Why Am I So Anxious? Understanding Anxiety During Perimenopause and Menopause
Have you noticed that you're feeling more anxious, overwhelmed or unsettled than you used to?
Perhaps you've always considered yourself fairly calm and capable, but lately you're worrying more, your thoughts are racing, you're struggling to switch off, or things that once felt manageable suddenly feel much harder.
You might even be wondering:
“What is happening to me?”
This is a question I hear from women in my counselling practice.
At 54, I also have a personal understanding of this stage of life. But every woman's experience of menopause is different, and I don't assume that my experience is the same as yours.
What I do understand, both professionally and personally, is that midlife can be a time of significant change.
Menopause isn't simply about hot flushes or periods stopping. For some women, it can coincide with changes in sleep, mood, confidence, relationships, family life, identity and the way they see their future.
And sometimes anxiety becomes part of that picture.
Can menopause cause anxiety?
Anxiety can occur during perimenopause and menopause. The Australian Government recognises anxiety, panic attacks, low self-esteem and mood changes as possible mental and emotional symptoms during the menopause transition.
Recent research also suggests that anxiety symptoms are common among women around the menopause transition, although estimates vary considerably depending on the population and how anxiety is measured. A 2026 systematic review and meta-analysis of more than one million women found substantial levels of anxiety and insomnia symptoms among perimenopausal and postmenopausal women.
That doesn't mean that every episode of anxiety in your 40s or 50s is caused by menopause.
This is an important distinction.
Menopause happens at the same time as many other things in women's lives.
You might be managing teenagers or adult children, changes in your relationship, work pressures, ageing parents, caring responsibilities, financial concerns or questions about what comes next.
Sometimes it can be difficult to work out what is hormonal, what is stress, what is sleep disruption and what is simply that life has become a lot.
Often, it's a combination.
What can menopause anxiety feel like?
Anxiety doesn't always look like a panic attack.
For some women, it may feel more like a constant sense that something isn't quite right.
You might notice:
worrying more than you used to
finding it harder to switch off your thoughts
feeling overwhelmed by things that previously felt manageable
becoming more irritable or emotionally reactive
experiencing racing thoughts
feeling restless or on edge
having difficulty concentrating
experiencing physical symptoms such as a racing heart or feeling tense
having panic attacks
feeling less confident in yourself
becoming more fearful about things that previously didn't bother you
Some women describe it as feeling as though their usual emotional “buffer” has disappeared.
And then there is the frustration of thinking:
“I've never been like this before.”
If you recognise yourself in this, it doesn't necessarily mean you have developed an anxiety disorder.
Anxiety exists on a spectrum, and it's worth looking at what has changed in your life, your body, your sleep and your emotional wellbeing rather than assuming there is one explanation.
Why can anxiety feel worse during perimenopause?
There isn't one simple answer.
During perimenopause, ovarian hormone levels fluctuate and eventually decline. At the same time, women can experience changes in sleep, mood and physical symptoms.
The Australian Government identifies anxiety, mood changes and sleep difficulties among the symptoms that can occur during the menopause transition.
But there is another part of the picture that I think is important.
1. Changes in sleep
Sleep and anxiety can become a frustrating cycle.
You may be waking during the night, experiencing night sweats or simply finding that your sleep isn't as restorative as it once was.
Poor sleep can affect mood and make it harder to manage stress and regulate emotions.
If you're already feeling anxious, a few nights of poor sleep can make everything feel more difficult.
Sleep disturbance is also common around menopause, and research has found an association between vasomotor symptoms, sleep difficulties and anxiety symptoms.
2. Changes in your body
Menopause can bring physical changes that can be uncomfortable or unfamiliar.
Hot flushes, night sweats, changes in your menstrual cycle, brain fog and changes in sexual health can all affect how you feel physically and emotionally.
It can be unsettling when your body no longer feels quite as predictable as it once did.
3. Life is changing too
This is the part I think can sometimes be overlooked.
Menopause doesn't happen in isolation.
For many women, this stage of life can coincide with significant life transitions.
Your children may be becoming independent. Your relationship may be changing. You may be questioning your career or wondering what you want the next 10 or 20 years to look like.
You may also be supporting ageing parents while trying to look after yourself.
There can be a lot of change happening at once.
Research into women's mental health during perimenopause increasingly recognises that social and psychological factors can contribute to anxiety and mood symptoms alongside physical and hormonal changes.
