Yes, menopause and perimenopause can cause anxiety. The NHS lists anxiety and mood changes as common symptoms, and notes that hot flushes can bring on palpitations or anxiety, while poor sleep can leave you feeling irritable, stressed and anxious (NHS).
There's effective help, and if anxiety is new for you in midlife, it's worth ruling out other causes too.
If you need help now: call 999 or go to A&E if you feel you can't keep yourself safe. In England you can also call NHS 111 and choose the mental health option (option 2), or call Samaritans free on 116 123, any time (NHS).
Key takeaways
- Anxiety is a recognised menopause symptom. In a UK survey of working women aged 40–60 with menopause symptoms, 67% reported psychological symptoms such as anxiety, low mood, panic attacks or poor concentration (CIPD, 2023).
- NICE recommends considering CBT for low mood or anxiety that arise as a result of the menopause (NICE NG23).
- HRT can help anxiety and low mood caused by menopause, according to the NHS, but it isn't right for everyone and has risks to weigh up (NHS).
- Rule out other causes. An overactive thyroid can cause anxiety, and NICE advises considering a thyroid test for unexplained anxiety (NICE NG145).
What does menopause anxiety feel like?
Women's Health Concern, the patient arm of the British Menopause Society, describes anxiety, panic attacks, irritability, low mood, difficulty concentrating and loss of confidence as common emotional symptoms of menopause (WHC).
| How it can show up | What you might notice |
|---|---|
| Worry | Feeling on edge, dreading things you used to take in your stride |
| Panic | Sudden waves of fear, a racing heart, feeling short of breath |
| Mood | Irritability, mood swings, tearfulness, low mood |
| Body | Palpitations, especially alongside hot flushes |
| Sleep | Trouble falling or staying asleep, waking with a racing mind |
| Thinking | Brain fog, forgetfulness, losing confidence at work |
Menopause and anger
Anger is the symptom people are least likely to raise with a GP and most likely to feel ashamed of. It rarely appears on symptom lists under that name — the NHS wording is "mood swings, low mood or depression" and feeling "irritable, stressed and anxious" (NHS) — but irritability at the intensity many women describe is better called what it is.
What people report:
- A short fuse over things that genuinely wouldn't have registered a year ago
- Rage that arrives fast, feels physical, and passes leaving guilt behind
- It landing hardest on the people closest to you, because they're who's there
- Feeling like a different person, and not one you like
It is not a character change. Women's Health Concern, the patient arm of the British Menopause Society, describes irritability alongside anxiety, panic attacks and low mood as part of the emotional picture of menopause (WHC).
Two things help more than willpower. Naming it to the people affected — partners generally respond better to "this is happening and I'm dealing with it" than to being left to guess. And treating it as a symptom worth raising clinically, rather than something to be endured: the same approaches used for menopausal anxiety and low mood apply, and the NHS lifestyle measures are a reasonable starting point (NHS).
Why does menopause cause anxiety?
Several things tend to overlap:
- Hormone changes. Fluctuating hormone levels during perimenopause directly affect emotional wellbeing (WHC).
- Poor sleep. Women's Health Concern notes that up to 63% of women are affected by poor sleep around menopause, and that untreated sleep problems make emotional symptoms worse (WHC).
- Hot flushes and night sweats. These can trigger palpitations and anxiety in the moment (NHS).
Our guide to perimenopause symptoms covers the full list.
What helps with menopause anxiety
Here's what UK guidance says.
| Option | What UK guidance says |
|---|---|
| Talking therapy (CBT) | NICE recommends considering CBT for low mood or anxiety arising from the menopause (NICE NG23). In England, adults can refer themselves to NHS Talking Therapies (NHS). |
| HRT | NICE recommends considering HRT for low mood that arises as a result of the menopause (NICE NG23). The NHS says it's effective for anxiety and low mood caused by menopause (NHS). |
| Antidepressants | NICE says there's no clear evidence that SSRI or SNRI antidepressants ease low mood in menopausal women who haven't been diagnosed with depression (NICE NG23). |
| Everyday steps | Regular exercise, rest, a regular sleep routine, and relaxation such as yoga, tai chi or meditation (NHS). |
About HRT's risks. The NHS says the benefits usually outweigh the risks, and that the risk of serious side effects is very low. But there are risks: around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years, and HRT tablets (though not patches, gels or sprays) slightly raise the risk of blood clots and stroke (NHS). Whether it suits you is a decision to make with a clinician who knows your history.
Is it menopause, or something else?
Anxiety in midlife isn't always hormonal.
- Overactive thyroid. Symptoms include nervousness, anxiety, irritability, a fast or irregular heartbeat, feeling hot and weight loss (NHS). NICE advises considering a thyroid test for people with unexplained anxiety, and cautions that thyroid symptoms can be mistaken for menopause (NICE NG145). See our guide to thyroid symptoms in women.
- Depression or an anxiety disorder. Women's Health Concern notes that untreated menopause symptoms can develop into clinical depression, so don't ignore how you feel (WHC).
When to see a GP
Book a GP appointment if:
- anxiety or worry is present most days, or is affecting your work, relationships or sleep
- you're having panic attacks
- your mood is low, or you've lost interest in things you usually enjoy
- you think you have menopause symptoms and want to know your options (NHS)
Get urgent help (NHS):
- Call 999 or go to A&E if your life is at risk or you don't feel you can keep yourself safe.
- In England, call NHS 111 and choose option 2, the mental health option, to speak to a trained mental health professional. It's available 24 hours a day (East London NHS Foundation Trust).
- Call Samaritans free on 116 123 to talk to someone any time.
To note down what you're experiencing before an appointment, try our perimenopause checklist. If you'd like to talk to a GP who focuses on menopause, our online menopause clinic can go through your symptoms and the options that fit you.
See also our guide to HRT side effects, including the mood changes that can track the progestogen phase.
Honest FAQs
Can perimenopause cause anxiety and panic attacks?
Yes. Anxiety and panic attacks are recognised emotional symptoms of perimenopause and menopause (WHC). They can start before your periods stop.
Does HRT help menopause anxiety?
The NHS says HRT is effective for anxiety and low mood caused by menopause (NHS). It has risks as well as benefits, so it's an individual decision to make with a clinician.
How long does menopause anxiety last?
There's no set timescale. Menopause symptoms usually last 7 to 9 years, sometimes longer, and they can change over that time (NHS).
Can I refer myself for CBT?
In England, yes. If you're 18 or over (16 or 17 in some areas), you can refer yourself to NHS Talking Therapies, or ask your GP to refer you (NHS).
Could my anxiety be caused by my thyroid?
Possibly. An overactive thyroid can cause anxiety, irritability and palpitations, and NICE advises considering a thyroid blood test for unexplained anxiety (NICE NG145).
This article is general information, not medical advice. Always speak to a qualified clinician about your own symptoms.
