Why Perimenopause Makes Everything Feel so Overwhelming (And How to Manage the Stress)
There’s a certain kind of overwhelm that tends to sneak up on women in midlife. Sometime between your late 30s to early 50s, suddenly everything can start to feel like too much.
Maybe you’ve always been someone who could handle a lot. You manage work, relationships, kids, household responsibilities, appointments, family schedules and all of the little things that go into running your life. You might have even thought of yourself as someone who is pretty good at handling stress.
Then all of a sudden you’re more irritable. You’re worrying about things that normally wouldn’t bother you. Your patience is shorter.
You’re waking in the night, kept up by racing thoughts or anxiety. You feel exhausted - but somehow also wired? Situations that you logically know aren’t a big deal can make you feel like your world is ending.
If this sounds familiar, you may be wondering: why am I suddenly so anxious and overwhelmed?
For many women, the answer may be connected, at least in part, to the onset of perimenopause. The hormonal changes of the menopause transition can affect mood, sleep and the way your body responds to stress. At the same time, midlife often comes with plenty of its own stressors and transitions, creating a perfect storm for anxiety and overwhelm.
The good news? Feeling more anxious during perimenopause doesn’t mean you’re losing your mind or that you’re destined to feel this way forever. There are things you can do to better understand what’s happening and feel more in control again. I’m Victoria, a seasoned Denver-based therapist specializing in women’s mental health. In this post we’ll uncover the relationship between perimenopause, hormones and anxiety - and give you tools to feel less stressed and overwhelmed as you’re navigating this transition.
Why is My Anxiety So Terrible During Perimenopause?
If you feel like your anxiety has suddenly gone from manageable to overwhelming, you’re not imagining it.
Anxiety symptoms can become more noticeable during the menopause transition - research shows that as much as 51% of women in midlife endorse experiencing anxiety symptoms. Perimenopause involves significant fluctuations in reproductive hormones, particularly estrogen and progesterone, and these changes can affect the brain and systems involved in mood regulation.
Perimenopause also typically comes with what’s called “vasomotor symptoms”: hot flashes and night sweats, which can be disruptive in and of themselves. Combined with sleep disruption, changes to your menstrual cycle, brain fog and other physical symptoms, all of a sudden your regular equilibrium can feel totally out of whack. When you aren’t sleeping well and your body is acting in unfamiliar ways, it can be quite destabilizing. You may feel untethered, disconnected and overall unlike yourself, making it harder to find the tools to deal with everyday worries and stress. Your anxiety may feel truly terrible, unmanageable or even paralyzing.
And then there’s everything else happening in this moment of your life. You may be raising children, navigating changes in your partnership, caring for aging parents, moving forward in your career or thinking about what you want your next chapter to look like.
If you’re thinking, “why does everything feel so much harder right now?”, it’s not a personal failing. You didn’t suddenly become less capable of handling life. Your body, brain and life circumstances may just be asking more of you than they used to - and that can feel overwhelming.
Can Hormonal Changes Make Anxiety Worse?
Yes, hormonal changes during perimenopause can play a role in increasing anxiety, although experiences can vary widely from person to person. There’s science behind this - progesterone typically declines in early perimenopause. Progesterone is also connected to the production of the neurotransmitter GABA, which is known to have a soothing effect on anxiety. Therefore, declining levels of progesterone often has the effect of increasing anxiety.
Progesterone isn’t the only hormone impacted by perimenopause. Estrogen also starts to decline, and the drop in estrogen accelerates especially towards the last 1-2 years before menopause. Estrogen helps boost both the serotonin and dopamine systems in the brain. Serotonin is connected to mood, and dopamine is connected to motivation and executive functioning (among other things). When estrogen drops, mood, attention and motivation can all be impacted.
Cortisol is another hormone impacted by perimenopause. Also known as the “stress hormone”, as progesterone and estrogen levels fluctuate, cortisol and your body’s stress response has less of a hormonal buffer to keep it in check. This can leave you feeling regularly more on-edge, wired at night (even if you know you’re exhausted), and struggling more to cope with everyday setbacks.
You may notice that your anxiety seems to come in waves. Some days you feel relatively calm, while other days you feel inexplicably on edge.
You might experience:
Racing or intrusive thoughts
Increased worry or overthinking
Irritability or less patience
A sense of dread or doom
Difficulty relaxing
Increased feelings of overwhelm or sensitivity to stress
Panic or physical symptoms of anxiety
Brain fog or difficulty focusing
Trouble falling or staying asleep
Hormonal changes may also interact with other symptoms. For example, hot flashes can be accompanied by a rapid heartbeat and anxiety, while anxiety itself can sometimes trigger or intensify hot flashes. This can create a confusing cycle where you’re not sure what’s causing what.
