If you have found yourself Googling “perimenopause and anxiety” at some ungodly hour of the morning, unable to sleep, heart racing for no obvious reason… this post is for you.
I have been there. More than once. And what I want to tell you right now, before we get into any of the science or the tools, is this: you are not losing your mind. You are not weak. And this is not just stress. Anxiety in perimenopause is real, it’s uncomfortable and its something you CAN manage…
What you are experiencing has a name, a biological explanation, and a way through.
What Nobody Tells You About Perimenopause and Anxiety
The thing that frustrates me most about how perimenopause is discussed, when it is discussed at all, is how the conversation almost always centres on the hot flushes. Maybe the irregular periods and, if you’re lucky, someone mentions sleep.
But the anxiety? The sudden, out-of-nowhere dread? The heart palpitations that send you to Google at 2am convinced something is seriously wrong? The feeling that your nervous system is stuck in flight and fight?
Well, that part tends to get labelled as depression, or burnout, or just stress, and you leave the doctor’s office with a prescription or a suggestion to try yoga and a vague sense that you might be truly crazy.
Research shows that between 40 and 51% of women in perimenopause experience significant anxiety symptoms, many of them for the very first time in their lives. That was my story, I’d never experienced anxiety until the crippling effects of perimenopause, and yet, it remains one of the least discussed and most misunderstood aspects of the midlife transition.
So let’s talk about it now!
What Is Actually Happening in Your Brain and Body
Oestrogen is not only a reproductive hormone, it also regulates serotonin (mood stabiliser), dopamine (motivation), and GABA (your brain’s primary calming signal). When it begins to fluctuate during perimenopause, these systems are directly disrupted. A 2015 study published in Nature Reviews Endocrinology, available via PubMed (https://pmc.ncbi.nlm.nih.gov/articles/PMC9934205/), describes perimenopause as a neurological transition state — not merely a hormonal one. That framing changed everything for me when I first read it.
Progesterone is your brain’s natural tranquilliser. It converts in the brain to a compound called allopregnanolone, which amplifies GABA’s calming effect. When progesterone drops — often years before oestrogen does, your inner brakes stop working properly. You feel overstimulated and unable to wind down even when things are going well.
At the same time, your autonomic nervous system is affected. Research published in the Journal of Physiology in 2024 (https://pubmed.ncbi.nlm.nih.gov/38064358/) shows that declining oestrogen increases sympathetic nervous system activity (fight-or-flight) while reducing parasympathetic (rest-and-repair) function. Your nervous system gets stuck in low-grade activation: alert, braced, on edge.
This is why perimenopause anxiety feels different to ordinary anxiety. It is not triggered by a thought. It arrives in your body first, somatically, in the chest, the throat, the racing heart. It is somatic before it is cognitive. And thinking your way out of it isn’t possible.
What I Have Learned From My Own Body
I am a woman who is navigating perimenopause with almost of 9 years of sobriety under my belt and what these two experiences share is the requirement to sit with discomfort rather than run from it. Before sobriety, my coping strategy was to not feel things. Perimenopause does not allow for that. The anxiety arrives. The 3am wakefulness moves in and you have a choice: resist it, or learn to navigate it. If you’re in perimenopause too, you’ll know that resistance is futile!
Three Things That Actually Help
- Breathwork
This the most direct route to your parasympathetic nervous system. Your breath is the only autonomic function you can consciously control. A lengthened exhale directly activates the vagus nerve and signals safety to the nervous system. You do not need a class or an app. Inhale for four counts. Exhale for eight. Repeat until you feel the shift back to calm.
With consistent practice, this does not just ease acute anxiety, it begins to rebuild vagal tone, changing your baseline.
2. Somatic therapy
Learn to work with your body, not around it. Because perimenopause anxiety is somatic before it is cognitive, it responds better to body-based approaches than to purely cognitive ones. Somatic work tracks sensation, releases stored stress patterns, and builds the capacity to tolerate activation without being overwhelmed. When a woman’s nervous system learns, really learns, that it is safe, the changes are significant. Sleep improves. Decisions come from a different place and life feels less overwhelming.
3. Believe in yourself
Not in a “I can do anything” framework but truly trust the messages you’re receiving from your body and brain. When you feel something is off in your body, trust that. It’s not “just stress” it’s your body responding to your changing environment. The best part of perimenopause is that your tolernace levels are lowered, what you used to put up with is no longer possible, you’re questioning your roles, your relationships and your life choices. Trust those instincts.
With a regulated nervous system you are able to make the changes that you need to, with an unregulated nervous system you’re likely to regret the fallout.
You Have Not Left It Too Late
Your nervous system retains neuroplasticity at any age. Your body can learn new patterns. You can feel well again, not despite being in midlife, but within it.
Perimenopause is not your body betraying you. It is an invitation, uncomfortable and inconvenient, to meet yourself with the care you have been giving everyone else for years.
Start with the breath. Four in, eight out. That is enough for now.
Denise Sohandev is a somatic midlife coach, based in South Africa. She is nine years sober, and navigating perimenopause in real time. To work with Denise, visit denisesohandev.com or email connect@denisesohandev.com
