When Hormones Hijack Your Calm: Understanding Anxiety in Perimenopause & What to Do About It

Dr. Rachel Winstedt, ND
Oct 20
4 min read

If you’ve found yourself feeling more anxious, restless, or emotionally on edge in your 40s, you’re not imagining it. Many women notice a surprising increase in anxiety during perimenopause, the years leading up to menopause when hormones begin to fluctuate. Understanding why this happens is the first step toward regaining your calm, clarity, and confidence.

Woman in her 40s relaxing with tea outdoors, representing calm after hormone balance during perimenopause.

What Happens During Perimenopause

Perimenopause typically begins in a woman’s late 30s or early 40s and can last anywhere from four to ten years. During this time, estrogen and progesterone levels fluctuate, which can affect mood, sleep, and energy. You may still get your period, but your hormones are anything but steady.

These hormonal changes can influence:

Brain chemistry, including serotonin and GABA, the neurotransmitters that regulate mood and relaxation.
Sleep quality, since estrogen and progesterone support deep, restorative rest.
Stress response, because cortisol, the body’s main stress hormone, often rises when estrogen and progesterone decline.

The result is a greater sensitivity to stress, more difficulty relaxing, and a tendency toward anxiety and irritability.

Illustration showing estrogen, progesterone, and cortisol balance and their effect on mood and anxiety.

How Hormonal Changes Can Trigger Anxiety

Let’s take a closer look at how these hormone shifts affect your mental health and sense of calm.

1. Estrogen

Estrogen helps regulate serotonin and dopamine, the brain chemicals that influence mood, motivation, and resilience. When estrogen levels drop, these neurotransmitters can decrease as well, leading to mood swings, irritability, and anxious thoughts.

2. Progesterone

Progesterone promotes relaxation by stimulating GABA, a neurotransmitter that calms the nervous system. As progesterone levels decline, many women notice nighttime anxiety, difficulty falling asleep, and physical restlessness.

3. Cortisol

Perimenopause often overlaps with a busy stage of life — career demands, parenting, and caring for aging parents — while hormonal support is declining. This combination can push the adrenal glands to overproduce cortisol, resulting in the familiar “wired but tired” feeling.

Artistic image symbolizing the brain–hormone connection and emotional calm during perimenopause.

Common Symptoms of Perimenopausal Anxiety

Anxiety during perimenopause doesn’t always appear as panic attacks. It can show up as:

Racing thoughts or difficulty quieting your mind
Feeling tense or overwhelmed by daily stress
Waking frequently or struggling to fall asleep
Heart palpitations or muscle tightness
Unexplained worry, irritability, or emotional sensitivity

If this sounds familiar, you’re not alone. Many women experience these symptoms as part of the perimenopausal transition, and there are ways to restore balance naturally.

A Naturopathic and Functional Medicine Approach

Supporting your body through this transition means caring for both your hormones and nervous system. A holistic approach looks at the root causes, not just the symptoms.

1. Test, Don’t Guess

Comprehensive hormone testing, such as the DUTCH Complete by Precision Analytical, can identify changes in estrogen, progesterone, testosterone, and cortisol. Testing reveals whether you’re experiencing estrogen dominance, progesterone deficiency, or adrenal imbalance that may be fueling anxiety.

2. Support Hormone Balance

Eat plenty of colorful vegetables, flaxseed, and cruciferous veggies to promote healthy estrogen detoxification.
Include lean proteins and healthy fats to stabilize blood sugar and improve mood.
Consider herbal support such as chaste tree (Vitex), black cohosh, or ashwagandha with professional guidance.

3. Calm the Nervous System

Gentle daily movement, such as walking or yoga, lowers cortisol and improves GABA activity.
Practice mindfulness, deep breathing, or journaling to retrain your stress response.
Supplements such as magnesium glycinate, L-theanine, or GABA can provide gentle support for calm focus and sleep.

4. Prioritize Sleep

Create a consistent bedtime routine that signals rest. Dim lights, avoid screens for an hour before bed, and try herbal teas like chamomile or passionflower to promote deeper sleep.

When to Reach Out for Help

If anxiety is disrupting your sleep, relationships, or daily life, it’s time for personalized support. A functional medicine approach can identify hormonal imbalances and guide you toward lasting solutions without relying solely on medications.

The Bottom Line

Perimenopause is a time of hormonal change, but it doesn’t have to mean losing your emotional balance. Understanding how hormone fluctuations affect anxiety allows you to take control of your health and restore your sense of calm and well-being. With the right support, you can feel confident, centered, and at peace again.

Next Step

Ready to uncover the root cause of your anxiety and hormone symptoms?

👉 Schedule a Free Discovery Call to explore a personalized hormone-balancing plan with Dr. Rachel, ND.Let’s help you feel calm, clear, and like yourself again.

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