Why Does My Day-to-Day Stress Suddenly Feel So Overwhelming?
One of the most frustrating parts of perimenopause can be feeling like your usual coping skills aren't working anymore - even the ones that have served you tried-and-true for years.
Maybe you used to be able to power through a busy week, or even thrive in a high-demand environment. Now, one unexpected change to your schedule can leave you feeling completely overwhelmed and paralyzed.
Think of your ability to hold stress quantified in a cup.
When you’re well-rested, emotionally supported and feeling relatively balanced, there’s plenty of room in your cup because those needs don’t take up space. But when you add in poor sleep, unpredictable moods and changes in bodily functioning to the work stress, parenting responsibilities, relationship challenges and never-ending mental load of daily life that you’re already dealing with, suddenly that cup is overflowing much more quickly.
Another helpful analogy is to think of progesterone and estrogen as shock absorbers - natural buffers for your nervous system that take the edge off of stressful life circumstances. When those shock absorbers start to wear thin due to declining levels of those hormones, all of a sudden stressful life events are hitting you directly instead of first connecting with that protective cushion.
All of this doesn’t mean you’re weak or incapable of handling stress - it means you’re a human being going through the natural parts of the life cycle.
Many women also reach perimenopause at a point in life when they have spent years putting everyone else’s needs first. You may be used to being the person who remembers everything, anticipates everyone’s needs and keeps the household running. This can make perimenopause symptoms feel disorienting and confusing not only to yourself, but to everyone who relies on you. Maybe you told yourself that this is just who you are, and you could keep going like this forever.
For many women, perimenopause brings them face-to-face with the fact that the amount they’ve been taking on isn’t sustainable, and that suddenly they’re running on empty.
What Kind of Symptoms Come With Perimenopause Stress?
Stress and anxiety during perimenopause can look different from person to person. Sometimes emotional symptoms are obvious, while other times they show up primarily in your body or behavior.
You might notice:
Feeling overwhelmed by everyday responsibilities
Increased irritability or anger
Racing thoughts
Constant worrying
Struggling to make decisions
Trouble concentrating
Feeling emotionally reactive
Feeling overstimulated
Difficulty falling or staying asleep
Feeling exhausted but unable to relax
Headaches or muscle tension
Changes in appetite
Heart racing or feeling shaky
Panic symptoms
Losing interest in things you normally enjoy
Brain fog is also common during the menopause transition. According to The Menopause Society, many midlife women report difficulty with memory, concentration, word recall and distractibility. These changes can in themselves create worry or panic that something is seriously wrong. It’s not uncommon to hear women experiencing perimenopause to feel like they’re quite literally losing their minds!
Can Perimenopause Cause an Anxiety Disorder?
There’s an important distinction between experiencing more anxiety and meeting the criteria for a clinical anxiety disorder. Perimenopause can contribute to increased anxiety symptoms, but that doesn’t necessarily mean that you have developed an anxiety disorder.
For some women, perimenopause may intensify anxiety they’ve experienced before. For others, it may be the first time they’ve noticed significant anxiety symptoms. Research suggests that the menopause transition can be a period of increased vulnerability for mood and anxiety symptoms, but experiences vary significantly from person to person.
Ultimately, anxiety disorders are diagnosed by the presence of specific symptoms within a certain timeframe - check out the Cleveland Clinic for more information on diagnosis of generalized anxiety disorder.
It’s important to keep in mind that whether or not you meet the criteria for a specific anxiety disorder isn’t always relevant to whether or not you need support. Instead of asking yourself “is this just hormones?”, it may be more helpful to ask “what is my body and brain trying to tell me right now?”
If anxiety is interfering with your relationships, work, sleep or ability to enjoy your life, it’s worth talking with a healthcare or mental health professional about treatment options.
How You Can Manage Stress and Anxiety in Perimenopause
Unfortunately there isn’t one magic solution for curing perimenopause anxiety - but it can be helpful to think about supporting yourself from several different angles to help things feel a little bit more manageable.
Pay attention to your physical health.
Sleep, movement, nutrition and other basic health habits can have a meaningful impact on how your body handles stress.
If you’re experiencing telltale physical symptoms like hot flashes, sleep disruption or cycle changes, don’t feel like you have to deal with this all on your own. You can talk with your healthcare provider about different treatment options. If you don’t feel like your gynecologist or primary care provider are particularly menopause-informed, The Menopause Society has a directory where you can search for providers with specialized training.
Give yourself permission to do less.
This one can be particularly difficult for women who are used to being productive, responsible and available to everyone. But if your capacity has changed, your expectations may need to change, too - otherwise you end up in a constant cycle of beating yourself up, feeling inadequate and experiencing more stress and anxiety as a result.
