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Understanding menopause anxiety and natural ways to manage it

Increased anxiety is one of the most common symptoms of menopause, and it can also be one of the most challenging. Recurring feelings of worry, tension and fear can knock your confidence and make navigating day-to-day life more difficult.

Anxiety is particularly common during perimenopause, when your hormones are in a state of flux. Other menopause symptoms, like sleep problems and hot flashes, can also contribute to anxiety.

We’ll explore the causes and symptoms of menopause anxiety in more detail below, as well as looking at how long you might expect it to last and the treatments that can help some women.

Along with hormone replacement therapy, these include a range of natural approaches, such as lifestyle changes, CBT and mindfulness practices, herbal remedies and supplements like probiotics.

The specific strains of bacteria in The Better Gut probiotic supplements have been shown to reduce the risk of both anxiety and depression for women going through menopause.

For extra support calming your mind, as well as improving your sleep, try the expert-formulated blend of herbal extracts, vitamins and minerals in Better Night

To find out more, visit The Better Menopause. And for 10% off your first order, use the discount code WELCOME10.

Can menopause cause anxiety?

Menopause is the point 12 months after your last period when reproductive hormones like oestrogen and progesterone settle at a permanently low level.

Perimenopause is the transition to menopause in the years before, when your levels of these hormones are going up as well as down.

It’s often these changing – rather than low – levels of oestrogen, that contribute to psychological symptoms, which is why as many as 50% of women experience anxiety during perimenopause.

One way that fluctuating oestrogen levels can make your anxiety worse is by influencing other hormones. As oestrogen goes up and down so does the ‘feel good’ hormone serotonin. More oestrogen also leads to higher levels of the stress hormone cortisol.

Many women don’t initially realise that their increased anxiety is due to perimenopause, especially if they don’t have other symptoms.

Being aware that your anxiety is partly hormonal can be helpful in itself, although it doesn’t make how you feel any less real.

Although anxiety is less common after perimenopause, that doesn’t mean you won’t experience it post-menopause – and there are contributing factors that can make it worse in both cases.

Sleep problems

Sleep problems are another common symptom of perimenopause and menopause. And just as lack of sleep can increase anxiety, so anxiety can make sleeping more difficult, creating a vicious cycle.

However, research suggests that poor sleep has a much bigger impact on mood than the other way around. And studies have shown that getting better sleep can significantly boost your mental health.

Later in this article, we’ll look at things you can do to help improve your sleep.

Other menopause symptoms

If not managed carefully, some of the other symptoms of menopause can also contribute to anxiety.

Changes like irregular, heavier or lighter periods can be disconcerting in themselves, while the prospect of symptoms like hot flashes and brain fog interrupting your daily life can be an extra source of worry.

Increased life stresses

For many women, the timing of perimenopause and menopause coincides with other increased life stresses and responsibilities. You may have both young children and older parents relying on you, as well as extra pressures around work.

Studies have shown that fluctuating oestrogen levels can have more of an impact on mood and anxiety if you’re also faced with more stressful life experiences.

Many women report that anxiety has negatively affected their careers, which in turn can cause more anxiety.

What does menopause anxiety feel like?

Everyone feels anxious at some point, but if you’ve noticed a significant increase in feelings of worry, stress or fear, the hormonal changes of menopause could be involved.

You might find specific life stresses, such as issues at work or home, harder to cope with than before. But your anxiety may also be a more general sense of tension or dread.

More acute feelings of anxiety can sometimes be accompanied by heart palpitations.

One of the reasons that psychological symptoms like anxiety can be so tricky is that you may not realise they’re a sign of menopause.

Not everyone experiences physical symptoms like hot flashes that give a clearer signal that you’ve started perimenopause.

However, most women will experience changes to their periods, such as a lighter or heavier flow or irregular cycles, which confirms that your hormone levels are fluctuating.

Menopause anxiety often comes with other mood symptoms, including:

  • mood swings, irritability and anger
  • loss of confidence or reduced self-esteem
  • low mood, sadness or depression
  • trouble thinking or concentrating, known as brain fog

As we’ve discussed, menopause and anxiety are also often linked by sleeping problems.

How long does menopausal anxiety last?

How long anxiety lasts depends to some extent on what’s causing it. As we’ve seen, a variety of factors can contribute to added levels of stress and tension at this time of life.

However, if your increased anxiety is largely due to fluctuating hormones during perimenopause, there’s a good chance it will start to improve as you head towards menopause and your hormone levels begin to stabilise.

Although perimenopause generally lasts for around 4 to 8 years, your hormone levels are at their most erratic during early and mid-perimenopause. While that could still mean a significant amount of time with increased anxiety, there are a number of things you can do to help manage your symptoms.

Does HRT help with anxiety?

Hormone replacement therapy (HRT) is a treatment that replenishes reproductive hormones lost due to menopause. It can be taken as tablets or via skin patches or gels.

HRT is an effective treatment for many menopause symptoms and lots of women find that their anxiety improves after taking it. For some, however, mood issues including anxiety can initially get worse, especially with sequential or cyclical HRT, which mimics the natural hormone changes of your menstrual cycle.

