Anxiety and Mood Changes During Perimenopause and Menopause

Perimenopause is the period leading up to menopause and continues until 12 months after your final menstrual period. It commonly begins during the 40s and can last several years. During this time, levels of oestrogen and progesterone fluctuate, and menstrual cycles often become irregular.

Menopause is reached after 12 consecutive months without a menstrual period. In Australia, natural menopause most commonly occurs between the ages of 45 and 55, with an average age of around 51.

While menopause is a normal biological process, the experience varies considerably from one person to another. Some women experience few symptoms, while others experience symptoms that significantly affect their everyday lives.

Hormonal changes are an important part of the picture.

During perimenopause, oestrogen and progesterone levels can fluctuate considerably before eventually falling to lower levels after menopause. These hormonal changes can be associated with physical, emotional and psychological symptoms.

But hormones are not the whole story.

The menopause transition often occurs at a time when women may also be managing significant changes and demands in their lives. Relationships, parenting, work, caring responsibilities, changes in identity, physical health, ageing and other life transitions can all contribute to emotional stress.

Physical symptoms can also have a psychological impact. For example, night sweats and other menopausal symptoms can interfere with sleep, while poor sleep can make it harder to regulate emotions, concentrate and cope with everyday stress. The Royal Women’s Hospital notes that night sweats can disturb sleep and subsequently affect mood and concentration during the day.

In other words, anxiety and mood changes during menopause can arise from an interaction between biological changes, physical symptoms, sleep, stress and life circumstances.

Anxiety during the menopause transition can look different for different people.

You might notice:

• feeling unusually worried or on edge
• increased sensitivity to stress
• racing or intrusive thoughts
• difficulty switching off or relaxing
• excessive worrying about things that previously felt manageable
• feeling overwhelmed by everyday demands
• physical symptoms of anxiety, such as a racing heart, tension or restlessness
• difficulty concentrating
• increased irritability
• sleep difficulties
• a sense that you are “not quite yourself”

Some women describe a feeling of suddenly becoming more anxious without an obvious reason. Others notice that situations they previously managed comfortably now feel much more difficult. There is more on psychological support for anxiety in adolescents and adults on a separate page.

It is important not to assume that every emotional or physical symptom in midlife is caused by menopause. The Australian Government recommends speaking with a doctor because some symptoms can have other causes and may require assessment or treatment.

Mood changes can be another common and disruptive part of the menopause transition.

You might experience:

• becoming tearful more easily
• irritability or frustration
• feeling emotionally overwhelmed
• sudden changes in mood
• feeling more sensitive in relationships
• reduced motivation
• periods of low mood
• feeling less resilient to everyday stress
• difficulty regulating emotional reactions
• feeling unlike your usual self

These experiences do not necessarily mean that you have a mental health disorder. However, persistent or significant anxiety, depression or emotional difficulties deserve attention, particularly when they begin to interfere with relationships, work, sleep or daily functioning.

The Australian Government identifies low mood, mood changes and anxiety among commonly reported menopause-related symptoms.

One of the challenges of the menopause transition is that several things can happen at once. You may be experiencing hormonal fluctuations while also sleeping poorly, coping with physical symptoms, managing work and family responsibilities, and adjusting to changes in your body or sense of identity.

When we are already under pressure, our capacity to manage stress can become reduced. Small problems can feel much bigger, emotional reactions can become stronger, and patterns of worrying or rumination can become more difficult to interrupt.

This can sometimes create a cycle:

Hormonal and physical changes → disrupted sleep → increased stress and emotional sensitivity → more anxiety or irritability → further difficulty sleeping and coping.

Breaking this cycle may require more than simply “trying to relax” or pushing through.

There is no single approach that works for everyone. Menopause management can include lifestyle strategies, medical treatment and psychological support, depending on the individual’s symptoms and circumstances.

1. Talk to your GP

If you are experiencing new or worsening anxiety, mood changes, sleep problems or other symptoms, it is worth discussing them with your GP.

A GP can assess whether your symptoms may be related to perimenopause or menopause and consider whether other medical factors should be investigated. They can also discuss treatment options, including Menopausal Hormone Therapy (MHT) and non-hormonal treatments where appropriate.

2. Look after your physical health

Regular physical activity, good nutrition, adequate sleep and maintaining social connections can all support wellbeing during the menopause transition.

The Australian Government recommends regular physical activity, including resistance, weight-bearing and aerobic exercise, as well as maintaining healthy sleep routines and looking after mental and emotional wellbeing.

These strategies are not about “fixing” menopause. Rather, they can strengthen the foundations that support your physical and psychological resilience.

3. Consider psychological support

Psychological therapy can be helpful when anxiety, low mood, irritability, stress or emotional difficulties begin to interfere with your quality of life.

Therapy can provide a space to understand what has changed, identify patterns that may be maintaining distress, and develop practical strategies for managing emotions and stress.

Depending on your needs, psychological therapy may focus on:

• reducing excessive worry and rumination
• identifying and challenging unhelpful thought patterns
• developing emotional regulation skills
• managing stress and overwhelm
• improving sleep-related behaviours
• building self-compassion
• navigating changes in relationships
• strengthening boundaries and assertiveness
• adjusting to changes in identity and life circumstances
• developing strategies for coping with uncertainty and change

Importantly, seeking psychological support does not mean that your symptoms are “all in your head”. Menopause involves genuine biological and physical changes. Psychological therapy can complement medical care by helping you manage the emotional and behavioural impact of those changes.

Menopause is a natural stage of life, but struggling with anxiety, mood changes or emotional distress does not have to be something you simply accept or endure.

The Australasian Menopause Society provides consumer resources addressing menopause symptoms, mental health, sleep, non-hormonal treatment options and other aspects of the menopause transition.

If you have noticed that you are feeling more anxious, emotionally reactive, overwhelmed or unlike yourself, it may be worth talking with both your GP and a psychologist. A collaborative approach can help you understand what is happening and identify strategies that are appropriate for your individual circumstances.