Menopause Anxiety: You’re Not Losing Your Mind
What… the Menopause?
Each week we spotlight an unexpected and frustrating symptom of menopause that no one warned you about. Because menopause is more than just hot flashes and missed periods.
This week’s spotlight: Anxiety and Panic Attacks
What’s Going On?
When you’re going through perimenopause or menopause, your body is undergoing big hormonal shifts. Estrogen, progesterone and testosterone levels begin to change, and these shifts affect more than just your menstrual cycle. They influence your brain, your nervous system, your sleep and your stress response.
- For example: as progesterone (which helps calm and stabilise) begins to decline, you might find yourself more keyed‑up, more restless or irritable. In my interviews and research I often talk about how women in their 40s or early 50s wake up with a racing heart, sudden overwhelm, or a sense of dread, and they think “what the heck is wrong with me?”
- At the same time: estrogen influences neurotransmitters like serotonin and GABA, which help regulate mood and anxiety. The drop in estrogen + the dysregulation of these brain chemicals can create a perfect storm of heightened arousal, low mood, and stress reactivity. (Cleveland Clinic)
- Then there’s the external factors that often accompany midlife: sleep disruption (night sweats, hot flashes), mounting life responsibilities (career, ageing parents, maybe children leaving home), and sometimes the underlying health issues that crop up during this life phase. All of this can make anxiety feel magnified.
- And yes, panic attacks: sudden episodes of intense fear, heart palpitations, shortness of breath, shaking, feeling like you might die or go crazy, can also surface during this transition. Research shows that panic attacks in postmenopausal women are more common than we used to think. One study found about 9.8% of post‑menopausal women reported full‑blown panic attacks in a six‑month period. (JAMA Network)
- It’s worth noting: sometimes what appears to be a hot flash may overlap with a panic attack: the heart racing, the heat, the sense of dread. The lines blur. (Harvard Health)
So yes, you’re not imagining it.
You’re Not Alone
If you’re reading this and thinking “wow, that’s me,” you’re absolutely not alone.
- Studies estimate that 15%‑50% of perimenopausal and post‑menopausal women may experience a range of psychological/emotional symptoms including anxiety. (PMC)
- In another review, anxiety prevalence in menopausal groups was reported as high as 55.7% in one sample. (PMC)
- And the burden of anxiety disorders during the perimenopausal period is increasing globally, one large‐scale study projects a 40% increase by 2035. (BioMed Central)
- So if you’re feeling anxious, fearful, or like you’re on a “panic rollercoaster” during menopause, then yes, you are part of a large, often invisible, community.
- And yet, despite how common it is, it’s under‑recognised. Anxiety and panic tend to be overshadowed by “classic” menopause symptoms, and women often feel isolated, or wonder if they’re “overreacting”. (Lippincott Journals)
What Can You Do?
Because yes, you can move through this. You don’t have to just suffer and wait for it to pass.
Here are practical strategies I recommend (and use myself):
- Ground the basics
- Prioritise sleep: consistent bed and wake times, dark and cool room, reduce stimulants after mid‑afternoon. Good sleep = less reactivity.
- Move your body: regular movement (strength + cardio + mobility) helps regulate mood and anxiety.
- Nutrition: stable blood sugar helps. Avoid big caffeine/spike crashes. Hydrate with clean water, eat plenty of vegetables, and focus on getting in adequate amounts of protein.
- Breathwork & nervous‑system regulation: On my podcast I talk a lot about how slow exhalations, nasal breathing, and calming routines help bring you out of fight‑or‑flight. (I’m certified with the Oxygen Advantage for this work.) (oxygenadvantage.com)
- Prioritise sleep: consistent bed and wake times, dark and cool room, reduce stimulants after mid‑afternoon. Good sleep = less reactivity.
- Recognise and interrupt the cycle
- Notice the early signs of anxiety: racing heart, breathlessness, sense of doom.
- When they come, use a “3‑2‑1” strategy: three deep nasal inhales/exhales, two minutes of grounding (feet on the floor, name three things in the room), one intentional movement (stretch, stand up, shake arms).