And sometimes anxiety is your mind's response to feeling uncertain, stretched or out of control.
What if I don't feel like myself anymore?
This is something worth paying attention to.
You don't necessarily need to have a mental health diagnosis to benefit from talking to someone.
Sometimes counselling is simply a space to stop, take stock and work out what is actually going on.
We can look at questions such as:
What has changed?
What am I worrying about?
What is within my control?
What am I struggling to accept?
What do I need at this stage of my life?
What do I want the next chapter to look like?
These questions can be particularly important during midlife because anxiety isn't always just about the symptoms you're experiencing.
Sometimes it can be connected to identity, relationships, expectations or a sense that life is changing faster than you are ready for.
What can help with anxiety during menopause?
There isn't one approach that works for every woman.
For some women, addressing physical menopause symptoms with their doctor can make a significant difference.
It's also important not to assume that every new symptom is caused by menopause. Menopause symptoms can overlap with other health conditions, so speaking with your GP is important if symptoms are new, persistent, worrying you or affecting your everyday life.
Psychological support can also be helpful.
Cognitive Behavioural Therapy (CBT), for example, is recognised in current Australian Government guidance as a psychological therapy that can help reduce the impact of some menopause symptoms, including anxiety, low mood and sleep disturbance.
But counselling doesn't have to be about simply “fixing” anxiety.
For me, it's also about understanding what is underneath it.
We might look at your thought patterns, stress levels, boundaries, relationships, self-expectations, sleep and the changes happening in your life.
Sometimes the goal isn't to eliminate every uncomfortable feeling.
It is to understand what is happening, develop better ways of responding to it and feel more like yourself again.
You don't have to work it all out at once
One of the things I often remind women is that they don't have to have everything figured out before they ask for support.
You may not even be sure whether what you're experiencing is menopause, anxiety, stress or simply a particularly difficult period of life.
That's okay.
You can start with that uncertainty.
Talking with a counsellor can give you a place to slow things down, make sense of what you're experiencing and work out what you need.
And if your symptoms are new, severe, rapidly changing or affecting your everyday life, it's important to involve your GP or another appropriate health professional as well.
Menopause, anxiety and your next chapter
Menopause is a physical transition, but it can also be a significant emotional and psychological transition.
For some women, it brings challenges they weren't expecting.
For others, it becomes a time to reassess what they want from their relationships, work, family life and themselves.
There is no single “right” way to experience this stage of life.
If you're feeling more anxious, overwhelmed or unlike yourself, you don't have to simply put it down to “hormones” or tell yourself to get on with it.
There may be something worth exploring.
As a counsellor supporting women through life transitions, I provide a calm, non-judgemental space to explore what is happening for you and what you need moving forward.
If you're looking for menopause counselling in Melbourne, or would prefer to talk via telehealth, you can learn more about my counselling services or get in touch to discuss whether counselling might be right for you.
Frequently Asked Questions
Can menopause cause anxiety?
Anxiety can occur during perimenopause and menopause, although not every experience of anxiety during midlife is caused by menopause. Hormonal changes, sleep disruption, physical symptoms and life circumstances can all be part of the picture.
When does menopause anxiety start?
Anxiety symptoms can occur during perimenopause, which is the transition leading up to menopause, as well as during postmenopause. The timing and severity of symptoms vary considerably between women.
Can counselling help with menopause anxiety?
Psychological therapies such as CBT can help reduce the impact of some menopause-related symptoms, including anxiety and sleep disturbance. Counselling can also provide an opportunity to explore the broader emotional and life changes that may be contributing to anxiety.
Should I see my GP about anxiety during menopause?
It's a good idea to speak with your GP if anxiety or other symptoms are affecting your daily life. Menopause symptoms can overlap with other health conditions, so it is important not to assume that every symptom is caused by menopause. The Australian Government recommends discussing concerning or disruptive symptoms with a health professional.
Is anxiety normal during menopause?
Anxiety can be experienced during the menopause transition, but that doesn't mean you need to simply put up with it. If anxiety is affecting your quality of life, there are psychological and medical approaches that may help.
A note about this article
This article is intended for general educational purposes and is not a substitute for medical advice, diagnosis or treatment.
If you are experiencing new, severe or persistent symptoms, speak with your GP or another qualified health professional.
Author: Laura Davis, Accredited Counsellor, Boost Wellness
Reviewed: September 2026