October is Menopause Awareness Month, and yesterday was World Menopause Day — a reminder of how vital it is to talk openly about this transition and its impact on women’s emotional wellbeing.
For many women, menopause is not just a physical shift; it’s also an emotional and psychological one. Anxiety, in particular, can rise sharply during this time. Sometimes it’s the return of familiar symptoms; for others, it’s something entirely new and unsettling.
In this post, I wanted to explore why that can happen — and how understanding the connection between menopause and anxiety can help us experience this phase of life with compassion and care.
Hormonal changes and the mind
During menopause, estrogen and progesterone — hormones deeply linked with mood regulation — fluctuate and eventually decline.
• Estrogen supports neurotransmitters like serotonin and dopamine, chemicals that steady mood. When levels fall, emotional resilience can drop, too.
• Progesterone has a naturally calming effect through its influence on GABA, the brain’s relaxation chemical. As levels fall, many women notice increased restlessness or tension.
The result? Emotional ups and downs that can feel unpredictable or disorienting.
Research has shown that anxiety explained the distress experienced by around two-thirds of women during perimenopause1, and many report higher levels of anxiety at work during their menopause years2.
If you haven’t experienced it before, you may not recognise these symptoms as anxiety. I personally found that because there were other physical symptoms coupled with significant life changes, my anxiety just got caught up in the jumble. It wasn’t until some things cleared that I recognised what I had been experiencing was actually anxiety.
It’s a time when many women feel unlike themselves — a new self emerging amid uncertainty.
Physical symptoms that fuel anxiety
Hot flashes, night sweats, and disrupted sleep can all heighten anxiety. A racing heart or sudden heat surge may even mimic panic. Over time, exhaustion and fear of these sensations can make anxiety feel cyclical.
Whilst changes in external temperature can impact hot flashes, when they happen is not always predictable — which can create further anxiety around social engagements or work events.
Changing estrogen and progesterone levels are often behind the 4 a.m. wake-ups many women experience during menopause. Combined with increased stress hormones such as cortisol, this can create persistent sleep disturbance. When sleep is poor, exhaustion creeps in and changes our emotional landscape.
I’ve witnessed how sleep loss quietly erodes emotional resilience and can contribute to the anxiety women feel as they struggle to navigate this experience.
Significant biological changes take place during menopause – what Dr Mindy Pelz describes as a “neurochemical upgrade”3.Falling estrogen levels reduce several ‘feel-good’ neurochemicals such as serotonin and dopamine. This can create what I call a kind of emotional ‘brittleness’ — something I’ve experienced myself and have heard echoed by other women.
Life transitions and emotional identity
Menopause rarely happens in isolation. It often overlaps with life changes — children leaving home, career transitions, changes in relationship dynamics, caring responsibilities, or reflections on aging.
It’s a time that invites reflection on identity, purpose, and self-worth. Some women describe a sense of unmooring — a quiet questioning of who they are now and who they will become.
Handling these life changes and reflections whilst simultaneously dealing with the physical and emotional changes happening in the body is a lot. This adds to the load on the nervous system, which in turn creates more stress and anxiety.
Whilst this can be a time of loss for many women, it can also bring positive change — a sense of liberation from old expectations. As we gain greater understanding of menopause and the post-menopausal years, we are also beginning to recognise the growth, insight, and renewal this period can bring.
When anxiety becomes overwhelming
Research shows that perimenopause and menopause can increase vulnerability to anxiety and panic disorders. The combination of fluctuating hormones, disrupted sleep, and accumulated life stress can overwhelm even well-established coping mechanisms.
One major longitudinal study found women are 56% more likely to experience high-anxiety levels during early or late perimenopause compared to when they were premenopausal4.
Alongside anxiety, many women also experience what’s often described as “brain fog” — difficulty concentrating, forgetfulness, or struggling to find the right words. These changes can be distressing, especially their impact in professional or demanding environments.
Research suggests that fluctuations in estrogen affect the brain regions linked to memory, attention, and processing speed. When combined with sleep deprivation and anxiety, cognitive clarity can decline further. This isn’t a sign of cognitive decline or reduced capacity — it’s a reflection of the brain adapting to hormonal change. With rest, regulation, and support, clarity often returns as the body adjusts.
I often hear women describe this as feeling like their minds are “full of cotton wool.” Simply naming it and knowing it’s temporary and physiological can bring enormous relief.
Support and treatment options
Every woman’s menopause is unique. It’s also a time to learn how to care for our bodies in new ways — to discover what truly supports us rather than what we think we ‘should’ do.
As awareness of menopause treatment has increased, the amount of information available can feel both empowering and overwhelming.
For some, Hormone Replacement Therapy (HRT) can bring relief, particularly if anxiety is linked to hot flashes and sleep disruption. For others, non-hormonal approaches such as natural supplements, mindfulness, therapy, or gentle lifestyle changes can be equally powerful.
Therapy can also provide space to explore the deeper emotional themes of this stage — identity, purpose, loss, and renewal — and to learn new ways of soothing the nervous system.
There’s no single path; sometimes it’s a combination of approaches that helps most.
Reclaiming calm and connection
Supporting anxiety during menopause often means slowing down, nourishing the body, and creating new rhythms of rest and reflection. A tutor from my counselling training described menopause as a time for ‘radical self-care’.
Small, consistent acts of care can have a profound effect:
• Mindfulness, yoga, or breathwork to calm the nervous system
• Regular, gentle movement to support mood and energy
• Social connection with friends or peers who understand
• Nutrition that supports brain and hormone health
Menopause not just an ending; it’s a transition into a new phase of life. By understanding what’s happening biologically and emotionally, we can meet it with curiosity, compassion, and care rather than fear.
So much of the anxiety around menopause isn’t just hormonal — it’s emotional. It’s the fear of change, the grief for who we were, and the uncertainty of what comes next. But there’s strength in this period — an invitation to pause, recalibrate, and reconnect with ourselves on new terms.
1 Muslić, L., & Jokić-Begić, N. (2016). The experience of perimenopausal distress: examining the role of anxiety and anxiety sensitivity. Journal of Psychosomatic Obstetrics & Gynecology, 37(1), 26–33. https://doi.org/10.3109/0167482x.2015.1127348
2 Menopause and the workplace – Women and Equalities Committee. (2022). Parliament.uk. https://publications.parliament.uk/pa/cm5803/cmselect/cmwomeq/91/summary.html
3 Roll, R. (Host). (2025–present). Women’s hormonal health, cyclical fasting, health as a verb, reclaiming your body’s intelligence & transforming menopause into empowerment [Audio podcast]. https://www.richroll.com/podcast/mindy-pelz-926/
4 Bromberger, J. T., Kravitz, H. M., et al. (2013). Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause, 20(5), 694–701. https://doi.org/10.1097/gme.0b013e3182730599
