How to manage perimenopause anxiety

From addressing your relationship with stigma, to actionable lifestyle changes, it’s time to take back control

When I first started using an app to track my periods, it gave me a sense of control. I understood my cycles better, and could work out when I might be susceptible to mood swings.

But, after a few months, I received an ‘analysis’ of my periods. Having been diagnosed with polycystic ovary syndrome (PCOS) in 2021 at age 31, I was well aware that they were irregular – but seeing perimenopause offered as an alternative explanation terrified me. Every time I logged a late period, I fretted.

Time will tell if I experience early menopause – other relatives have experienced early menopause, so it isn’t outside of the realms of possibility – and I take note of potential symptoms. But after speaking to friends, I realised that anxiety about perimenopause (the transitional phase during which your hormone levels start to change, before your periods stop and you reach menopause) is common. In a survey of 947 people, published in the journal Women’s Health, a third said they dreaded going through it. So, what can we do to attempt to manage that dread and anxiety?

Consider whether stigma is playing a role in anxiety

Perimenopause used to be a taboo subject only spoken about in euphemisms but, thankfully, it’s now talked about more openly. However, negative sociocultural attitudes towards menopause still influence how we feel about it.

“Much like menstruation, perimenopause is commonly associated with emotional, mental, and physical discomfort,” says Kate Merrick, psychotherapist and spokesperson for the UK Council for Psychotherapy. “It’s also linked with ageing, and in a society that values youth and fertility in women, this creates layers of unconscious anxiety.”

The reproductive and hormonal changes during perimenopause can also lead us to question our identity. Our sense of self is shaped by how we see ourselves, and if hormonal fluctuations affect our mood – for example, if we are more irritable than usual – it can be unsettling.

However, soul worker and womb medicine woman, Melanie Swan, adds that we tend to hear about the ‘bad’ bits, but this isn’t the whole story. “There is a body of knowledge emerging, initiated by women who have gone through perimenopause and healed themselves of the associated symptoms, and utilised the time to make quantum leaps in their personal growth and development,” she says.

Assess where the anxiety is coming from

The anxiety you might be experiencing could be linked to some of the ideas above, but there could be another element involved. Several studies, including one published in Psychoneuroendocrinology, have found that fluctuating oestrogen levels during perimenopause can raise the risk of anxiety and depression. Your GP may be able to offer support, and you could be prescribed hormone replacement therapy, anti-anxiety medication, or supplements to help you manage these symptoms.

Try diet and lifestyle changes

“We need to prioritise ourselves, listen to our needs and desires, set strong boundaries, and allow more time for rest and play,” says Kate. And prioritising self-care, as well as an active and varied lifestyle, during this time can make a real difference.

Additionally, paying attention to your diet is important. A study published in the journal Nutrients highlights the importance of eating whole and unprocessed foods during perimenopause. Rather than following a restrictive diet, use this as a prompt to try new healthy recipes and flavours, and get experimental in the kitchen.

Some studies suggest that taking magnesium might help with anxiety, but the evidence for the efficacy of such supplements is mixed. However, because it is relatively inexpensive, it is commonly recommended.

Reach out to others going through the same thing

Much of the discourse around perimenopause is about ‘riding out’ the symptoms, which can lead you to feel powerless. But with the right support, perimenopause doesn’t have to be scary. Speaking to others who are experiencing it can help, as can talking to friends and family. There are lots of support groups online, such as at menopausesupport.co.uk, on forum sites such as Reddit, and in private Facebook groups.

“If the focus is on all of the changes that are associated with perimenopause like brain fog, then understandably women are going to feel anxious,” says Melanie. “But if the conversation includes what we can do, there’s going to be less anxiety about experiencing it.”