In 2025, a national report on Australian women’s mental health made a blunt finding. Poor mental health has become “the new normal” for half of Australian women. One figure inside that report stood out to us as clinicians who regularly see the link between perimenopause and anxiety.
More than one in three women currently going through perimenopause or menopause are experiencing perimenopausal anxiety or depression. That is nearly five times the rate of the general population.
For many of these women, the connection is never made. They are told they have anxiety. They are told they have depression. However, nobody asks about their menstrual cycle or their sleep. Nobody asks about the night sweats they have been putting down to a warm doona. As a result, a whole generation of women in their 40s and early 50s are being treated for a mental health condition. In reality, that condition is, at least in part, hormonal.
This is not a fringe issue. It affects hundreds of thousands of Australian women, usually during years when they are also juggling careers, teenagers, and ageing parents. On top of that, their body no longer feels like their own. In this article, we look at what is actually happening in the body during perimenopause. We explain why perimenopause and anxiety are so often mistaken for a purely psychological problem. Finally, we cover how to tell the difference, and what genuinely helps, whether that is therapy, your GP, or both together.
What Is Actually Happening in Your Body During Perimenopause?
Perimenopause is the transition leading up to menopause, and it can last anywhere from a few years to a decade. It usually begins in a woman’s 40s, although it can start earlier. During this time, oestrogen and progesterone do not decline in a smooth, predictable line. Instead, they fluctuate, sometimes sharply, from one cycle to the next.
This matters for mental health because oestrogen has a direct, protective effect on the brain. It supports the systems that regulate serotonin and dopamine. These are the same neurotransmitters targeted by many antidepressant and anti-anxiety medications. Therefore, when oestrogen levels swing unpredictably, so does a woman’s capacity to regulate mood, tolerate stress, and sleep well. New or worsening anxiety during this window is a physiological event, not only a psychological one.
Researchers behind Harvard’s Study of Moods and Cycles followed women with no history of depression through the menopausal transition. They found these women were significantly more likely to develop a first episode of depression during perimenopause. This held true compared with women who remained premenopausal (Cohen et al., 2006). Similarly, the Study of Women’s Health Across the Nation, known as SWAN, looked at this same pattern. Researchers found that women with a prior history of depression face an even steeper risk during the transition, with more than half experiencing a depressive episode (Bromberger et al., 2011).
Why Perimenopause and Anxiety Get Mistaken for Each Other So Often
We see this pattern often in our practice. A woman in her mid-40s describes symptoms that sound exactly like generalised anxiety, for example:
- Racing thoughts at 3am
- A short fuse with her kids
- A constant low hum of dread she cannot explain
She has usually already seen her GP, and she has usually already been prescribed something for anxiety or depression. Rarely has anyone asked about her periods or her temperature at night. Rarely has anyone asked whether this feeling arrived out of nowhere in the past year or two.
This is not a failure of any one clinician. Rather, it reflects a broader gap in how the health system is set up. Medical training has historically given limited attention to the psychological impact of hormonal transitions. In addition, a standard ten-minute GP consultation leaves little room to properly unpack it. The Liptember Foundation’s 2025 report on Australian women’s mental health found something similar. Hormonal fluctuation and menopause were named among the top triggers for mental distress. Even so, only 43 per cent of affected women sought help at all, and many who did described the support they received as dismissive, or not tailored to what they were actually going through.
There is also a newer thread in this conversation worth naming briefly. Emerging research is looking at how hormonal changes in perimenopause can intensify ADHD symptoms in women who were previously undiagnosed or well managed. This can include brain fog, emotional reactivity, and difficulty concentrating (Kooij et al., 2025). For some women, what looks like new-onset anxiety in their 40s is something else entirely. It is a lifelong neurodivergence becoming harder to mask as oestrogen declines. It is one more reason why a single label of “anxiety” can miss what is really going on.
How to Tell the Difference Between Perimenopause and Anxiety
In practice, perimenopause and anxiety rarely arrive as two separate, tidy experiences. They overlap and feed into each other. However, there are patterns that can help you and your health professionals start to untangle what is happening.
Consider timing first. Anxiety that has been part of your life since your teens or twenties is less likely to be purely hormonal. That said, perimenopause can still make it worse. In contrast, anxiety, low mood, or irritability that is genuinely new deserves a closer look. This is especially true if it has sharply intensified in your early-to-mid 40s.
