Level 1 Menopause Mental Health Certification
By: Sarah Schufreider, LCSW, Menopause Mental Health Certified Therapist
Find out the differences and similarities between generalized anxiety and perimenopause symptoms.
You are going about your day as usual, and suddenly, your heart starts pounding like it is going to jump out of your chest. You start sweating uncontrollably. You have an intense sense of doom and dread that washes over you, and you can’t place an exact thing that triggered the overwhelming fear. All of these sudden symptoms stop you in your tracks. And you wonder, “Why is this happening to me?” You think to yourself, “Is this my brain or my hormones?”
(Note: Any new chest pain or severe symptoms need medical evaluation first).
Questions about the role of hormones and menopause on women’s mental health and their mood are common. In this blog post, we will work to create a better understanding of the overlap and differences between anxiety and perimenopause, in order for you to feel more prepared to deal with the symptoms as they arise.
Why Is It So Hard to Tell Anxiety and Perimenopause Apart?
While the majority of women have heard of some of the physical symptoms of menopause, many fewer know about the mood changes that can accompany this transition. This lack of knowledge about mood changes in menopause is troubling when the research shows that “the prevalence of anxiety was estimated to be 52.5% and 55.7% in the menopausal and premenopausal groups, respectively.” In my practice working with women experiencing menopause, this statistic rings true as the majority of women initially report increased anxiety as a major factor in seeking therapy services. To complicate matters, perimenopause symptoms often overlap with anxiety symptoms, which makes telling them apart extra challenging.
Comparing Anxiety and Perimenopause
Let’s look at this table comparing the two. Take a moment to notice the differences and overlap between generalized anxiety and the perimenopause transition. As you look at it, you can see that not only can these exist separately, but it is not unusual for them to co-occur.
Co-Occurring Anxiety and Perimenopause
As you can see in the table above, the symptoms of both anxiety and perimenopause often mirror each other. The things going on in our bodies are not only determined by biology, but are also influenced by the outside world including our family lives, work commitments, and identity struggles. Taking this into account, it should come as no surprise that perimenopause can worsen anxiety that already existed OR it can even trigger anxiety for the first time.
What to Track to Help Notice the Differences
As with anything, the more data and evidence we have, the better able we are to acquire an unbiased understanding of what is going on. Since anxiety and perimenopause symptoms can be influenced by a number of different factors, it is helpful to look at a few key ones.
Tracking changes in mood, sleep, and triggers can help someone better understand whether their symptoms are related to perimenopause, anxiety, or both.
Timing of Your Cycle: Do the symptoms have any correlation to your menstrual cycle? Often, symptoms are related to perimenopause, fluctuating hormone levels will play a significant role in symptoms. Additionally, evidence shows that women who historically have Premenstrual dysphoric disorder (PMDD) are more likely to have more intense symptoms in perimenopause.
(Source: Understanding PMDD and how symptoms change as you get older - Mayo Clinic Press )
Sleep: Your sleep or lack thereof, has a significant impact on how a person functions, both mentally and physically. Unfortunately, both anxiety and perimenopause can hijack someone’s sleep and contribute to difficulty falling asleep, staying asleep, and insomnia. It can be helpful to track your sleep using a sleep diary. This can help give you a baseline understanding of your current sleep experience. Further assessments such as sleep studies for sleep apnea, bloodwork, or insomnia assessments may be helpful, and you can talk to your doctor about whether or not those might be useful to you.
Triggers: Both generalized anxiety and perimenopause can often feel like they show up completely out of nowhere. However, often there are clues and patterns as to why the disruptive symptoms show up.
Who to See For Help
Figuring out who to see to help with these problematic symptoms can feel overwhelming and confusing.
Doctors: Doctors are the place to start to help you better understand the hormonal picture. Depending on your symptoms, you might start by seeing your primary care physician, an OB/GYN, a psychiatrist, a sleep specialist, or another specialist. If you are concerned about possible anxiety symptoms, it can be helpful to get connected to a psychiatrist who is not only skilled in mental health but also has an understanding of menopause. A list of menopause informed providers can be found at The Menopause Society and Bria Better Health.
