I’ve spent more than 30 years helping people manage anxiety.

I understand grounding techniques. I know how the nervous system works. I’ve sat with clients through panic attacks, racing thoughts, sleepless nights, and overwhelming fear. I’ve helped people untangle trauma, stress, and relationship patterns that fueled anxiety.

So when anxiety hit me hard during perimenopause, I honestly didn’t recognize it at first.

I thought I was stressed.
I thought I was overreacting.
I thought maybe I just needed better boundaries or more sleep.

But this felt different.

I would wake up at 3am with my heart racing. My thoughts would immediately start spinning. Small things suddenly felt huge. I became more emotionally reactive, especially in my close relationships.

Poor Chris. 😅

As a counselor, I understood anxiety intellectually. But perimenopause gave me a completely different understanding of what anxiety feels like physically.

And I know now that many women are walking through this same experience without realizing how connected hormones and mental health actually are.

Can Perimenopause Cause Anxiety?

Yes. Absolutely.

Perimenopause anxiety is incredibly common, even for women who have never struggled with anxiety before.

During perimenopause, estrogen and progesterone levels fluctuate dramatically. Those hormonal shifts affect neurotransmitters like serotonin and dopamine, which help regulate mood, sleep, and emotional stability.

Hormonal changes can also affect:

• Cortisol and stress response

• Sleep quality

• Energy levels

• Brain fog and concentration

• Emotional regulation

• Nervous system sensitivity

When your body is constantly shifting hormonally, it can feel like your nervous system is always slightly on edge.

For many women, this shows up as:

• Racing thoughts

• Increased irritability

• Panic attacks

• Waking up anxious in the middle of the night

• Health anxiety

• Relationship anxiety

• Feeling emotionally overwhelmed by things that previously felt manageable

And here’s what makes it even more confusing:

A lot of women in midlife are also navigating major life transitions at the same time.

Kids leaving home.
Changing marriages.
Aging parents.
Career shifts.
Questions about identity and purpose.

So it can be hard to tell:
“Is this emotional?”
“Is this hormonal?”
“Is this stress?”
“Is this all of the above?”

Honestly, sometimes it’s all connected.

Why Anxiety Often Gets Worse at Night During Perimenopause

One of the biggest surprises for me was the nighttime anxiety.

I would wake up around 3am and immediately feel alert, anxious, and unable to settle my mind back down.

There’s actually a physical reason this can happen.

Hormonal fluctuations can affect cortisol rhythms, blood sugar regulation, and sleep cycles. Lower progesterone levels can also reduce the calming effect this hormone has on the nervous system.

When sleep becomes disrupted, anxiety often increases even more.

Then the cycle feeds itself:
Poor sleep increases anxiety.
Anxiety disrupts sleep.
And suddenly your body feels exhausted while your brain refuses to rest.

Many women assume they’re “losing it” when this starts happening.

You’re not losing it.
Your body is changing.

And your mental health is deeply connected to what’s happening physically.

The Connection Between Hormones, Vitamin Deficiencies, and Anxiety

This is one reason I’m so passionate about women getting bloodwork done during midlife.

I think many women spend years blaming themselves for symptoms that may actually have a physical component.

Low vitamin D levels can affect mood and energy.
Low B vitamins can impact nervous system functioning.
Hormonal imbalances can increase anxiety and emotional sensitivity.
Poor sleep and chronic stress can make everything feel worse.

Of course, mental and emotional factors matter too. Anxiety is never “just hormones.”

But I do think women deserve a more complete picture of what’s happening in their bodies.

Sometimes we need therapy.
Sometimes we need boundaries.
Sometimes we need grief work.
Sometimes we need better support.
And sometimes we also need bloodwork, nutritional support, hormone support, rest, and nervous system care.

It’s rarely just one thing.

Sometimes Anxiety Is a Warning Sign

This part feels important to say too.

Not all anxiety is simply a hormonal imbalance.

