Perimenopause · Mood
Perimenopause anxiety: worry, a shorter fuse and restless nights
Many women in their 40s tell me they suddenly feel anxious or on edge, without a clear reason. Here's what we know about anxiety in perimenopause, what the research says, and how I work with it.
Yes, anxiety can be part of perimenopause. The NHS mentions mood swings, low mood and anxiety among the symptoms of this phase, and hot flashes and poor sleep can add to the feeling of being on edge [1][3]. Talking therapy, steadier sleep and support for night sweats are where many people start, and worry that is hard to control is worth taking to your vårdcentral (local primary care clinic) or 1177.
If you’ve started to feel anxious in a way you don’t recognize, you’re not imagining it. I’m a US-trained naturopath and acupuncturist in Östermalm, and this is something women in perimenopause bring up with me often, sometimes only at the end of a visit.
How anxiety can show up in perimenopause
Perimenopause can start years before your periods stop for good. Symptoms usually last 7 to 9 years, sometimes longer, and they can change along the way [1].
On mood, the NHS lists mood swings, low mood and problems with memory or concentration [1]. Swedish 1177 says you may feel low and become extra sensitive to stress [2]. Anxiety in general can feel like this [6]:
- worry that is hard to control and affects your daily life
- feeling restless or tense
- irritability and a shorter fuse
- trouble concentrating
- difficulty sleeping and getting tired easily
- a more noticeable or unusual heartbeat
- feeling lightheaded or dizzy
Many of these overlap with other perimenopause symptoms. That’s one reason anxiety in this phase is easy to miss, or to put down to stress at work.
Anxiety at night
Many women tell me the worst hours are between 3 and 5am. There are a few reasons this can happen.
Hot flashes can cause palpitations or anxiety [1]. When they come at night, as night sweats, they can disturb your sleep [2]. And poor sleep can make you feel irritable, stressed and anxious the next day [1]. So the night and the day start to feed each other.
A 2023 systematic review looked at whether menopause raises the risk of depression and anxiety [4]. The authors found less data on anxiety than on depression, and the results pointed in different directions. They could only cautiously suggest a link between hot flashes, sleep problems and anxiety [4]. So the picture isn’t settled, but the link with sleep and night sweats comes up again and again.
If night sweats are a big part of your nights, my article on perimenopause night sweats goes deeper. For waking at 3am in general, see perimenopause insomnia.
Perimenopause rage and irritability
“Rage” is a word I hear more and more. It often describes a fuse that suddenly feels very short, with partners, children or colleagues.
The research doesn’t use that word. What the NHS does describe is mood swings, and irritability that comes with poor sleep [1]. Irritability is also listed as a common sign of anxiety [6]. In practice, many women tell me the anger and the worry come together, and both get worse after a bad night.
None of this means something is wrong with you as a person. It does mean it’s worth taking seriously, and talking about it.
What the research says
Everyday habits
For mood swings, low mood and anxiety around menopause, the NHS suggests getting as much rest as you can, exercising regularly and doing relaxing activities [3]. More generally, it suggests relaxing things such as yoga, tai chi or meditation, talking to others going through the same thing, and not drinking more than the recommended alcohol limit [3]. 1177 mentions mindfulness for stress, and talking support for worry or low mood [2].
CBT and talking therapy
The NHS describes CBT (cognitive behavioral therapy) as a talking therapy that can help with low mood and feelings of anxiety in menopause, and with sleep problems [3].
A 2022 meta-analysis pooled 14 randomized trials with 1,618 participants [5]. Cognitive and behavior therapy reduced anxiety and low mood more than the control groups did, with small to moderate effects. The effects held up over time but faded somewhat [5]. Your vårdcentral can tell you what’s available in Sweden.
Acupuncture
I want to be honest here. A 2025 meta-analysis compared real and sham acupuncture in 14 trials with 968 adults [7]. Many of them had anxiety alongside another condition, such as insomnia, migraine or menopausal mood problems. Real acupuncture lowered anxiety scores more, but the effects were modest, and the certainty of the evidence was low to very low. The trials were small, results varied a lot, blinding was often weak, and most trials were done in China [7]. Most weren’t studies of perimenopause specifically.
So the research is promising in places and uncertain overall. For many people, a session is also simply an hour of lying still. I see acupuncture as one part of a plan, not the whole answer.
How I work with perimenopause anxiety
Your first visit is 60 minutes and costs 3,500 SEK, in person or online, in English or Swedish. I ask when the anxiety shows up, how you sleep, what wakes you, and how your cycle has changed. We also talk about stress, food, digestion, caffeine and alcohol, and what you’ve already tried.
