Perimenopause Anxiety and Mood Swings: What’s Happening to Me and How Do I Handle It?
Let’s talk about something that hits hard and often out of the blue: anxiety and mood swings during perimenopause.
If you’ve found yourself wide awake at 3 a.m., spiraling over whether your teen will get into college, or suddenly overwhelmed by the idea of driving at night (even though you’ve never had a problem before), you're not alone. This is real. It’s not “in your head.” And no, you’re not crazy.
Welcome to perimenopause, where your hormones start shifting before your periods actually stop and take your mood, memory, and emotional regulation along for the ride.
So... What’s Actually Going On?
Perimenopause, meaning "around menopause," is the 4-10 years leading up to that final period. For most women, it starts in their 40s (sometimes late 30s), and during this time, estrogen and progesterone levels fluctuate unpredictably. And it’s that drop in progesterone our calming, sleep-supporting, mood-regulating hormone that throws us for a loop.
Anxiety during perimenopause doesn’t always look like traditional anxiety. It’s often this persistent unease, a sense of dread, or constant overthinking, worrying about bills even though you’ve paid them, catastrophizing random health fears, or suddenly panicking about tasks you've done a thousand times.
The thing is, your neurotransmitters, hello, serotonin and dopamine are directly affected by these hormonal shifts. And that means your mood, sleep, memory, and even your ability to focus can start to feel... off.
Is It Perimenopause Anxiety or Something Else?
Good question.
The mood changes and anxiety symptoms during perimenopause can mimic traditional mood disorders, but they’re often hormone-driven. This matters because it shifts the approach to support.
If your anxiety feels cyclical, flares mid-cycle, or has shown up with other midlife changes (hot flashes, brain fog, or weight gain), hormones may be the root of it.
Common Perimenopause Mood Symptoms
You might notice:
Restlessness or a racing mind
Irritability or sudden anger
Fear or panic around things that never used to bother you
Forgetfulness and brain fog
Waking in the middle of the night and not falling back asleep
Crying at random commercials
I’ve lived this. I’ve coached women through this. You are not imagining things.
What Can You Actually Do to Feel Better?
This is where we ditch the all-or-nothing mindset. Midlife doesn’t need more rigid routines it needs flexible, sustainable support.
Here’s what I recommend:
Nourish Your Body
Fuel your body with nutrient-rich, fiber-filled, plant-diverse meals. Leafy greens, berries, lean protein, healthy fats: they all support hormone balance and stabilize mood.
Move (Gently and Consistently)
You don’t need a 5 a.m. bootcamp. Walks, yoga, dancing in your kitchen: all help regulate mood, improve sleep, and reduce anxiety. Consistent movement (even 20 minutes) can make a world of difference.
Prioritize Sleep
Sleep and mood are tightly linked. Cut screen time before bed, create a wind-down routine, and aim for 7–8 hours. Cool, dark, quiet. Your sleep matters.
Breathe and Reset
Try box breathing: inhale for 4, hold for 4, exhale for 4, hold for 4. It calms your nervous system and brings you back to center—especially during spiraling moments.
Consider Progesterone (Talk to Your Provider)
Micronized progesterone, the bioidentical form of what your body naturally makes, can be a game changer. Even if you're still getting regular periods, supplementing can support sleep, mood, and anxiety.
Therapy, Medication, and Community
Low-dose SSRIs, therapy (especially CBT), and support groups can all be helpful. In the Women Mastering Midlife Community, we talk openly about these struggles and cheer each other on through the messy middle.
The Bottom Line:
You’re not broken. You’re not failing. You’re in a transition, one that deserves care, compassion, and support.
This phase of life is challenging, yes. But with knowledge, community, and small intentional steps, you can feel like yourself again.
I help women like you figure out what works for their actual life. No shame, no rigid plans just guidance, support, and science-backed solutions.
Let’s walk this path together.
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