If you've started feeling anxious, on edge or tearful in your 40s, and it doesn't feel like you, perimenopause may be part of it. Hormone changes can affect mood, and many women notice anxiety for the first time in these years.
In short
- European menopause experts (EMAS) note that depressive symptoms are more common in perimenopause than in the years before it.
- Swinging estrogen affects mood messengers in the brain, and poor sleep makes everything harder.
- CBT and other treatments help, and you don't have to cope alone.
What can it feel like?
Worrying more than usual, feeling tense or irritable, a racing mind at night, sudden waves of panic, feeling tearful or flat, losing confidence.
Why does perimenopause affect mood?
Estrogen supports serotonin and other messengers that keep mood steady. When estrogen swings and falls, mood can swing too. Night sweats and broken sleep, plus the many demands of midlife, add to it.
What can help?
- Look after sleep and daily movement.
- Cut down on alcohol and caffeine, which can both make anxiety worse.
- Talk to someone you trust.
- Try CBT. Talking therapies such as cognitive behavioural therapy are a recommended non-drug option for anxiety and low mood around menopause.
- Ask your doctor about treatment. HRT can help some women's mood symptoms, and other treatments are available too.
When to see a doctor
See your doctor if anxiety or low mood affects your daily life, work or relationships, if you have panic attacks, or if it lasts more than a couple of weeks.
Get help straight away if you ever feel unable to cope or have thoughts of harming yourself: contact a doctor, a crisis line or emergency services.
Frequently asked questions
Can perimenopause cause panic attacks?
Some women experience them. Palpitations can also feel like panic, so mention both to your doctor.
Is it perimenopause or depression?
They can overlap. A doctor can help you work out what's going on.
Does it go away?
For many women mood settles after the transition, but help is worth getting now.
Seeing the pattern helps
Log your mood next to your cycle and sleep in Pausie. Seeing the pattern can be a relief, and it helps your doctor too. No account, and your diary stays on your phone.
This article is general information, not medical advice. Written by the Pausie team. Published and last reviewed 30 October 2026.
Sources
- World Health Organization: Menopause (fact sheet)
- EMAS Menopause Essentials: Depression
- The Menopause Charity: 2024 NICE menopause guideline