Too Much Anxiety and Worry Can Be Caused By Hormone Imbalance

In perimenopause, estrogen can spike and fall within a single cycle. Many women feel the drops as sudden dread, a racing mind, or a sense that something is wrong. This often begins years before hot flashes, which is why it is so frequently missed. Women with a history of PMS, PMDD or postpartum mood changes are more likely to notice it.

Too much estrogen can cause anxiety too. That includes a hormone therapy dose that is higher than you need.

Our guide to estrogen overload and anxiety covers that in detail, including how to tell a dose that is too high from one that is too low.

One of its breakdown products acts on the same GABA receptors as anti-anxiety medications. That is why many women feel calmer and sleep better in the days after ovulation. Progesterone falls in the week before a period, and more erratically in perimenopause. Anxiety that reliably arrives before a period, then lifts, is the classic progesterone pattern.

A baseline stays high because of ongoing stress, pain, poor sleep or too little food.

The signs:

In perimenopause, falling estrogen makes the stress response more reactive, so cortisol and estrogen problems often arrive together.

Our guide to adrenal fatigue explains why we talk about stress load rather than a worn-out gland.

Both are common in midlife women, and both are easy to test for with TSH and free T4. That is why thyroid should be checked whenever anxiety is new.

See how low thyroid levels affect your life.

1. 1

   Protect sleep and steady the inputs.

   Regular meals, less alcohol, caffeine before noon only, and treating night sweats. These reduce the swings that every hormone then amplifies.

2. 2

   Treat the anxiety itself.

   Cognitive behavioral therapy has the strongest evidence for anxiety, and it also helps hot flashes and sleep. See CBT for menopause. SSRIs and SNRIs are effective for anxiety and can reduce hot flashes; they are a reasonable choice when hormone therapy isn't.

3. 3

   Test what's testable.

   Thyroid first. Hormone panels can help in perimenopause when the symptom pattern isn't clear, though a single estrogen reading is often misleading because the level changes day to day. Our guide to hormone tests explains when testing is useful.

4. 4

   Hormone therapy, when the anxiety tracks with the swing.

   For women in perimenopause whose anxiety arrives with hot flashes, night sweats and poor sleep, hormone therapy can reduce the anxiety by steadying what is causing it. It is not a treatment for anxiety disorders on its own, and a dose that is too high can cause anxiety. Your prescriber will weigh it alongside the options above.

5. 5

   Supplements, with care.

   Magnesium and L-theanine have modest evidence; most others sold for "hormonal anxiety" have little. They are optional. See supplements for perimenopause and menopause.

Golden Leaf's care team treats perimenopause and menopause by video in the states we serve. The first visit covers your symptoms, history and what you want to feel like again.

1. Talk.

   A one-on-one video visit about your symptoms, your history and what you want to feel like again. Your first visit is $99, refunded if you cancel at least 24 hours ahead.

2. Test.

   If your provider thinks it will help, a hormone blood panel adds lab results to what you’ve told them. Not everyone needs this step.

3. Treat.

   If treatment is right for you, your plan can include hormone prescriptions, non-hormonal options, lifestyle changes and optional supplements. Then two to three follow-up visits with a doctor and text check-ins through HIPAA-compliant messaging, included in membership at $49 a month, which begins one month after your first visit. Prescriptions and labs are priced separately.