The question
You may have expected hot flushes. You may have expected some sleep disruption. What you perhaps did not expect is a persistent, sometimes overwhelming sense of anxiety that does not seem to have a cause, or that feels wildly out of proportion to whatever triggered it.
Yes, it is normal and very common
Anxiety is one of the most common symptoms of perimenopause and menopause, affecting a significant proportion of women during the transition. It is not a separate condition that coincidentally arrives at the same time. It is a direct neurological consequence of the hormonal changes occurring in the brain.
What makes it particularly difficult to manage is that it often does not feel like what most people think of as menopause. It arrives alongside, or sometimes instead of, the physical symptoms, and is frequently attributed to stress or a mood disorder rather than to the hormonal transition.
Why menopause causes anxiety
Oestrogen affects serotonin availability and the amygdala, which governs the threat response. Progesterone supports GABA, the calming neurotransmitter. During perimenopause, both hormones fluctuate unpredictably — which is why anxiety can feel erratic: worse at some points in the cycle, better at others, and impossible to predict.
Sleep disruption, also very common during perimenopause, independently amplifies anxiety by reducing the brain’s capacity to regulate its response to perceived threat. The result is a feedback loop: hormonal change produces anxiety, anxiety disrupts sleep, sleep disruption worsens anxiety.
What it can look like
Perimenopausal anxiety can present as a physical feeling of dread with no obvious cause, episodes of panic without trigger, heightened irritability, a sense of not being able to relax or settle, racing thoughts that prevent sleep, or sensitivity to situations that were previously manageable.
What to do next
Understanding that anxiety during menopause is a physiological response rather than a personal failing is often the first step. A nurse practitioner who understands the hormonal picture can help you identify what is driving your experience.