Common presentations of anxiety during perimenopause include:

• health-related anxiety;
• social anxiety, which might lead to cancelling plans with friends or avoiding dining out;
• a feeling of being overwhelmed, even by minor tasks; 
• generalised anxiety, characterised by constant worry about various aspects of life; and/or
• panic attacks. 

Several factors can exacerbate anxiety during perimenopause:

• Sleep deprivation: Symptoms can worsen due to insufficient sleep, and sleep disturbances from night sweats, vaginal irritation, and frequent urination can contribute to this.
• Alcohol: Some women increase their alcohol intake in an attempt to improve sleep, but alcohol disrupts the normal sleep cycle, acts as a depressant, intensifies hot flushes and night sweats, and increases night time bathroom visits. This leads to non-restorative sleep and contributes to fatigue, further aggravating anxiety.
• Caffeine: Caffeine is a stimulant that can induce palpitations, disrupt the sleep cycle, and should be avoided, especially after 6PM or noon for those sensitive to its effects.

To manage perimenopausal anxiety, consider the following self-help strategies:

• Keep a mood diary to identify triggers and patterns of symptoms.
• Talk to friends and family to gain understanding and support.
• Spend time outdoors in nature or engage in activities with friends.
• Practice controlled breathing techniques.
• Maintain a consistent sleep routine.
• Keep a notebook by your bedside for jotting down worries during night time awakenings.
• Maintain a healthy diet with complex carbohydrates and avoid sugary foods.
• Spend time with people who bring you joy.
• Exercise during the day to reduce stress and improve physical health.
• Find a fulfilling activity, such as gardening, knitting, sewing, reading, or singing.
• Explore meditation apps or consider practicing Yoga.
• Avoid overcommitting and set realistic short-term goals.
• Focus on ACE activities that bring Achievement, Connection, and Enjoyment.

If you find yourself still struggling with anxiety, consider the following options:

• Hormone Replacement Therapy (HRT): HRT can help alleviate psychological symptoms during perimenopause and menopause when hormonal imbalances may be contributing to symptoms like insomnia, fatigue, irritability, anxiety, panic attacks, and low mood. Using a Period Tracker can help identify changes in your menstrual cycle that may indicate hormonal imbalance.
• Cognitive Behavioural Therapy (CBT): CBT is an evidence-based talking therapy effective in managing anxiety, depression, and hot flashes. Many areas provide direct access to CBT without the need for a GP referral. Search for availability in your area using NHS services or look for private registered CBT therapists.
• Medication: In some cases, medication may be necessary to manage severe anxiety, either in the short-term to enable engagement with CBT or as a long-term solution. Consult with your clinician to determine the most suitable medication based on your specific symptoms and needs.