Maybe dinner doesn’t have to be homemade every night. Maybe you don’t need to say yes to every invite. Maybe your house can be a little messier. Maybe someone else can do the grocery shopping, or handle back to school shopping, or scheduling doctors appointments.
Doing less isn't failing - sometimes, it’s the only way to take care of yourself.
Notice your anxiety spirals.
When you’re overwhelmed, your brain may start looking for problems to solve.
“What if something goes wrong?”
“Did I handle that right?”
“What if I can’t keep up?”
“What if this is how I feel forever?”
Learning to notice and label these thought patterns without automatically believing everything your anxious brain tells you can be incredibly helpful. Try calling them “worry thoughts”, "anxious thoughts”, "intrusive thoughts” - whatever resonates most with you.
Mindfulness and grounding practices can help you return your attention to what is actually happening in the present moment instead of getting pulled into an endless loop of worry.
Make space for yourself.
If your entire day revolves around what everyone else needs, it’s easy to lose touch with what you need. Even small moments of intentional time for yourself can make a difference. Take a walk. Sit outside with your coffee. Read something you enjoy. Call a friend. Spend ten minutes doing absolutely nothing.
You don’t need to “earn” rest - you deserve it just for being you.
Externalize whenever possible.
Maybe prior to perimenopause you prided yourself on being someone who could just “remember” things, or keep track of your busy life all on your own. There is no shame in needing extra support as you’re going through this major life transition. Think about what tools are available to you - use calendars (paper or electronic, whatever works!), make lists, set reminders or start keeping a journal. There’s no need to keep carrying everything all on your own.
Prioritize stress management.
Each of us is unique in what helps us to de-stress. If intentional “relaxing” is something that’s unfamiliar to you, start paying attention to what helps you feel the most calm and restored. Some examples can be things like yoga, meditation, spending time outdoors, reducing sensory stimulation in your environment, gentle exercise and giving yourself breaks throughout your day or week. Because your hormones are responding to stress differently, your mind needs to be more intentional about actively making choices that promote calm and relaxation.
Can Therapy Help Me Cope with Perimenopause Stress and Anxiety?
Absolutely.
Therapy can’t stop your hormones from doing what they’re doing, but it can help you develop a healthier relationship with the stress and anxiety that may come along with them. Therapy can give you a dedicated place to slow down and understand what’s actually happening beneath the chaos and overwhelm.
You might work on:
Identifying what is contributing to your anxiety
Learning skills to manage racing thoughts and worry
Managing irritability and emotional reactivity
Challenging unrealistic expectations of yourself
Setting boundaries without feeling paralyzed by guilt
Making space for your own needs
Identifying narratives from earlier in life that are no longer serving you or you no longer wish to carry
Healing from past traumas that have resurfaced in midlife
Navigating changes in your identity
Perimenopause is not just a biological or hormonal transition - it occurs within the context of our whole lives. It’s not uncommon for us to find that without our hormones as buffers, the way we’ve been going about our responsibilities and relationships is no longer working for us. Perimenopause can be an opportunity to shift our perspective and capacity, and take greater responsibility for our choices. Such a major life change rarely occurs without grief, but it can also allow us to find more fulfillment and meaning in life if we let it.
When to Reach Out to a Women’s Health Therapist for Support
You don’t have to be in crisis to benefit from therapy.
Consider reaching out if you notice that anxiety or stress is:
Interfering with your work or relationships
Causing overwhelming or uncomfortable levels of anxiety
Leading you to withdraw from things you enjoy
Causing frequent irritability or emotional outbursts
Making it difficult to care for yourself
Affecting your confidence or sense of control
And perhaps most importantly: you don’t have to prove that your struggles are “bad enough” to deserve help.
If you’ve spent years being the person who takes care of everyone else, this may be an opportunity to start taking care of yourself, too.
You are not failing because you’re struggling.
You are not “too sensitive” because things feel harder right now.
And you are certainly not alone.
With the right support, it is possible to feel calmer, more grounded and more like yourself again - even in the middle of a season of significant change. At my therapy practice Root to Rise Therapy, I work with women going through the changes of perimenopause, struggling with anxiety or self-doubt, or wanting to break free from limiting beliefs that have haunted them since childhood. I work with clients living throughout Colorado, New York and New Jersey. Reach out today to schedule a free 15 minute consultation and get started on your journey to freedom and self-empowerment.
Related Posts:
Is It Perimenopause or ADHD? Dealing with Brain Fog and Mental Overload for Women in Midlife
How Anxiety Therapy Can Help with People-Pleasing and Self Esteem
Therapy for Overwhelmed Moms: Coping with Anxiety and Stress
How to Find Self Love and Leave the Inner Critic Behind
How to Manage Stress Without Sacrificing Success: Work and Personal Life Balance for High Achievers