- Use cognitive awareness: Another layer is saying to yourself: “This is not a heart attack, I am in transition, hormones are shifting, this will pass.” Changing the narrative changes the physiology.
- Notice the early signs of anxiety: racing heart, breathlessness, sense of doom.
- Talk to your doctor about hormones + other contributors
- Because yes, hormones can help. Bioidentical hormone therapy (if appropriate for you) may help stabilise mood, sleep and anxiety.
- Also get your thyroid, adrenal, gut health checked, because so many things interplay (thyroid issues often show up around menopause).
- Because yes, hormones can help. Bioidentical hormone therapy (if appropriate for you) may help stabilise mood, sleep and anxiety.
- Build a toolkit of “emergency” strategies
- Mini‑meditations: 5 minutes of guided audio, or “box‑breathing” (inhale for 4, hold 2, exhale for 6).
- Calming habit: Put a “stop” icon on your phone as a reminder to check in with your body once/hour. Are you tense? Breathe. Release!
- Support network: Talk to other women going through this, share what you feel. Isolation amplifies anxiety.
- Professional help: If panic attacks are frequent, incapacitating, or you have trauma history or major mood issues, you might need a therapist experienced in menopause/trauma/anxiety. CBT (cognitive behavioural therapy) and mindfulness have evidence that it can help.
- Mini‑meditations: 5 minutes of guided audio, or “box‑breathing” (inhale for 4, hold 2, exhale for 6).
- Lifestyle tweaks specific to menopause‑anxiety
- Limit stimulants: caffeine, excess sugar and alcohol can amplify anxiety.
- Temperature regulation: hot flashes/night sweats = poor sleep = higher anxiety. Fans, layered bedding, cool room help.
- Vagal activation: cold‑plunge, sauna (if safe for you), deep breathing, singing/humming, all stimulate the parasympathetic nervous system and calm you.
- Realise it’s not just “in your head”: knowing that hormone shifts are biologically pushing you towards more anxiety can reduce self‑judgment.
- Limit stimulants: caffeine, excess sugar and alcohol can amplify anxiety.
What Worked for Me?
I don’t usually experience anxiety or panic attacks, but I’ll never forget the one time I did.
A few days before my first hip replacement surgery, I started waking up at 2:00 a.m. with a racing mind and a million questions: Will this surgery hurt? What if I wake up in the middle of it? Will I need therapy for the rest of my life if I do wake up?
I recognized the tightness in my chest, something many women who deal with anxiety have described to me. It was obvious I was anxious and nervous about my surgery. So, I decided to take my own advice. Among the therapies I usually recommend, I turned to NuCalm, a neuroacoustic technology that uses soundwaves through headphones to calm the brain. (I have a podcast episode on it if you want to learn more.) I recommend it often because the feedback I get from women who struggle with anxiety is remarkable.
I even called the company, explained my situation, and they advised using NuCalm at least three times a day. I followed their instructions and guess what? The night before surgery, I slept better than I had in weeks. No awakenings whatsoever. The next morning, I felt calm and ready. If you’ve ever been wheeled into an operating room, you know that moment when the big double doors swing open, revealing the bright lights and the Frankenstein-like table waiting for you. But somehow, I was as calm as a summer breeze. That’s not typical for me, which told me something powerful was happening.
And then… my worst nightmare came true. I actually did wake up during surgery. I heard the saw cutting through my femur, felt the rhythmic pounding as they fitted the prosthetic, and listened to the surgeons chatting. But here’s the wild part, I wasn’t panicked. I was calm. Even curious.
After surgery, I kept using NuCalm several times a day, and still do occasionally. I can say with complete confidence that it’s a game changer. If anxiety is stealing your peace, it’s worth checking out nucalm.com. They even offer a 7-day free trial, so you’ve got nothing to lose, except those heart palpitations.
Want to learn about more strange symptoms that can show up during the menopause transition? Check out this article for a deeper dive or for a quick recap, watch this Instagram reel.
And if you’ve ever felt these symptoms, hit reply or tell us your story in our free Facebook group Biohacking Menopause. You just might help another woman feel seen.