Anxiety in Perimenopause: Why It Spikes—and 6 Ways to Settle Your System
During perimenopause, shifting estrogen and progesterone can make the brain’s stress response more reactive. Night sweats and broken sleep add fuel to the fire, so you feel wired and tired at the same time. The goal isn’t perfection—it’s steady inputs that calm your nervous system and protect your sleep.
Six ways to calm your system
Anchor your body clock. Get outside light within an hour of waking (10–15 minutes) and keep a consistent wake time. Morning light is a strong cue that stabilizes circadian rhythm—and steadier rhythm supports steadier mood.
Reduce evening stimulants and stimuli. Cut caffeine after early afternoon and avoid alcohol near bedtime; both can fragment sleep and raise nighttime awakenings. Dim bright lights and screens at least 60 minutes before bed to lower sensory load.
Keep nights cool, dark, and quiet. If hot flashes hit, use layered bedding, a fan by the bedside, and breathable fabrics. Reducing heat and noise helps your sleep stay continuous (which your mood depends on).
Do quick nervous-system resets. Try an exhale-heavy breath (inhale 4, exhale 6–8), a 2-minute body scan, or a brief guided mindfulness practice—simple ways to shift the body out of “fight or flight.” Mindfulness training can be as effective as medication for anxiety
Offload the “mental tabs.” Before bed, do a 3–5 minute “worry dump”—write everything down, pick one next step for tomorrow, and close the notebook. Less cognitive buzz = easier sleep onset.
Treat the symptoms that wake you. If vasomotor symptoms (hot flashes/night sweats) are the main disruptor, talk with your clinician. Menopausal hormone therapy is the most effective treatment for these symptoms; there are also nonhormonal options if HT isn’t a fit. Better nights usually mean calmer days.
References
American Academy of Sleep Medicine (AASM). Position statement on circadian alignment/standard time and sleep health. AASM
Hoge EA, et al. JAMA Psychiatry (2022/2023): Mindfulness-Based Stress Reduction noninferior to escitalopram for anxiety disorders. JAMA Network
The Menopause Society (NAMS) 2023 Position Statement: Hormone therapy is most effective for vasomotor symptoms; evidence-based nonhormonal options available.Lippincott Journals