Anxiety in Perimenopause: Hormones, History — and the Life You’re Living
- Nina Isabella
- 18 hours ago
- 6 min read
There is a particular kind of anxiety that can arrive in perimenopause that feels unfamiliar.
You may have lived most of your life steady, capable, resilient; and then - suddenly, or sometimes gradually - something shifts.
You wake with your heart racing at 3am.
Your patience thins.
You feel wired and exhausted at once.
Small worries swell.
A quiet sense of dread hums beneath the surface.
Many women tell me, “I don’t recognise myself.”
If this is happening for you, you are not alone. And you are not unraveling.
Perimenopause is not simply a hormonal event. Contemporary psychology understands it as a biopsychosocial transition - a convergence of biological change, personal history, relational dynamics, and cultural context.
Anxiety during this time is rarely just one thing.
It is often hormones.
And history.
And the life you are holding.
All at once.
The Hormonal Landscape: A More Reactive Nervous System
Perimenopause - the years leading up to menopause is characterised by fluctuating oestrogen and progesterone. These hormonal shifts influence brain systems involved in mood regulation, stress sensitivity, and emotional processing.
Psychological research suggests that hormonal variability, rather than stable low levels, is associated with increased vulnerability to anxiety and mood disturbance (Gordon et al., 2015). Fluctuations can affect serotonergic functioning, stress responsivity, and sleep regulation - all of which shape emotional resilience.
Sleep disruption and vasomotor symptoms such as hot flushes are strongly associated with increased anxiety and depressive symptoms during the menopausal transition (Freeman et al., 2006). When sleep is fragmented, emotional regulation becomes more effortful and threat sensitivity increases.
Common experiences include:
· Heart palpitations
· Night waking with racing thoughts
· Heightened sensitivity to stress
· Internal agitation
· Increased health anxiety
This is not weakness.It is a nervous system adapting to change.
And yet - hormones are rarely the whole story.
When Old Patterns Become Louder
Perimenopause often coincides with a psychologically dense life stage.
You may be:
· Parenting adolescents
· Supporting ageing parents
· Navigating career shifts
· Facing relationship change
· Becoming aware of mortality in a new way
Longitudinal findings from the Study of Women’s Health Across the Nation (SWAN) indicate that women with prior histories of depression are at increased risk for recurrence during the menopausal transition (Bromberger et al., 2011). From a psychological perspective, hormonal fluctuation may reduce previously reliable coping buffers, making earlier patterns - perfectionism, hyper-responsibility, attachment anxiety, unresolved grief - feel less containable.
Sometimes anxiety in perimenopause is not new - it's newly amplified.
Midlife as Psychological Reorganisation - Not Breakdown
Perimenopause is frequently medicalised, yet lifespan developmental research positions midlife as a period of identity renegotiation and psychological reorganisation (Lachman, 2015).
Midlife can bring:
· Reassessment of identity
· Reduced tolerance for self-abandonment
· Boundary renegotiation
· Grief for unlived possibilities
· A desire for meaning beyond productivity
Distress during life transitions can reflect adaptive restructuring rather than pathology. Anxiety may signal tension between who you have been and who you are becoming.
The Nervous System and Embodied Anxiety
Anxiety is not only cognitive - it is embodied. Neuroscientist Bruce McEwen (2004) described the cumulative physiological burden of chronic stress as allostatic load - the wear and tear that results from repeated adaptation to life demands. Across decades of caregiving, emotional labour, and professional responsibility, stress physiology can become sensitised.
Hormonal shifts may further reduce stress tolerance, increasing autonomic reactivity.
From a somatic psychology perspective, anxiety often feels like:
· Bracing in the chest or diaphragm
· Shallow breathing
· Muscle tension
· Hypervigilance - constantly on the look-out for danger
· Exhaustion paired with restlessness
Research on interoceptive awareness - our capacity to sense internal bodily states suggests that strengthening this awareness can support emotional regulation and reduce distress (Mehling et al., 2011). Sometimes the work is not analysing every thought. It is restoring safety in the body.
Acceptance and Commitment Therapy in Midlife
Acceptance and Commitment Therapy (ACT), developed by Steven C. Hayes and colleagues, offers a particularly resonant framework for this life stage. ACT is grounded in the concept of psychological flexibility - the ability to remain present with uncomfortable internal experiences while taking action guided by personal values (Hayes et al., 2006).
