It can start at night. Your heart is suddenly racing, your mind runs through every way tomorrow could go wrong, and nothing in the room explains it. Or it is the phone call you keep putting off, the wedding you dread going to, the feeling of being wired and worn out at the same time.

If you have never thought of yourself as an anxious person, this can be frightening. It is also common in these years, and the guidance says so.

What it can feel like

Anxiety in perimenopause does not always look like the anxiety you have read about. It can be:

  • a pounding heart in bed, or a surge of dread as the lights go off
  • snapping at people, then feeling tearful
  • everyday stress that used to roll off you suddenly feeling too much
  • restlessness, panic or a sense that something bad is about to happen
  • tired all day and unable to switch off at night

The NHS lists anxiety, palpitations, difficulty sleeping, brain fog and mood swings among the common symptoms of perimenopause and menopause. If several of those sound familiar, they may be connected.

Yes, it can be perimenopause

The American College of Obstetricians and Gynecologists (ACOG) says hormonal shifts during the menopause transition can affect brain chemistry and contribute to anxiety, especially alongside stress and poor sleep. The Pakistan Menopause Society's 2026 recommendations list anxiety among the early symptoms, which can start while your periods are still coming, and ask doctors to ask about panic too. They also say women who have had anxiety or depression before are at higher risk of it getting worse during the transition.

Hormones are rarely the whole story. Broken sleep, night sweats, work, looking after children and parents at once, and the strain of not feeling like yourself all feed the same worry. A study in PLOS ONE found that stressful life events were linked with worse menopause symptoms. Calling it "just stress" does not make it smaller.

A racing heart

Get emergency help if a racing heart comes with chest pain, shortness of breath, or feeling faint. The NHS lists anxiety as a common cause of palpitations, but it lists heart problems too, and you cannot tell which it is on your own.

Do you need a hormone test?

This is one of the first questions women ask, and for most women over 45 the answer is no. NICE NG23 says perimenopause is identified from symptoms and changes in your cycle in otherwise healthy women of that age, without laboratory tests. ACOG says the same: most women probably do not need hormone testing, because a doctor can usually recognise perimenopause from age, symptoms and changes in periods.

Your hormones still matter. A single blood result can swing a long way from one week to the next in these years, so a careful conversation with a doctor tells you more than one number. Testing is more likely to be useful if you are under 45. Our page Is there a test? explains when.

Write it down

When symptoms come and go, it is easy to forget last week and hard to explain it in a short appointment. A simple daily note of your anxiety, sleep, mood, hot flushes (sudden waves of heat), night sweats and anything stressful that happened turns "something is off" into something a doctor can work with. After a few weeks, you may see anxiety rise after poor nights, around your period, or in weeks when the night sweats are worse.

A 2021 review in Frontiers in Global Women's Health found that tracking menopause symptoms helped women understand them, talk to their doctors and take part in decisions about treatment. Your Memory Is a Poor Witness explains what to note.

Do not carry it alone

Anxiety pushes you to keep it to yourself, and that makes it heavier. Telling one person does not fix a symptom, but it takes away some of the shame and confusion. Say the awkward thing out loud. Message the friend who will not brush it off. One honest sentence to a sister or your husband is a start.

What helps

The NHS website says CBT, a talking therapy, can help with anxiety, low mood and sleep problems. The Pakistan Menopause Society lists it for mood problems, face to face, in a group or online, with self-help CBT where specialists are hard to reach. It also says reducing stress, better sleep and mindful practices can improve mental health.

Whether HRT or another treatment fits you is a conversation for your doctor. If anxiety is affecting your work, your family or your sleep, that is reason enough to have it.

If worry comes with hopelessness or thoughts of harming yourself, see a doctor today. The Pakistan Menopause Society lists suicidal thoughts among the red flags that need prompt assessment.

Questions women ask

Can perimenopause cause anxiety even if I have never had it before?

Yes. The Pakistan Menopause Society lists anxiety among the early symptoms of perimenopause, and the NHS lists it among the common ones. It can be the first change a woman notices.

Why is it worse at night?

Night sweats and broken sleep are part of it, and a quiet, dark room leaves nothing to distract a busy mind. Noting when your worst moments come is useful information for your doctor.

Should I ask for my hormones to be checked?

If you are 45 or over with typical symptoms, NICE NG23 says a blood test is not usually needed. Ask for your symptoms to be assessed instead.

At your next appointment, ask: "Could this be perimenopause, and is CBT available here or online?" Our page on anxiety goes further.