Side effects like this will usually settle down after a while. If not, your doctor may suggest trying a different form of HRT.

Natural remedies for menopause anxiety

Whether or not you decide to use HRT to help tackle your menopause anxiety, there are plenty of other things that can help, including lifestyle changes, mindfulness practices, herbal remedies and other supplements.

Regular exercise

Exercise reduces coritsol and adrenaline and boosts stress-relieving endorphins. Working out can also help take your mind off anxiety-inducing thoughts, or give you a chance to process them.

A Menopause Society review of studies found that perimenopausal and menopausal women who did regular exercise had lower rates of anxiety than those who didn’t.

Remember, any exercise is better than none – if going for a run or hitting the gym feels daunting, start with a brisk walk each day and work your way up from there.

Cognitive behavioural therapy (CBT)

The talking therapy CBT can help you to better understand your anxiety symptoms and break out of negative thought patterns that could make them worse.

One review of research found that CBT reduced participants’ menopausal anxiety symptoms and improved their overall quality of life. 

In the UK, you can find a CBT therapist via the NHS.

Meditation and mindfulness

Meditation, and other mindfulness practices like deep beathing and yoga, teach you to notice your thoughts and feelings without judging them.

Studies involving menopausal women suggest that mindfulness can be similarly effective as CBT when it comes to reducing anxiety. Research has also shown that these techniques can lower cortisol levels.

Probiotic supplements

Probiotics are friendly bacteria that can improve the balance of your gut microbiome.

Your gut communicates directly with your brain via a series of pathways known as the gut-brain axis, meaning your gut health can have a significant impact on your mental health.

Probiotic supplement The Better Gut contains specific strains of bacteria that have been shown in studies to help reduce anxiety during menopause, as well as improve your sleep.

Improving your diet

The UK’s Menopause Charity says following a healthy eating pattern like the Mediterranean diet can help improve anxiety and other mood issues.

That means limiting ultra-processed foods and refined carbs and focusing on a wide range of plant foods, including fruit, vegetables, legumes like beans and pulses, wholegrains, nuts and seeds. Many of these foods contain substances called phytoestrogens that mimic some of the functions of oestrogen.

The Mediterranean diet also includes plenty of extra virgin olive oil, which has been specifically linked to reduced anxiety levels in postmenopausal women.


Ashwagandha root – also called Indian ginseng – is a herbal remedy used in traditional Ayurvedic medicine.

Studies suggest it can increase circulating oestrogen in menopausal women, which could help with some menopause symptoms.

Research involving both men and women has also shown that taking daily ashwagandha supplements can lower cortisol and reduce anxiety.


    Magnesium plays a crucial role in your body’s response to stress. Studies have shown that taking magnesium supplements can lower cortisol levels and reduce anxiety.

    One review of the research found that for mild to moderate anxiety magnesium can be as effective as pharmaceutical anxiety medications, including for women whose anxiety is influenced by changes in hormone levels.

    Both magnesium and ashwagandha are among the key ingredients in Better Night, an expert-blended menopause supplement designed to reduce anxiety and improve sleep.

    A better sleep routine

    As we’ve seen, regular insomnia can increase your chances of developing anxiety, which can in turn make it harder to sleep.

    These changes to your daily and bedtime routines can help to improve things:

    • Get up and go to bed at the same time each day
    • Avoid caffeine later in the day
    • Limit alcohol
    • Don’t use your phone before bed or watch TV in bed
    • Keep your bedroom cool, dark and quiet
    • If you get night sweats, wear loose clothing and keep water and a fan by your bed


    Although doctors sometimes prescribe antidepressant medications for mental health symptoms during menopause, the NHS says there are often more appropriate treatments unless you’ve been specifically diagnosed with an anxiety disorder.

    The UK’s Menopause Charity says there’s no evidence that antidepressants can help with mood problems caused by hormonal changes and that they shouldn’t be the first treatment offered to women in these cases.


    Anxiety is a common menopausal symptom that’s especially prevalent during perimenopause. Fluctuating oestrogen levels during this time can impact hormones responsible for mood, including serotonin and cortisol.

    Other menopause symptoms, such as sleep problems and hot flashes, can also contribute to anxiety, along with potential increased life stresses.

    As well as the worry, fear and tension of menopause anxiety, you may also experience heart palpitations, mood swings, brain fog and a general loss of confidence.

    Anxiety caused by changing hormone levels may start to improve in the later stages of perimenopause as these hormones stabilise.

    HRT can be an effective treatment for anxiety for some women, although in certain cases it can also cause anxiety as an initial side effect.

    Natural approaches to managing menopause anxiety include:

    • regular exercise
    • a healthy, plant-based diet
    • a better sleep routine
    • cognitive behavioural therapy
    • mindfulness practices
    • ashwagandha
    • magnesium
    • probiotic supplements

    The Better Gut probiotics contain specific strains of friendly bacteria that have been shown to reduce the risk of anxiety.

    Better Night contains ashwagandha, magnesium and a range of other herbal extracts, vitamins and minerals that together can calm your mind and help you to sleep better. 

    To find out more about both, visit The Better Menopause. And for 10% off your first order, use the discount code WELCOME10.