Therapists: Therapist can help manage the anxiety symptoms using tools such as psychoeducation and mental health interventions to help a women gain more coping skills. Whether the anxiety stems from brain chemistry, hormones, or a mixture of both, therapist can assist in creating tailored treatment plans to give clients concrete tools to help decrease the negative impact that anxiety plays on their lives.
A Team Approach: Since the origins of anxiety can be influenced by both biological factors such as hormones and brain biology, as well as by environmental factors such as stress and trauma, it often is helpful to enlist a team of providers to support you. A combined approach of seeking assistance from both doctors and therapists allows for collaboration and opportunities for a more holistic approach.
What Helps You Feel Better:
Regardless of the cause of the anxious feelings, you want to feel better. Thankfully, there are a number of treatments and interventions that can help mitigate the anxious feelings. Some interventions that we use in my practice to help decrease the negative impact of anxiety include:
Behavioral Activation (BA): BA is a psychotherapy technique that aims to target anxiety by replacing avoidance behaviors associated with the anxiety and replacing those behaviors with meaningful and rewarding activities. In fact, a paper from the Journal of Mood and Anxiety published in June 2023 found that BA showed to be an effective treatment for anxiety in adults.
Cognitive Behavioral Therapy (CBT): CBT is an intervention that looks at the connection and impact that thoughts, feelings, and behaviors have on each other. Using that framework, CBT use concrete tools to help people identify and change unhelpful patterns of thoughts and behaviors.
Exposure and Response Prevention (ERP): ERP is a specialized form of CBT. It focuses on slowly exposing people to their anxieties in a controlled way and replacing their safety behaviors. Through this process, the intensity of anxiety symptoms gradually lessens. ERP was also found to be helpful with managing anxiety in the same Journal of Mood and Anxiety paper from June 2023.
Final Thoughts:
Whether perimenopause is the origin of your anxiety or not, you still deserve help to feel better. Unfortunately, neither you nor I can diagnose you from a blog post. Therefore, I encourage you to get connected to menopause-informed providers in Chicago and across Illinois who focus on anxiety and perimenopause. They can help you on your journey to better understanding yourself and to feeling better.
(If you are in crisis, please go to your local emergency room, call 911, or call 988 to reach a 24/7 mental health crisis line.)
Not sure whether it's anxiety, perimenopause, or both? Online therapy for anxiety is available across Chicago and Illinois. Let's talk.
Frequently Asked Questions about Perimenopause and Anxiety
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Yes. Perimenopause can worsen anxiety that was already there, or trigger it for the first time. Fluctuating hormones, disrupted sleep, and life stress often all play a part.
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It's often hard to tell, because the symptoms overlap and the two can occur together. Tracking your cycle, sleep, and triggers for a few weeks can reveal patterns. Neither a blog post nor a therapist alone can diagnose the cause, so a menopause-informed provider is the best next step.iption text goes here
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Often both. A doctor can look at the hormonal and medical picture, and a therapist can help you manage anxiety with practical coping tools. In Chicago and across Illinois, online therapy is available alongside your medical care.
Sarah Schufreider, LCSW, is a Licensed Clinical Social Worker (Illinois license # 149016639) based in Chicago, IL and the founder of Six Hearts Counseling PLLC. She is has a Menopause Mental Health certification from Bria Better Health. She focuses on mid-life transitions including menopause, parenting special needs and medically complex children, SPACE (Supportive Parenting for Anxious Childhood Emotions), grief, and postpartum depression. Sarah’s goal is to help her clients feel like they can take control of their life again through identifying their values, learning concrete skills to manage and regulate their emotions, and work to challenge mental obstacles that are creating stuck points to change. Learn more about her work at About Sarah.
Last updated: October 6, 2026