Feeling more anxious in your 40s? What perimenopause may have to do with it

You've always been the calm one. The one who handles things. Lately, though, there's a low hum of worry that won't switch off. Your heart races over small things. You lie awake running through tomorrow's list, then the week's, then everything that could go wrong.

If that's you, you're far from the only one. Many women describe feeling more anxious in their 40s. This post looks at what reputable health organizations say about anxiety and perimenopause, what else might be going on, and when it's time to reach out.

Is anxiety a perimenopause thing?

The honest answer is: it can be part of the picture, but research is still catching up.

ACOG, the professional organization for ob-gyns in the US, says there are few studies about anxiety and perimenopause, but some women do report symptoms of anxiety during this time (ACOG). Cleveland Clinic says something similar: there are only a few studies about anxiety specific to perimenopause, but many people report feeling more anxious then (Cleveland Clinic).

Mood changes more broadly are well recognized. Mayo Clinic lists mood swings, irritability and an increased risk of depression among perimenopause changes (Mayo Clinic). ACOG says about 4 in 10 women have mood symptoms during perimenopause that are similar to PMS, like irritability, low energy, tearfulness or trouble concentrating, except they may show up at times that have nothing to do with your cycle (ACOG).

What anxiety can feel like

ACOG describes anxiety as constant worrying that gets in the way of your day-to-day life. It can come with physical signs too, like muscle tension, sweating or nausea (ACOG). Cleveland Clinic adds that perimenopause anxiety can make it hard to sleep and get through your daily routine (Cleveland Clinic).

Both anxiety and depression can make it harder to concentrate, sleep and look after yourself, ACOG notes. So if you've also felt foggy or exhausted, those things can feed each other.

Why it might be happening now

There usually isn't one single cause. Reputable sources point to a mix of things.

Hormone shifts. The Menopause Society explains that the brain has estrogen receptors in areas involved in mood, and that mood symptoms may be related to big swings in estrogen during perimenopause, though the exact mechanism isn't known (The Menopause Society).

Hot flashes and anxiety can feed each other. The Menopause Society notes that hot flashes may make anxiety worse because they're unpredictable and can be embarrassing, and that anxious thoughts can also trigger hot flashes (The Menopause Society). The NHS mentions that hot flushes can cause palpitations or anxiety (NHS).

Poor sleep. The NHS says not being able to get to sleep or stay asleep can make you feel irritable, stressed and anxious (NHS).

A very full life. ACOG points out that your 40s and 50s are often when life's pressures are greatest: demanding jobs, kids at home or leaving home, and caring for aging parents (ACOG).

Your history. Mayo Clinic notes that women who have had depression or anxiety before, or hormone-related mood changes like PMS or postpartum depression, are more likely to have mood changes during perimenopause (Mayo Clinic).

It's not always perimenopause

Anxiety can have many causes at any age, and some physical symptoms that feel like anxiety, like a racing heart, can have other causes too. The NHS suggests contacting your GP if you have symptoms like palpitations (a fast, pounding or fluttering heartbeat) (NHS). Mayo Clinic also notes that mood changes can happen for reasons that aren't related to perimenopause at all (Mayo Clinic).

That's why the most useful next step isn't figuring out the cause yourself. It's telling someone qualified what's been happening.

When to reach out

ACOG encourages women to see their ob-gyn regularly during perimenopause and talk about how they're feeling, and says ob-gyns can help work out whether symptoms point to a mental health condition and refer you on if needed (ACOG). Cleveland Clinic also suggests talking to your provider if perimenopause is affecting your emotional well-being (Cleveland Clinic).

The Menopause Society offers one clear marker to watch for. If you've been feeling hopeless, having trouble concentrating, remembering or making decisions, lost interest in things you used to enjoy, and had trouble sleeping and waking up, most of the day, nearly every day, for at least two weeks, these may be signs of depression, and you should see a healthcare professional (The Menopause Society).

If you ever feel unsafe or have thoughts of harming yourself, don't wait. In the US and Canada you can call or text 988 any time (988 Lifeline, US; 9-8-8, Canada). If you're in immediate danger, call your local emergency number.

Getting ready to talk about it

It can be hard to describe anxiety in a short appointment. A few notes can help:

• When did you first notice it, and has it changed over time?
• What does it feel like in your body (racing heart, tight chest, upset stomach)?
• Is it worse at certain times, like at night or before your period?
• How is your sleep? Any night sweats?
• What's it getting in the way of: work, relationships, rest?

The bottom line

Feeling more anxious in midlife is real, it's common, and it's not a personal failing. Perimenopause may be part of it, alongside sleep, stress and everything else on your plate. You don't have to sort out the "why" alone. Talking to your doctor is a strong, sensible first step.