Anxiety and Low Mood During Perimenopause

By DR Saleem Khan
Consultant Gynaecologist
MBBS,DOWH,MRCOG, Dip Psy-sextherapy, FRCOG

Why It Happens and What Helps

Many women expect hot flushes and irregular periods during perimenopause.

What often comes as a surprise is the emotional impact.

You may suddenly find yourself feeling:

More anxious than usual
Easily overwhelmed
Irritable or tearful
Less confident
Emotionally sensitive
Unmotivated or low in mood

For some women, these feelings appear despite never having struggled with anxiety before.

If this sounds familiar, you are not alone.

Anxiety and low mood are among the most common symptoms of perimenopause, yet many women fail to connect them to hormonal changes.

The reassuring news is that these symptoms are real, common, and often improve with the right support.

Why Does Perimenopause Affect Mood?

Hormones do much more than regulate the menstrual cycle.

Oestrogen directly influences brain chemicals such as:

Serotonin (mood and wellbeing)
Dopamine (motivation and reward)
GABA (calmness and relaxation)

As hormone levels fluctuate during perimenopause, these neurotransmitters can become less stable, affecting emotional wellbeing.

At the same time, many women are navigating one of life’s busiest phases:

Careers
Family responsibilities
Teenagers
Ageing parents
Financial pressures

The combination of hormonal changes and life stressors can create the perfect storm for anxiety and low mood.

Common Emotional Symptoms of Perimenopause

You may notice:

Increased worry
Racing thoughts
Panic attacks
Feeling overwhelmed
Irritability
Loss of confidence
Reduced resilience to stress
Low mood
Emotional sensitivity
Loss of enjoyment in activities

Many women describe feeling like “a different version of themselves.”

The Hidden Role of Sleep

Sleep and mood are closely connected.

Poor sleep can increase:

Anxiety
Irritability
Stress sensitivity
Negative thinking

Many women find that improving sleep quality significantly improves emotional wellbeing.

If you are regularly waking at 3 am, experiencing night sweats, or struggling to fall asleep, addressing sleep should be a priority.

What Can Help?

The most effective approach is usually a combination of lifestyle, stress management, brain training, and professional support when needed.

1. Move Your Body Daily

Exercise is one of the most effective natural treatments for mild anxiety and low mood.

Physical activity helps:

Reduce stress hormones
Increase serotonin
Improve sleep
Boost confidence

Aim for:

Daily walking
Strength training 2–3 times weekly
Yoga
Pilates
Swimming
Cycling

Even a 20-minute brisk walk can improve mood.

2. Train Your Brain Away From Worry

The anxious brain becomes highly skilled at spotting problems.

Brain training helps redirect attention towards balance and resilience.

The Three Good Things Exercise

Each evening write down:

Three positive things that happened today
Why they happened

Research from positive psychology suggests this simple practice can improve mood and reduce anxiety over time.

Attention Training

Anxiety narrows focus towards worries.

Spend five minutes noticing:

Five things you can see
Four things you can feel
Three things you can hear
Two things you can smell
One thing you can taste

This grounding technique helps bring the brain back to the present moment.

Neurobics for Emotional Resilience

Just as neurobics can improve cognitive flexibility, they can also help break repetitive worry patterns.

Try:

Taking a different walking route
Learning a new hobby
Using your non-dominant hand for simple tasks
Listening to unfamiliar music
Trying a new recipe

Novel experiences stimulate neuroplasticity and encourage the brain to form new pathways rather than repeating anxious thought patterns.

3. Practise Relaxation Daily

Relaxation is not a luxury during perimenopause—it’s a health strategy.

Box Breathing

Breathe in for four counts.

Hold for four.

Breathe out for four.

Hold for four.

Repeat for 2–5 minutes.

This simple technique helps calm the nervous system and reduce feelings of anxiety.

Progressive Muscle Relaxation

Starting at your feet:

Gently tense a muscle group for five seconds
Relax for ten seconds
Move gradually up the body

This technique helps release physical tension that often accompanies anxiety.

Mindfulness Meditation

Even five to ten minutes daily can:

Reduce stress
Improve emotional regulation
Increase resilience
Enhance sleep quality

The goal is not to stop thoughts but to observe them without becoming trapped by them.

4. Nourish Your Brain

Nutrition affects mood more than many people realise.

Focus on:

Protein-Rich Foods

Eggs
Fish
Poultry
Beans
Lentils

These provide the building blocks for neurotransmitters.

Omega-3 Fatty Acids

Salmon
Sardines
Mackerel
Walnuts
Flaxseeds

Research suggests omega-3 fats may support mood and brain health.

Limit Excess Sugar and Alcohol

Both can worsen mood fluctuations and disrupt sleep.

Can HRT Help Anxiety?

For some women, anxiety is strongly linked to hormonal fluctuations.

When this is the case, treating menopausal symptoms appropriately may improve emotional wellbeing.

Hormone Replacement Therapy (HRT) can be helpful for some women but should always be discussed with a healthcare professional as part of an individualised treatment plan.

When Should You Seek Professional Help?

Please seek medical advice if:

Anxiety is affecting daily life
You are experiencing panic attacks
Low mood persists for several weeks
You lose interest in activities you normally enjoy
Symptoms are affecting relationships or work
You have thoughts of self-harm

Support is available, and you do not have to manage these symptoms alone.

The Bottom Line

Anxiety and low mood during perimenopause are common, but they are not something women should simply “put up with.”

Hormonal fluctuations, poor sleep, stress, and life pressures all contribute to emotional symptoms during this transition.

The encouraging news is that the brain remains adaptable throughout life.

Regular exercise, good sleep, healthy nutrition, brain training techniques, neurobics, mindfulness, and relaxation exercises can all help improve emotional wellbeing and build resilience.

Perimenopause may change how you feel, but with the right support, it does not have to define how you live.

References

The Menopause Society. Mood Changes and Menopause.
National Health Service. Menopause Symptoms and Mental Wellbeing.
National Institute on Aging. Menopause and Emotional Health.
Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the Evaluation and Treatment of Perimenopausal Depression. Menopause. 2018;25(10):1069–1085.
Gordon JL, Girdler SS. Hormone Fluctuations and Mood in Perimenopause. Current Psychiatry Reports. 2014;16(12):517.
Kabat-Zinn J. Mindfulness-Based Interventions in Health Care Applications. Clinical Psychology: Science and Practice. 2003.
Katz LC, Rubin M. Keep Your Brain Alive: 83 Neurobic Exercises to Help Prevent Memory Loss and Increase Mental Fitness. Workman Publishing.
National Institute for Health and Care Excellence (NICE). Menopause: Diagnosis and Management. NG23.