Anxiety can affect a person during menopause, because estrogen is not just a sex hormone but also plays a role in the brain.

Story by: David Steen Martin; Reviewed by Kris E. Barnsfather, M.D. on January 10, 2024

As you approach menopause, your body starts producing less estrogen. This affects not only your body, but also your behavior, and potentially could lead to anxiety and other changes.

These behavioral changes happen because estrogen is not just a sex hormone. It also plays a role in the brain, and the transition to menopause can cause changes in how you feel and how you think. One symptom you may experience as your estrogen levels drop is anxiety. This can create a constant worry that gets in the way of your daily life and makes it hard to concentrate.

Anxiety also can be felt physically and result in sweating, muscle tension and nausea. You may even start having panic attacks. Panic attacks can cause your heart to pound, make you feel as if you can’t breathe, or even give you an intense fear that you are dying. It’s important to realize that these symptoms could be related to changes in your hormones, but if you start experiencing panic attacks, contact your health provider to rule out other potential causes.

“It’s not as common as irritability, but I’ve had patients start having panic attacks and anxiety during perimenopause,” said Kris E. Barnsfather, M.D., an obstetrician and gynecologist with Women’s Care Physicians of Louisville in St. Matthews, a part of Norton Women’s Care. “If it’s one or two panic attacks a month and isn’t interfering with the patient’s life, understanding the cause and normalizing the anxiety seems to be enough for some women.”

The transition to menopause, called perimenopause, begins in the 40s and 50s, a time when many women are already feeling a lot of stress while managing demanding jobs, raising children and caring for elderly parents — sometimes all at once.

Researchers have found that the transition to menopause causes 4 in 10 women to have mood changes similar to premenstrual syndrome, or PMS. These include being tearful, moody or irritable. You may find that you have “a short fuse” and are angered by things that didn’t bother you before. Perimenopause causes estrogen levels to drop, but they do so in an irregular fashion, meaning there is no pattern to the changes in mood. This “perimenopausal mood instability” can last anywhere from a few months to four years or more.

Perimenopause also is associated with forgetfulness, trouble with words and an inability to concentrate, in what often is described as “brain fog.” Other changes in your behavior can include loss of self-esteem, loss of confidence, and feelings of sadness and depression. The transition to menopause can cause a range of changes in your body and brain. Researchers have found that during this time, women are at higher risk of developing depression, stress, anxiety and emotional distress. These changes may be unpleasant, but they are normal as the body adapts to new, lower levels of estrogen. It’s important to see your OB/GYN or primary care provider regularly to discuss how you are feeling.