes you more tense, and stress can trigger more flashes. Ways to break the cycle include:
- Reframe the sensation: "This is a hot flash; it will pass in a few minutes."
- Use slow breathing as soon as you notice it starting.
- Prepare for situations you worry about, with layers, water and a seat near a door or window.
- Consider menopause-specific CBT, which specifically targets how much hot flashes bother you.
- Treat the hot flashes themselves if they’re frequent.
Supporting someone with menopause anxiety
If someone close to you is struggling:
- Listen without rushing to fix things.
- Avoid dismissing it as "just hormones." Their experience is real.
- Help practically: share tasks, protect their sleep, and adjust the room temperature.
- Encourage them to seek help, and offer to go along to appointments if they’d like.
Questions to ask at your appointment
- Could my anxiety be linked to perimenopause, or should anything else be checked?
- Should I have my thyroid tested?
- Can I access CBT, including menopause-specific CBT?
- Would treating my hot flashes or sleep help my anxiety?
- Is hormone therapy an option for me, and would it help my mood?
- If I have an anxiety disorder, which treatments would you recommend?
See your first menopause appointment.
Low mood · Irritability · Heart palpitations · Sleep problems · Hot flashes
Frequently asked questions
Can perimenopause cause anxiety even if my periods are regular?
Yes. Anxiety can be an early sign of perimenopause, sometimes before periods change noticeably. See the early signs of perimenopause.
Can perimenopause cause panic attacks?
Some people experience panic attacks during perimenopause, and hot flashes can feel similar. Panic attacks deserve assessment and can be treated effectively.
Does HRT help anxiety?
Hormone therapy may help if anxiety is linked to hot flashes, night sweats and poor sleep. NICE recommends considering HRT for depressive symptoms that begin alongside other menopause symptoms. It isn’t a treatment for anxiety disorders on its own.
Will menopause anxiety go away?
For many people, mood improves after the menopause transition, but it’s better to seek help now than to wait.
References
- NHS: Menopause: symptoms
- NHS inform: Signs and symptoms of menopause
- NICE guideline NG23: Menopause, identification and management (2024 update)
- NICE NG23 recommendations (CBT for low mood or anxiety; SSRIs and low mood)
- Avis NE et al. Duration of menopausal vasomotor symptoms (anxiety and duration). JAMA Internal Medicine, 2015
- El Khoudary SR et al. SWAN progress report (anxiety and memory)
- First onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause
- Mayo Clinic Press: Menopause symptoms? It could be a copycat
- Menopause-associated depression (review)
- The 2022 hormone therapy position statement of The North American Menopause Society
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
