Understand this symptom
Anxiety in menopause
Written by
Uma Health
Medically verified by
Dr. William Declerck
Physician
Insight
The essentials
This symptom is caused by the hormonal shifts your body is going through. Understanding what's happening helps you better cope with what you're feeling.
The cause
Oestrogen and progesterone influence the brain systems that regulate your mood and stress response. When these hormones start to fluctuate and fall in perimenopause, your "calming system" settles less easily. Poor sleep, hot flushes and stress make it stronger. For many women, this is the first time they have felt anxiety like this.
What helps
Start with the basics: protect your sleep, move regularly, cut back on alcohol and caffeine, and learn a breathing or worry-management technique you can use in the moment. Cognitive behavioural therapy (CBT) works well for persistent anxiety. If anxiety keeps running your life, it is worth talking to a care provider who knows menopause inside out.
Honest and transparent
The most frequently asked questions
It can feel unsettling, especially if you never thought of yourself as an anxious person. Yet anxiety is common in this phase, and the risk of it rises during perimenopause. That is not only because your brain is adjusting to a new hormonal balance: progesterone helps keep your calming system running by an indirect route, and it is that system that weakens as your hormones fall and fluctuate.
Many women experience anxiety for the first time in their forties, and it takes them by surprise. Oestrogen and progesterone influence the brain areas for mood and stress: progesterone keeps your brain calm by way of an intermediate substance, and that substance falls as progesterone falls. When your hormones fluctuate and fall, your system can become more sensitive, so anxiety or a panic attack surfaces more easily. That does not happen to everyone.
A fair question, because the symptoms feel so alike. A hot flush brings a faster heartbeat, warmth and sweating, the same physical signals that come with a panic attack, so one can amplify or trigger the other. Research also shows a link between anxiety and hot flushes, although it is unclear which comes first.
An important question, and the answer is in the pattern. If anxiety persists day after day, you start avoiding things you used to do easily, or it affects how you function at home or work, it may point to an anxiety disorder or depression. If you are having thoughts of harming yourself, do not wait: contact your GP or a crisis line straight away.
A smart reflex to look wider, because menopause is not the only possible explanation. An overactive thyroid, iron or vitamin B12 deficiency, too much caffeine, certain medications and prolonged stress can all cause anxiety. A blood test at your GP can rule out many of these causes quickly.
A logical question, and the honest answer is nuanced. Studies on hormone therapy and anxiety are mixed, so it is not prescribed to treat anxiety on its own. Indirectly it can make a difference, because with fewer hot flushes and better sleep you often feel calmer. That your hormones can play a part is a separate matter: when anxiety is new to you, or far heavier than anything you knew before, perimenopause belongs on the list of possible explanations.
Your heart pounds without you having done anything. You worry about things that barely touched you before. And sometimes the anxiety just hits, in the middle of an ordinary day. Maybe it is happening for the first time, just as you reach your forties. This page explains why anxiety so often belongs to menopause, how to tell a panic attack from a hot flush, when it is more than menopause and what actually helps.
How women describe it
"I feel restless without knowing why."
"I wake in the night with a pounding heart."
"Small things suddenly send me into a panic."
"I don't recognise myself, I was never an anxious type."
Sound familiar? You are far from alone. Anxiety and tension are among the most reported mental symptoms in menopause, and for a large group of women it is the very first time they have felt it this way.1 That is exactly why hardly anyone connects it to hormones straight away.
Why anxiety shows up now
Oestrogen and progesterone do more than regulate your cycle. They also influence the brain systems that steer your mood and your stress response. Oestrogen is linked to serotonin, the messenger that keeps your mood steady. Progesterone is converted in the brain into a substance that has a calming effect through GABA, a kind of natural brake on your stress system.
In perimenopause these hormones do not fall smoothly; they swing sharply from one day to the next. It is precisely those swings that can make your stress system more sensitive, so anxiety rises more quickly and settles less easily.2 Not everyone notices it to the same degree. That is why women who were never anxious can suddenly struggle with it.
Anxiety rarely travels alone, either. Poor sleep, night sweats and mood swings all become more common in the same phase, and each one puts extra strain on your nervous system. That is why the unease feels heavier some weeks than others.
Anxiety, hot flushes and panic attacks
A hot flush and a panic attack feel confusingly alike. Both bring a faster heartbeat, warmth, sweating and sometimes a tight feeling in the chest. A hot flush can trigger a panic reaction, and anxiety in turn can make a hot flush feel more intense. Research confirms a link between anxiety and hot flushes, though it is unclear which sets off the other.
Do you get attacks of intense anxiety with heart palpitations, shortness of breath or dizziness that fade after a few minutes? Those may be panic attacks. They feel frightening and are rarely dangerous in themselves. Always have a first attack checked, along with any attack that runs differently from what you know or comes with chest pain, breathlessness or fainting. That way a doctor can rule out a heart problem first.
