Can perimenopause cause anxiety?

Yes, it can. Both the HSE and the NHS list anxiety, along with low mood and mood swings, among the common symptoms of perimenopause and menopause. It often comes alongside poor sleep, hot flushes and brain fog, which can make it worse. If anxiety has crept up on you in your 40s or early 50s, it’s worth talking to your GP, because there are treatments and simple changes that can help.

Why perimenopause can bring anxiety

Perimenopause is the time before your periods stop, when your hormone levels change and symptoms begin. The HSE says symptoms can start 7 to 10 years before your periods stop, so many women notice changes long before they’d think of menopause.

The HSE’s list of common mental health symptoms of perimenopause and menopause includes:

• changes to your mood, such as low mood, anxiety, mood swings and low self-esteem
• irritability
• problems with memory or concentration (brain fog)

On its things you can do page, the HSE puts it simply: it’s common to have mood swings, low mood and anxiety around the time of perimenopause and menopause. So if this is happening to you, you’re not imagining it, and you’re far from alone.

How sleep, hot flushes and anxiety feed each other

Anxiety in perimenopause rarely shows up on its own. The NHS describes a few links that are worth knowing about:

• Sleep. Not being able to get to sleep or stay asleep can make you feel irritable, stressed and anxious, the NHS says, and sleep problems may be worse if you also have night sweats.
• Tiredness. Mood changes and memory problems may feel worse if you’re sleeping badly and feel very tired.
• Hot flushes. A hot flush can make you sweat a lot, feel dizzy, and cause palpitations or anxiety.

Palpitations (a heartbeat that feels faster, slower, fluttering or more noticeable) are on both the HSE and NHS symptom lists. They can feel frightening, especially if you’re already anxious. The NHS says to see your GP if you have symptoms like palpitations, so do get them checked rather than assuming.

Symptoms can also change over time. The NHS notes that you might have hot flushes and night sweats for a while, then find they ease and are replaced by low mood and anxiety. Everyone’s experience is different.

What can help

Treatments your GP may talk about

HRT. The HSE’s things you can do page lists HRT (hormone replacement therapy) among the treatments that can help with mood changes in menopause. The HSE’s treatment page calls HRT the main medicine treatment for perimenopause and menopause symptoms. Whether it suits you depends on your health and history, which is a conversation for your GP. (See our guide to the different types of HRT.)

CBT. Cognitive behavioural therapy is a talking therapy that helps you notice and change unhelpful patterns of thinking. The HSE says CBT can help with low mood and feelings of anxiety, and that it can also help with hot flushes and sleep problems.

Antidepressants. The NHS treatment page says that if you have low mood, depression or anxiety caused by perimenopause or menopause, you may be offered antidepressants. It lists them among the non-hormonal treatments, which it describes as options if HRT doesn’t work for your symptoms, you can’t take it, or you don’t want to.

Every treatment has its own benefits and risks, and what’s right for one woman isn’t right for another. Talk to your GP before starting, stopping or changing any medicine.

Things you can try yourself

The HSE suggests that to ease mood changes, you try to:

• get plenty of rest, including keeping to a regular sleep routine
• do relaxing activities, such as yoga, tai chi or meditation
• make time for things you enjoy
• exercise regularly, which the HSE says releases endorphins that help your mood
• talk to other people going through the same thing, such as family, friends or colleagues

Because hot flushes can bring on anxiety, the HSE’s advice on hot flush triggers may help too: it suggests cutting down on spicy food, caffeine, hot drinks, smoking and alcohol, and trying to reduce stress.

A word on supplements: the NHS says there is very little evidence on how well herbal remedies such as red clover and black cohosh work, or how safe they are, and some can cause serious side effects alongside other medicines. The HSE advises talking to a GP before taking herbal supplements.

When to see your GP

The HSE says to talk to your GP if you experience low mood or depression, or if your symptoms are difficult. The NHS says early advice can help reduce the effects of perimenopause and menopause on your health, relationships and work.

Also see your GP if:

• you have palpitations
• you’re under 45 and have menopause symptoms, or your periods have stopped for a year or more before 45 (both are on the HSE’s list of reasons to talk to your GP)
• you have any bleeding from the vagina after menopause, even spotting, which the HSE and NHS both say needs checking

If your GP can’t help, the HSE says you may be referred to a specialist, for example if treatment isn’t working or you can’t have HRT. In Ireland there are complex menopause clinics at several hospitals, listed on the HSE’s treatment page.

Ireland and the UK

The advice above is much the same in both countries. In Ireland, start with your GP; HRT is free at participating pharmacies with a medical card or Drugs Payment Scheme card (our guide explains how). In the UK, start with your GP or practice nurse; the NHS also says you can talk to a pharmacist about HRT and other options.

What to do next

• Track it for a few weeks. Note when the anxiety comes, how you slept, any hot flushes or palpitations and, if you still have periods, where you are in your cycle. Patterns help your GP.
• Book a GP appointment and say plainly that you think it may be linked to perimenopause. Ask: could this be hormonal? Would HRT, CBT or another treatment suit me? What are the benefits and risks for me?
• Pick one or two small changes from the HSE’s list, such as a regular bedtime or a daily walk, and see how you feel.
• Tell someone. A friend, partner or colleague who knows what’s going on can make a hard day easier.

If you’re struggling

If anxiety or low mood is getting too much, please reach out. Talk to your GP. You can call Samaritans free on 116 123, any time, in Ireland and the UK. In Ireland, you can call Pieta on 1800 247 247 or text 50808. In the UK, you can text SHOUT to 85258. In an emergency, call 999 or 112.