Why Anxiety Can Increase During Perimenopause

For many women, anxiety appears or intensifies during perimenopause in ways that feel unfamiliar and unsettling. You may notice new worries, a sense of inner restlessness, sudden nervousness, or physical anxiety symptoms that weren’t part of your earlier life. These changes can feel confusing—especially if you’ve never considered yourself an anxious person.
It’s common to ask, Why is this happening now? Is something wrong with me? Why do I feel less emotionally steady than I used to? When anxiety shows up alongside changes in sleep, energy, or mood, it can feel overwhelming.
An increase in anxiety during perimenopause is a common and well-recognized experience. It reflects how hormonal shifts interact with the nervous system, not a personal failing or loss of emotional strength. This article offers calm, symptom-first clarity about what perimenopausal anxiety often feels like, why it happens, how it varies, and when it may be helpful to consider additional support.

For a broader understanding of how hormonal changes influence mood and emotional patterns across life stages, visit Hormonal Life Stages & Mood Changes.

What this feels like

Anxiety during perimenopause can feel different from anxiety earlier in life. Many women describe a more physical, restless quality—an internal buzzing, jitteriness, or sense of being on edge that’s hard to explain.
Worries may feel louder or more intrusive. Thoughts can spiral more easily, even around everyday concerns that never used to cause distress. You may find it harder to “talk yourself down” once anxiety starts.
Sleep-related anxiety is common. You might wake in the night feeling tense or alert, or notice anxiety building as evening approaches. Poor sleep can then intensify anxiety the next day.
Emotionally, you may feel less resilient. Situations that once felt manageable may now feel draining or overwhelming. Mood swings, irritability, or emotional sensitivity can accompany anxiety, adding to the sense of instability.
Physically, anxiety during perimenopause often comes with familiar sensations—heart palpitations, chest tightness, shortness of breath, lightheadedness, nausea, or muscle tension. These symptoms can feel alarming when they appear without a clear trigger.
Importantly, many women feel unsettled by the change itself. The anxiety may feel new, stronger, or harder to predict than before, which can increase fear about what it means.

Why this happens (body / nervous system)

Perimenopause is a time of significant hormonal fluctuation, and the nervous system is highly sensitive to these changes.
During perimenopause, estrogen and progesterone levels no longer follow predictable monthly patterns. Instead, they rise and fall irregularly. These hormones influence neurotransmitters involved in mood regulation, stress response, and emotional stability. Rapid shifts—rather than low levels alone—can make the nervous system more reactive.
Estrogen supports serotonin, a neurotransmitter that helps regulate mood and anxiety. When estrogen fluctuates or declines, serotonin signaling can become less stable, making anxiety more likely.
Progesterone has calming effects for many women. Irregular progesterone levels during perimenopause can reduce this calming influence, leading to increased nervous system activation.
The stress-response system itself can become more sensitive during this life stage. Hormonal changes lower the threshold for fight-or-flight activation, meaning the body may react strongly to stressors—or even to internal sensations—without much warning.
Sleep disruption is another major factor. Night sweats, temperature changes, or lighter sleep are common in perimenopause. Even subtle sleep fragmentation reduces emotional regulation and increases anxiety sensitivity.
Psychological context matters as well. Perimenopause often coincides with life transitions—career shifts, caregiving responsibilities, changes in relationships, or health concerns. These stressors don’t cause perimenopausal anxiety on their own, but they can amplify it.
For women with a history of anxiety, trauma, or high stress, perimenopause often intensifies existing patterns rather than creating something entirely new.

Patterns & variability

Anxiety during perimenopause does not follow a single pattern.
Some women experience intermittent waves of anxiety that come and go unpredictably. Others notice a more persistent baseline of nervousness with periodic spikes.
Symptoms often fluctuate with hormonal shifts. Anxiety may feel worse during certain months, after missed or irregular periods, or during times of noticeable physical changes.
Time of day can matter. Many women report increased anxiety in the evening or during the night, especially if sleep has been disrupted.
Not every woman experiences perimenopausal anxiety in the same way. Some feel primarily mental anxiety, others more physical symptoms, and many experience a combination of both.
Importantly, variability does not mean instability or decline. It reflects a nervous system adapting to fluctuating hormonal signals.

How perimenopausal anxiety differs from other anxiety

Anxiety during perimenopause is often mistaken for generalized anxiety or panic disorder. While symptoms can overlap, context is key.
Perimenopausal anxiety often appears alongside other hormonal changes—irregular cycles, sleep disruption, temperature sensitivity, or mood swings. It may arise even during periods when life stress feels unchanged.
Unlike lifelong anxiety patterns, perimenopausal anxiety may feel “new” or different in quality. Many women describe a sense of unfamiliarity with their own reactions, which can be distressing.
Understanding this distinction can be reassuring. Experiencing anxiety during perimenopause does not mean your mental health is deteriorating—it often reflects a temporary period of heightened nervous system sensitivity.

When it starts affecting daily life

Perimenopausal anxiety deserves attention when it begins to interfere with daily functioning or emotional well-being.
You might notice difficulty concentrating at work, increased avoidance of activities, or withdrawal from social situations due to feeling overwhelmed.
Sleep disruption can worsen anxiety, creating a cycle of fatigue and emotional reactivity.
Relationships may feel strained if irritability, worry, or emotional sensitivity increases. You may feel less patient or more easily upset than before.
Another sign anxiety is taking up too much space is persistent self-doubt—questioning your emotional strength or worrying that something is “wrong” with you.
These experiences do not mean you are failing to cope. They indicate that hormonal changes are significantly influencing your stress response.

When to consider professional support

Professional support can be helpful when anxiety during perimenopause feels persistent, intense, or confusing.
Consider reaching out if anxiety interferes with sleep, work, or relationships, or if symptoms feel progressively worse rather than episodic.
Support is also appropriate if anxiety is accompanied by panic episodes, ongoing low mood, or physical symptoms that increase worry.
Women with a history of anxiety, trauma, or postpartum mood challenges may benefit from earlier support, as hormonal transitions can amplify vulnerability.
If you are unsure whether symptoms are hormonal, anxiety-related, or part of a broader health change, seeking clarity can be reassuring and empowering.

How understanding can reduce distress

Understanding the role of perimenopause in anxiety often brings relief.
When anxiety is recognized as a response to hormonal fluctuation rather than personal weakness, self-judgment often softens. Reduced fear can lower nervous system activation and make symptoms feel more manageable.
Awareness of patterns—such as symptom waves or links to sleep—can also help you feel less caught off guard.
Support from trusted people or professionals can further reduce isolation and help restore confidence during this transition.

Takeaway

Anxiety during perimenopause is common and reflects hormonal shifts interacting with the nervous system—not loss of emotional strength or stability. Symptoms may feel unfamiliar or intense, but they often fluctuate and can improve with understanding and support. When anxiety begins to limit daily life or well-being, help is available and appropriate.