Sometimes anxiety is information.

Sometimes it’s your body trying to get your attention after years of pushing through exhaustion, overgiving, stress, resentment, loneliness, or emotional disconnection.

Sometimes anxiety is the warning light on the dashboard saying:
“This pace isn’t sustainable.”
“This relationship dynamic needs attention.”
“You can’t keep abandoning yourself.”

I think one of the biggest lessons of midlife is learning to pay attention to ourselves instead of constantly pushing through.

For many women, midlife is the first time they stop long enough to realize how disconnected they’ve become from their own needs.

That awareness can feel uncomfortable at first.
But it can also become the beginning of real healing.

What Helped Me Navigate Anxiety During Perimenopause

I’m still learning what support looks like in this season, but here are a few things that made a real difference for me:

• Paying attention to my physical health

• Getting bloodwork done

• Supporting sleep and nervous system regulation

• Spending time outside and moving my body

• Learning how stress affected me physically

• Talking honestly about what I was experiencing

• Giving myself more compassion instead of judgment

• Recognizing when anxiety was connected to deeper emotional patterns

And honestly? Simply understanding that hormones were part of the picture helped tremendously.

There was relief in realizing:
“This isn’t just me failing to cope.”

Midlife Mental Health Deserves More Attention

May is Mental Health Awareness Month, and I think midlife women deserve to be included in this conversation more often.

Because many women are quietly struggling.

Not because they’re weak.
Not because they’re incapable.
But because their minds, bodies, hormones, relationships, and identities are all shifting at once.

That’s a lot for one nervous system to carry.

If you’re in this season, my encouragement is simple:

Pay attention to yourself.

Pay attention to your body.
Pay attention to your stress.
Pay attention to what no longer feels sustainable.
Pay attention to the areas where you may need support instead of more pressure to “handle it.”

You don’t have to white-knuckle your way through midlife.

And sometimes the healthiest thing we can do is stop treating ourselves like machines and start treating ourselves with care. 💗

FAQ: Anxiety During Perimenopause

Is anxiety a symptom of perimenopause?

Yes. Anxiety can absolutely be a symptom of perimenopause. Hormonal fluctuations during midlife can affect mood, sleep, emotional regulation, and nervous system sensitivity. Some women experience anxiety for the first time during perimenopause, while others notice existing anxiety becomes more intense.

Why does perimenopause anxiety feel worse at night?

Many women experience increased anxiety at night or wake up around 3am with racing thoughts during perimenopause. Hormonal shifts can affect cortisol levels, blood sugar regulation, and sleep quality. Lower progesterone levels may also reduce the body’s natural calming response, making it harder to stay asleep and emotionally regulated.

Can hormone imbalance cause panic attacks?

Yes. Hormonal fluctuations during perimenopause can contribute to panic attacks, heart racing, shortness of breath, and feelings of overwhelm. It’s important to rule out medical concerns and talk with a healthcare provider if symptoms feel severe or sudden.

Should I get bloodwork done during perimenopause?

Bloodwork can be incredibly helpful during midlife. Vitamin deficiencies, thyroid issues, hormonal changes, and chronic stress can all contribute to anxiety symptoms. Many women discover there are physical factors affecting their mental health that deserve attention and support.

How do I know if my anxiety is hormonal or emotional?

Often, it’s both. Midlife women are navigating hormonal changes alongside relationship shifts, caregiving stress, identity changes, grief, and emotional burnout. Anxiety during perimenopause is rarely caused by just one thing. Looking at both physical and emotional health usually provides the clearest picture.

Gentle Next Step

If this season feels unfamiliar or overwhelming, you don’t have to figure it out alone.

The Midlife Roadmap was created for women who feel like something is shifting internally and want support understanding themselves, reconnecting with what matters, and creating a healthier next chapter.

Because midlife isn’t about pushing harder.
It’s about learning to pay attention differently.

If this resonated, share itwith a friend who might need it 💗