Let’s talk about something many women experience but few feel prepared for: perimenopause. One minute you’re going about your life, and the next, you’re wide awake at 3 a.m., heart pounding, mind racing, and on the verge of tears because of a commercial.
Sound familiar? That’s not just stress — it could be your hormones.
Perimenopause, the transitional phase leading up to menopause, is a time of hormonal upheaval, especially when it comes to estrogen and progesterone. These hormones aren’t just responsible for regulating your menstrual cycle — they also play a key role in mood, sleep, and emotional regulation. As they begin to fluctuate and decline, it can throw your nervous system—and your emotions — into disarray.
If you feel like your body is betraying you, you’re not alone. And those feelings are real.
“If someone in your personal life is being dismissive, you are allowed to say, ‘Let’s agree to disagree, I know my body. I know my experience,” says Dr. Sreela Roy-Greene, PhD, LMHC, Senior Clinical Operations Manager at BetterHelp. “It’s important to not minimize your own experience, even when others don’t understand. Hormonal and emotional changes are deeply connected.”
How hormone imbalance triggers anxiety
Research shows that women in perimenopause are at increased risk for developing new-onset anxiety disorders, even if they’ve never had anxiety before. And the shift often comes out of nowhere. One day you’re fine, and the next, you’re hit with a wave of panic that feels completely out of proportion to the situation.
So what’s happening inside your brain?
- Estrogen helps regulate serotonin, the brain chemical responsible for mood and emotional stability. When estrogen levels dip, your ability to cope with stress often takes a nosedive.
- Progesterone has a natural calming effect and promotes sleep, but fluctuating levels can lead to irritability, restlessness, and insomnia — fuel for anxiety.
In short: when your hormones are all over the place, your brain chemistry is, too.
You’re not imagining it
BetterHelp is the world’s most trusted online therapy platform – with over a decade of experience matching millions of clients to licensed therapists. It provides a fast, reliable, and affordable way to prioritize your mental health – from wherever you are.
Hormonal anxiety isn’t “in your head.” It’s a biological response to real shifts happening inside your body. Unfortunately, society tends to trivialize perimenopause, reducing it to jokes about hot flashes and mood swings. But the mental health impacts — including anxiety, depression, and panic — are very real and deserve attention.
Lifestyle shifts that can help
The good news? You’re not powerless. While you can’t stop the hormonal changes, you can manage how they affect you. Here are a few strategies to support both your physical and emotional well-being:
1. Prioritize sleep
Sleep is often the first casualty during perimenopause — and poor sleep only makes anxiety worse. Try:
- Keeping a consistent sleep schedule
- Avoiding screens an hour before bed
- Practicing relaxation techniques like deep breathing, progressive muscle relaxation, or guided meditation
2. Move your body
Exercise is a natural mood booster. It increases endorphins and helps regulate stress hormones like cortisol. Studies show that women who engage in regular physical activity report fewer symptoms of anxiety during perimenopause.
Even a brisk 20-minute walk can shift your mindset.
3. Eat for balance
Your diet can either support or sabotage your hormonal health. To reduce mood swings and anxiety:
- Cut back on caffeine, alcohol, and sugar
- Eat foods rich in omega-3 fatty acids (like salmon, chia seeds, and walnuts)
- Prioritize complex carbs, leafy greens, and magnesium-rich foods to support brain and hormonal function
4. Consider hormonal support
For some women, hormone replacement therapy (HRT) can help balance estrogen levels and relieve anxiety. Others may benefit from other remedies. Always talk to your doctor before starting any new treatments, especially supplements.
5. Talk about it
One of the hardest parts of hormone-related anxiety is the isolation — especially when friends or even healthcare providers don’t understand what you’re going through. Whether it’s a therapist, an online community, or a trusted friend, having someone to talk to is vital.
"Even just being heard without judgment can reduce the emotional burden,” says Dr. Roy-Greene.
You deserve support
Perimenopause isn’t just about irregular periods — it’s a transition that impacts your whole being. If you're experiencing unexpected anxiety, mood swings, or emotional sensitivity, your hormones might be the reason — and that’s nothing to be ashamed of.
You’re not losing it. You’re navigating a profound shift in your body and brain chemistry. With the right support, information, and care, you can come through this chapter feeling more connected to yourself — not less.
Emmy Hayes Condon is a creative strategist and freelance copywriter. She has a diverse portfolio across Fortune 50 healthcare brands, FemTech startups, and independent beauty brands. On her journey of connecting the dots of wellness, she has launched her project, The Wellness Department, to explore all areas of holistic wellness, beauty, and health. She resides in Austin, Texas, with her husband and rescue mutt Grace, and enjoys “romantasy” books, current event podcasts, and learning how to perfect a classic caesar salad.