“This is not how anxiety used to feel”

Perhaps anxiety used to mean worrying about something identifiable. You could name the concern, talk it through, and eventually settle.

Now you wake feeling tense before you have thought about anything. Ordinary demands seem harder to manage. You feel unusually irritable, or become apprehensive in situations that previously felt routine.

If you are approaching menopause, you may wonder whether the change is connected.

It can be. Perimenopause—the transition leading up to menopause—can involve changes in mood as well as menstrual cycles, temperature regulation, and sleep. Understanding that possibility can help you seek appropriate care.

Anxiety can change during the menopause transition

A long-term study of anxiety during the menopause transition followed nearly 3,000 women over ten years. Women who began with low anxiety were more likely to report high anxiety symptoms during and after the transition than before it.

Women who already had high anxiety continued to experience it frequently, but their likelihood of high anxiety did not differ significantly by menopausal stage.

The study measured a cluster of symptoms rather than diagnosing anxiety disorders. It also cannot tell you what is causing your particular experience.

Its findings do support taking new anxiety seriously during this transition. You do not need a long history of anxiety for your current symptoms to deserve attention.

Sleep belongs in the conversation

Anxiety is harder to understand when sleep has changed alongside it.

Night sweats, difficulty falling asleep, and repeated waking can leave you facing the day with less rest than you need. Poor sleep can affect mood, concentration, and patience. Anxiety can also interfere with sleep.

The National Institute on Aging’s guidance on menopause and sleep recommends discussing persistent sleep difficulties with a doctor. It also identifies therapy for insomnia as a treatment option when appropriate.

Tell your provider about the whole pattern: when you wake, whether you feel hot or sweaty, how rested you feel, and what happens to your mood the next day.

“I'm anxious” is useful information. “I'm waking repeatedly and feeling frightened and exhausted by morning” gives the conversation more detail.

Your circumstances still matter

Midlife can bring substantial demands: caring for parents, changes in family relationships, work pressures, financial concerns, or uncertainty about what comes next.

A hormonal transition does not make those circumstances irrelevant. Nor does identifying stress rule out a contribution from perimenopause.

In The Satir Model, congruence includes honoring yourself, other people, and the context. That offers a useful way to examine what you are asking of yourself during a period of change.

Are you acknowledging your current capacity? Have you told anyone that you are sleeping poorly? Are you agreeing to responsibilities you no longer have room to carry?

You can take responsibility for how you communicate while also asking for changes that make your life more manageable.

Where does trauma therapy fit?

Some anxiety has recognizable connections with earlier experiences. A disagreement brings intense fear. Someone’s disappointment feels dangerous. You remain watchful even when the immediate situation is safe.

If those patterns are present, therapy can explore them alongside the physical changes you are experiencing.

Deep Brain Reorienting (DBR) is a trauma therapy that attends to the bodily sequence associated with overwhelming experiences. A randomized controlled trial of Deep Brain Reorienting for PTSD found reductions in PTSD symptoms compared with a waitlist.

That study did not test perimenopausal anxiety. DBR’s relevance would depend on whether trauma-related reactions are contributing to your difficulties. Medical assessment and trauma therapy can each address different parts of the picture. You may also wonder whether you actually have ever experienced “trauma” at all.

Bring the change to someone who can help assess it

Schedule a conversation with your primary care provider or gynecologist, particularly if anxiety is new, worsening, or interfering with daily life.

Brief notes about menstrual changes, sleep, hot flashes, anxiety, medications, and caffeine or alcohol use can help. Ask about other possible contributors and treatment options suited to your health history.

Persistent low mood, loss of enjoyment, or hopelessness also deserves assessment for depression.

You do not need to decide on your own whether this is “hormonal” or “psychological.” Describe what has changed and how it affects you. That is a concrete place to begin.

About the Author

Anne Lindyberg, LMHC (Iowa), LCPC (Illinois), integrates the experiential therapy of Virginia Satir with Deep Brain Reorienting (DBR) and the Alexander Technique. She specializes in helping adults with complex and developmental trauma create lasting emotional change through therapy.

This article and other informational content on this website are provided for educational purposes only. They are not a substitute for individualized professional care, do not constitute advice specific to your circumstances, and do not establish a therapist-client relationship.

This work is created on the traditional and unceded lands of Indigenous peoples; a fuller acknowledgment of the land, its history, and its peoples is available on this website.

If you are experiencing depression, schedule an appointment with your primary care provider or a mental health professional, and tell someone you trust how you are feeling. You can also review this resource. This practice does not provide on-call services or crisis response. If you are in emotional crisis or having thoughts of suicide, call or text 988in the United States for support at any time. If you are in immediate danger, call 911 or go to the nearest emergency department.

These blog posts are drafted with the support of ChatGPT. All posts are reviewed and edited by the author for accuracy, and consistency with the values of the author and this practice.

References

Bromberger, J. T., et al. (2013). “Does Risk for Anxiety Increase During the Menopausal Transition? Study of Women’s Health Across the Nation.” https://pubmed.ncbi.nlm.nih.gov/23615639/

National Institute on Aging. (2021). “Sleep Problems and Menopause: What Can I Do?” https://www.nia.nih.gov/health/menopause/sleep-problems-and-menopause-what-can-i-do

Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir Model: Family Therapy and Beyond. Science & Behavior Books. Chapter 4, pp. 66, 68. https://bit.ly/SatirModel1stEd

Kearney, B. E., et al. (2023). “A Randomized Controlled Trial of Deep Brain Reorienting: A Neuroscientifically Guided Treatment for Post-traumatic Stress Disorder.” https://pubmed.ncbi.nlm.nih.gov/37581275/

Lindyberg, A. L. (2026.0919), blog post, “Can Childhood Emotional Neglect Affect Me If My Childhood Seemed Fine?” https://mwcftc.com/can-childhood-emotional-neglect-affect-me-if-my-childhood-seemed-fine

Safety resource from practice website: https://drive.google.com/file/d/1p_lLev3rQzBMpYFFzhnJvgAqk4KKzSOF/view

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