It helps to write down for a week or two when you feel anxious or irritable, how you slept, and where you are in your cycle. That gives us something concrete to work with, and you can bring the same notes to your doctor.
After the visit, you get a written plan. It can include:
- advice on sleep, meals and evenings
- support for night sweats
- Chinese and Western herbs
- homeopathy and supplements
- Japanese acupuncture, my main style
If you take medicine for anxiety, low mood or sleep, tell me, and I’ll factor it in when we choose herbs and supplements. Questions about changing or stopping a medicine go to your doctor or pharmacist.
I work in parallel with your doctor, whether or not you take HRT. The decision about hormone therapy is one you make with your doctor, and the plan for sleep, food and stress works either way. You can read more in perimenopause without HRT, perimenopause symptoms and my main page on perimenopause.
If you’d like to start with acupuncture only, a first acupuncture visit is 50 minutes and 1,750 SEK. All options are on the prices page, and you can read how a first visit works.
When to see a doctor
Contact your vårdcentral or call 1177 (Sweden’s healthcare advice line) if:
- worry or anxiety is hard to control and affects your daily life [6]
- you feel low or unwell during this phase [2]
- you have a fast or pounding heartbeat (palpitations) [1]
- you have panic attacks, or anger that feels out of your control
- you bleed after your periods have stopped for 12 months or more [1]
- you have new, severe or unclear symptoms
If you have thoughts of harming yourself or not wanting to live, or in an emergency, call 112.
Not sure where to start? Book a free 15-minute call with me on a Tuesday between 13:00 and 14:00, or send me a message.
Sources
- NHS. Symptoms of menopause. Page last reviewed 19 May 2026. Accessed 2026-11-09. https://www.nhs.uk/conditions/menopause/symptoms/
-
- Klimakteriebesvär (in Swedish). Updated 2026-09-17. Accessed 2026-11-09. https://www.1177.se/sjukdomar--besvar/hormoner/klimakteriet/klimakteriebesvar/
- NHS. Menopause: things you can do. Page last reviewed 19 May 2026. Accessed 2026-11-09. https://www.nhs.uk/conditions/menopause/things-you-can-do/
- Alblooshi S, Taylor M, Gill N. Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australasian Psychiatry, 2023;31(2):165–173. Accessed 2026-11-09. https://pmc.ncbi.nlm.nih.gov/articles/PMC10088347/
- Ye M, Shou M, Zhang J, et al. Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis. Psychological Medicine, 2022;52(3):433–445. Accessed 2026-11-09. https://www.cambridge.org/core/product/identifier/S0033291721005407/type/journal_article
- NHS. Symptoms of generalised anxiety disorder (GAD). Page last reviewed 22 October 2024. Accessed 2026-11-09. https://www.nhs.uk/conditions/generalised-anxiety-disorder/symptoms/
- Jiang H, Ma R, Huang Y, Li X, Hao Y. Efficacy of acupuncture versus sham acupuncture on generalized anxiety disorder: a meta-analysis of randomized controlled trials. Frontiers in Neurology, 2025;16. Accessed 2026-11-09. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1682400/full
Common questions
Can perimenopause cause anxiety?
It can play a part. The NHS mentions mood swings, low mood and anxiety among the symptoms around perimenopause and menopause. Hot flashes can bring palpitations or anxiety, and poor sleep can leave you irritable and stressed. Research on how much perimenopause itself raises the risk is still mixed. If worry is hard to control or affects your daily life, talk to your vårdcentral or 1177.
Why is my anxiety worse at night in perimenopause?
Night sweats can wake you, and a hot flash can come with a racing heart. Once you're awake, worries often feel bigger in the dark. Poor sleep then makes the next day harder, and the cycle repeats. Writing down when you wake and what you notice can help you and your doctor see a pattern. We go through the same notes at a first visit with me.
Is perimenopause rage a real thing?
Many women describe a much shorter fuse in this phase. The NHS describes mood swings as a common symptom, and notes that poor sleep can make you irritable. Irritability is also a common sign of anxiety. If anger feels out of character, scares you or harms your relationships, it's worth talking to your vårdcentral. You don't have to just wait it out.
Does CBT help with anxiety in menopause?
The NHS describes CBT as a talking therapy that can help with low mood and feelings of anxiety in menopause. A 2022 meta-analysis of 14 randomized trials found that cognitive and behavior therapy reduced anxiety and low mood more than control groups in menopausal women, with small to moderate effects. Ask your vårdcentral what's available to you in Sweden.
Want to know how I can help?
Book your first visit with me in Östermalm, or start with a free 15-minute call.