Physical symptoms are the other clue. The following often travel alongside perimenopausal anxiety and depression, even when a woman has not consciously connected them to her hormones:
- Night sweats, or a sense of your temperature regulation being “off”
- Irregular or changing periods
- New or worsening sleep disruption
- Joint aches
Many women never make this connection themselves. If your low mood or anxiety is accompanied by several of these, it is worth raising perimenopause explicitly with your GP, rather than waiting for them to raise it with you. If your symptoms instead follow a clear monthly pattern tied to your cycle, our article on premenstrual mood changes may be more relevant.
“But I’ve Had Anxiety My Whole Life. How Do I Know This Is Different?”
This is one of the most common questions we hear, and it is a fair one. If you have lived with anxiety for years, it can be genuinely hard to tell what is happening now. Is this more of the same anxiety, or something new layered on top?
A useful starting point is intensity and pattern, not just presence. Many women describe their perimenopausal anxiety as qualitatively different from their usual anxiety. It can feel more physical, more sudden, and less tied to an obvious trigger. For example, panic that seems to come from nowhere is worth mentioning to a psychologist or GP. So is rage that feels disproportionate to the situation. The same goes for a sense of dread that arrives and lifts within hours, rather than building gradually.
Both things can be true at once. You can have a longstanding anxiety disorder and also be experiencing a hormonally driven flare of it during perimenopause. Treatment does not need to choose between the two explanations. It needs to account for both.
What Actually Helps
The most effective approach we see is one that treats perimenopause and anxiety together. This means not picking one lens and ignoring the other.
On the medical side, this usually starts with your GP. A proper work-up can involve:
- Tracking your cycle and symptoms over a few months
- Blood tests, where appropriate
- A conversation about whether menopausal hormone therapy is suitable for you
This is a medical decision that sits outside what we do as psychologists. However, it is a conversation worth having, particularly if your symptoms are significant.
On the psychological side, evidence-based therapy can be genuinely effective for perimenopausal anxiety and depression, hormones or not. Cognitive behaviour therapy helps identify and shift the thought patterns that anxiety feeds on. It also gives you concrete tools for the racing thoughts and catastrophising that tend to intensify during this transition. For women experiencing rage, grief, or a sense of losing themselves, therapy creates space to process what this life stage represents. It is not just about managing symptoms. You can read more about how we approach this in our worry and generalised anxiety and depression and low mood services.
The relationship with your psychologist matters here too. Perimenopause is not something every clinician has been trained to recognise. Finding someone who takes the hormonal picture seriously, alongside the psychological one, makes a real difference. It changes whether you feel properly heard.
Supporting Yourself Day to Day
Alongside professional support, there are things that genuinely help day to day. None of these replace proper treatment when your symptoms are significant, but each one is worth building into your routine:
- Protect your sleep. Consistent wake times, reducing alcohol and caffeine in the evening, and cooling your bedroom can all help with both sleep and night sweats.
- Move regularly. Gentle, consistent movement, particularly strength training and walking, has reasonable evidence for supporting mood during the menopausal transition.
- Track your cycle and symptoms, even informally in a notes app. This can help you and your GP spot patterns that are easy to miss in the moment.
- Talk openly with a partner, close friend, or your GP about what you are experiencing. This can reduce the isolation that so often comes with this stage of life.
If you have also noticed a broader shift in how you are feeling about work or identity, that is worth naming too. Our article on why mental health often shifts in midlife looks at this from a wider angle.
You Deserve the Full Picture
If any of this sounds familiar, you are not imagining it, and you are not alone. Perimenopause and anxiety showing up together is common, under-recognised, and treatable. You deserve care that looks at the whole picture. You do not deserve a diagnosis that only tells half the story.
Book a free 15-minute call with our Care Coordinator to find out more. We’ll will help match you with a psychologist who understands both the psychological and hormonal sides of what you are going through.
References
- Liptember Foundation. (2025). Women’s Mental Health Research Report 2025.
- Cohen, L.S., Soares, C.N., Vitonis, A.F., Otto, M.W., & Harlow, B.L. (2006). Risk for new onset of depression during the menopausal transition: The Harvard Study of Moods and Cycles. Archives of General Psychiatry, 63(4), 385–390.
- Bromberger, J.T., Kravitz, H.M., Chang, Y., Cyranowski, J.M., Brown, C., & Matthews, K.A. (2011). Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychological Medicine, 41(9), 1879–1888.
- Kooij, J.J.S., et al. (2025). Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health, 6, 1613628.
- The George Institute for Global Health. (2025). Creeping rates of poor mental health show depressed, anxious state is ‘new normal’ for half of Australian women.
Disclaimer: This article is for general informational purposes only and is not a substitute for individual psychological advice, assessment, or treatment. Reading this content does not establish a therapeutic relationship. If you have concerns about your mental health, please seek support from a registered health professional.