There is good news too: for some women the anxiety eases again once hormones stabilise after perimenopause.
When anxiety is more than menopause
Anxiety is part of life and usually passes once its cause is gone. It becomes something to act on when the pattern shifts: the anxiety persists day after day, you start avoiding things you used to do without a thought, or it affects how you function at home or work. That may point to an anxiety disorder or depression, and both respond well to treatment.
Have it checked, too, if you are not sure menopause is the only cause. An overactive thyroid, an iron or vitamin B12 deficiency and some medications can produce the same symptoms.
If you are having thoughts of harming yourself, do not wait. Contact your GP, or call a crisis line. You do not have to carry this on your own.
What you can do yourself
There is no pill that removes anxiety, but there are habits with solid evidence behind them, and they support your general health at the same time.3
- Move regularly. The World Health Organization recommends around 150 minutes of moderate activity per week, such as brisk walking or cycling. Movement has a proven calming effect on mood and stress.
- Protect your sleep. Too little sleep makes anxiety worse, and anxiety makes sleep harder. If night sweats wake you, discuss them with a doctor, because they are treatable. There is more on this under sleep problems.
- Cut back on alcohol and caffeine. Both feed unease and disrupt your sleep. A strong coffee or a glass of wine can amplify the feeling of anxiety before you even notice.
- Practise a breathing technique. Slow, long out-breaths signal to your body that the danger has passed. It works best if you practise it in calm moments, so you can fall back on it when tension rises.
- Consider cognitive behavioural therapy. CBT teaches you to recognise and break worry patterns, and has good results for anxiety in menopause.
Does hormone therapy help?
Hormone therapy is not prescribed to treat anxiety on its own. For oestrogen, the studies on its effect on anxiety are mixed: some show an effect, others do not.4,5,6
For progesterone it sits a little differently. In the brain, progesterone is converted into allopregnanolone, the same substance that drives your calming system through GABA.7 In research, oral progesterone showed a favourable effect on sleep, though the trials vary, and perimenopausal women reported less interference from menopause in their daily life.8,9 So it is not used as a dedicated treatment for anxiety, but the mechanism does line up with what changes hormonally, and the response differs from woman to woman.
Indirectly, hormone therapy can make a difference by another route. If hot flushes and night sweats stop you sleeping through, you wake up more on edge. Treat those symptoms and the unease often settles with them. So if you are already considering hormone therapy for other menopause symptoms, this is a welcome bonus.
Is the anxiety pronounced, or does it come with a low mood? Then put it to a doctor. A care provider who knows menopause well can look at which form (oestrogen, progesterone, or a combination) is useful and safe in your specific situation.
Where to find help
Is anxiety still running your life, or are you worried about panic attacks? You don't have to figure this out alone.
Your GP (huisarts) is a good first stop. With a blood test they can rule out other causes, refer you to a gynaecologist or a psychologist if needed, and take the first steps with you. Some Belgian hospitals also run a dedicated menopause clinic.
Want to talk directly to someone who works on menopause every day? On Uma you will find care providers who specialise in (peri)menopause. Your consultation takes place online, you discuss all your symptoms together, the mental ones included, and you leave with a concrete plan. Uma is active mainly in Belgium, the Netherlands, Luxembourg and France, but any woman in Europe can consult a care provider on Uma. Prescriptions are valid across Europe.
Sources
- Bromberger, J.T. et al. (2013). Does Risk for Anxiety Increase During the Menopausal Transition? Study of Women's Health Across the Nation (SWAN). Menopause, 20(5), 488–495.
- Lang, X.-L. et al. (2025). From physiology to psychology: An integrative review of menopausal syndrome. World Journal of Psychiatry.
- World Health Organization (2024). Physical activity (fact sheet).
- Rozenberg, S. et al. (2026). Guidelines Menopause. Belgian Menopause Society.
- National Institute for Health and Care Excellence (2024). Menopause: identification and management. NICE Guideline NG23.
- BCFI (2025). Hormone therapy during perimenopause: benefits and drawbacks.
- McEvoy, K. & Osborne, L.M. (2019). Allopregnanolone and reproductive psychiatry: an overview. International Review of Psychiatry, 31(3), 237–244.
- Nolan, B.J., Liang, B. & Cheung, A.S. (2021). Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data. The Journal of Clinical Endocrinology & Metabolism, 106(4), 942–951.
- Prior, J.C., Cameron, A., Fung, M. et al. (2023). Oral micronized progesterone for perimenopausal night sweats and hot flushes: a Phase III Canada-wide randomized placebo-controlled 4 month trial. Scientific Reports, 13(1), 9082.
The content on this page is intended for informational purposes and does not replace medical advice. Please consult a physician for a personal assessment.