Across anxiety conditions, psychological flexibility has been associated with improved wellbeing and reduced symptom severity. In perimenopause, attempts to control or suppress anxiety can inadvertently intensify it. ACT shifts the stance:
· Allowing uncomfortable sensations rather than fighting them
· Noticing anxious thoughts without becoming entangled in them
· Clarifying what truly matters in this stage of life
· Committing to values-aligned action, even in the presence of uncertainty
Midlife often invites a deeper question:Given who I am now, how do I want to live?
ACT supports women to relate differently to anxiety - not as something that must disappear before life can expand, but as an experience that can coexist with meaning, vitality, and growth.
Hormones and History: A Both/And Approach
It is tempting to search for a singular explanation:
Is this hormonal?
Is this unresolved trauma?
Am I just stressed?
Psychological science supports a both/and understanding. Anxiety in perimenopause is often multilayered - biological sensitivity interacting with developmental transition, accumulated stress, and personal history.
An integrated approach may include:
· Medical assessment and hormonal consultation
· Nervous system stabilisation strategies
· Exploration of identity shifts
· Processing earlier experiences that resurface
· Values clarification and committed action
· Re-evaluating relational dynamics and boundaries
Women deserve nuanced, contextual care during this transition.
When to Seek Support
Consider reaching out if:
· Anxiety is consistently affecting sleep
· You feel persistently on edge or irritable
· Panic feels new or unfamiliar
· You no longer feel like yourself
· You sense this phase is asking something deeper of you
You do not need to wait until you are in crisis. Perimenopause can be disorienting. It can also be clarifying.
A Different Narrative of Perimenopause
What if this is not collapse - but recalibration?
What if anxiety is not simply pathology - but signal?
Midlife can be a portal:
· Toward clearer boundaries
· Toward truer self-expression
· Toward releasing roles that no longer fit
· Toward inhabiting your body differently
· Toward a more integrated sense of self
Support during this time is not indulgent; it is developmentally appropriate.
You do not have to navigate this threshold alone.
Anxiety may be speaking.Together, we can listen more closely to what it is asking for.
About Nina Isabella - Womanly Counsellor
I have a Master of Counselling; Advance Diploma of Therapeutic Yoga; I am a somatic movement practitioner; Trauma-Focussed Acceptance and Commitment Therapist. My practice is holistic, with over twenty years of experience in empowering women during their significant life transitions.
My compassionate practice is affirming and inclusive, centring the voice of women and gender-diverse individuals. I combine person-centred counselling with somatic psychotherapies including mindfulness, breathwork, and therapeutic yoga, creating a unique and relational approach to support women and gender-diverse individuals in their journey towards wellness.
References
Bromberger, J. T., Schott, L. L., Kravitz, H. M., Joffe, H., Avis, N. E., Gold, E. B., Matthews, K. A., & Randolph, J. F. (2011). Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: Results from the Study of Women’s Health Across the Nation (SWAN). Archives of General Psychiatry, 68(4), 407–415. https://doi.org/10.1001/archgenpsychiatry.2011.23
Freeman, E. W., Sammel, M. D., Lin, H., & Nelson, D. B. (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry, 63(4), 375–382. https://doi.org/10.1001/archpsyc.63.4.375
Gordon, J. L., Girdler, S. S., & Meltzer-Brody, S. E. (2015). Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: A novel heuristic model. American Journal of Psychiatry, 172(3), 227–236. https://doi.org/10.1176/appi.ajp.2014.14070918
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Lachman, M. E. (2015). Mind the gap in the middle: A call to study midlife. Research in Human Development, 12(3–4), 327–334. https://doi.org/10.1080/15427609.2015.1068048
McEwen, B. S. (2004). Protective and damaging effects of stress mediators: Central role of the brain. Dialogues in Clinical Neuroscience, 6(2), 121–132.
Mehling, W. E., Wrubel, J., Daubenmier, J. J., Price, C. J., Kerr, C. E., Silow, T., Gopisetty, V., & Stewart, A. (2011). Body awareness: A phenomenological inquiry into the common ground of mind–body therapies. Philosophy, Ethics, and Humanities in Medicine, 6(6). https://doi.org/10.1186/1747-5341-6-6
