Guest blog: Perimenopause and Anxiety: Understanding the Connection and Finding Your Way Through
As a therapist working with women navigating long-term health conditions, I've noticed a pattern emerging in my practice, many women in their 40s and early 50s find themselves grappling with unexpected waves of anxiety. Often, they're surprised by the intensity of these feelings, especially if they have never experienced significant anxiety before. What many don't realise is that they're experiencing a natural but challenging phase of life: perimenopause.
The Hidden Link Between Hormones and Anxiety
Perimenopause, the transition period before menopause, typically begins in our 40s and can last several years. During this time, our bodies undergo a dramatic hormonal orchestra, with oestrogen and progesterone levels fluctuating unpredictably. These hormones don't just affect our reproductive system – they play crucial roles in our emotional wellbeing and stress response.
Here's what's happening behind the scenes:
Oestrogen affects the production of serotonin, our "feel-good" neurotransmitter. As oestrogen levels become erratic during perimenopause, our mood regulation system can feel like it's on a rollercoaster. This hormonal dance also impacts the stress hormone cortisol, making us more sensitive to stress and anxiety.
Why We Become More Vulnerable to Anxiety
During perimenopause, our bodies become less resilient to stress for several biological reasons. The fluctuation in hormones affects our:
Sleep patterns: Night sweats and insomnia are common, leaving us exhausted and more susceptible to anxiety
Brain function: Changes in oestrogen can affect memory and concentration, leading to work-related stress
Temperature regulation: Hot flushes can trigger panic-like symptoms
Stress response: Our natural ability to cope with stress becomes compromised as our hormonal balance shifts
Adding to these biological changes, we're often juggling multiple life stressors during this time – caring for teenagers or aging parents, career demands, and our own shifting sense of identity.
Finding Your Way Through: Practical CBT Strategies
While we can't control our hormones, we can develop tools to manage anxiety during this transition. Here are some evidence-based CBT approaches that have helped many of my clients:
Recognise and Reframe Your Thoughts
When anxiety strikes, pause and notice your thoughts. Are you catastrophising? Perhaps a moment of forgetfulness leads to thoughts like "I'm losing my mind" or "I can't cope anymore." Challenge these thoughts gently. Could there be a more balanced perspective? Remember, these symptoms are temporary and natural.
Build Your Stress-Resilience Toolkit
Create a personalised collection of coping strategies:
Practice parasympathetic breathing: This powerful technique helps activate your body's natural "rest and digest" response. Here's how to do it:
Find a comfortable position, either sitting or lying down
Breathe in through your nose for a count of 4
Hold your breath gently for a count of 4
Exhale slowly through your mouth for a count of 6, making your exhale longer than your inhale
As you exhale, imagine releasing tension from your body
Repeat this cycle 5-10 times
Practice this technique 2-3 times daily when calm, so it becomes natural to use when anxiety strikes
Schedule regular "worry time": This effective CBT technique helps contain anxiety to specific periods:
Choose a consistent 15–20-minute time slot each day (not too close to bedtime)
Find a quiet space where you won't be interrupted
Keep a worry diary throughout the day, jotting down concerns as they arise
During your designated worry time, review these concerns one by one
For each worry, ask yourself: "Is this something I can take action on?" If yes, make a specific action plan. If no, practice accepting uncertainty
When worries arise outside this time, gently remind yourself "I'll think about this during worry time" and refocus on the present
Maintain a consistent sleep routine: Quality sleep is crucial for managing anxiety, especially during perimenopause. Here's how to create a sleep-supporting routine:
Set consistent sleep and wake times, even on weekends
Create a calming 30-minute wind-down routine before bed:
Dim lights to signal to your body it's time to rest
Avoid screens, or use blue light filters
Try gentle stretching, reading, or listening to calming music
Practice your parasympathetic breathing
Make your bedroom sleep-friendly:
Keep the room cool (around 18°C) to help manage night sweats
Use layers of bedding you can easily remove
If you can't sleep after 20 minutes, don't lie there worrying:
Get up and do a quiet activity like reading
Return to bed only when you feel sleepy
Avoid checking the time repeatedly
Important tips for perimenopausal sleep:
Keep a glass of water and small fan nearby for night sweats
Avoid caffeine after 2pm
Exercise regularly, but not within 3 hours of bedtime
If anxiety strikes at night, remember your parasympathetic breathing
Embrace Lifestyle Adjustments
Small changes can make a significant difference:
Regular gentle exercise helps regulate mood and reduce anxiety
Minimise caffeine and alcohol, which can worsen anxiety and sleep issues
Practice mindfulness to stay grounded in the present moment
Prioritise self-care activities that bring you joy and relaxation
The Importance of Support and Self-Compassion
Remember, you're not alone in this experience. Many women find it helpful to connect with others going through similar challenges. Consider joining a support group or speaking with a therapist who understands the unique challenges of perimenopause.
Most importantly, be kind to yourself. Your body is going through significant changes, and it's okay to need extra support during this time. Think of this period as an opportunity to develop a deeper understanding of yourself and build new coping skills that will serve you well beyond the perimenopause years.
Moving Forward
While perimenopause can feel overwhelming, it's important to remember that this is a natural transition, not a permanent state. With understanding, support, and the right tools, you can navigate this phase of life with greater ease. If you're struggling with perimenopausal anxiety, reaching out to your GP or therapist who specialises in women's health can provide additional support and strategies tailored to your unique needs.
Remember, you've navigated many life transitions before, and you have the strength to navigate this one too. Sometimes, we just need a little extra support along the way.
About the Author
Kerry Alleyne is a Cognitive Behavioural Therapist (CBT) accredited by the British Association for Behavioural & Cognitive Psychotherapies (BABCP) and an EMDR therapist. Her journey in mental health included working with diverse populations across NHS mental health teams and leading private healthcare providers. She is passionate about making therapy accessible and providing evidence-based support that acknowledges both the physical and emotional aspects of mental health. When working with clients, she draws on her CBT and EMDR training to create personalised therapeutic approaches that respect each person's unique experiences and needs.
Website: Resilient Mind Therapies
