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Symptoms of anxiety are increasingly prevalent during the menopause transition and are often associated with hot flashes. Anxiety can manifest as intense feelings of worry and fear, often along with physical symptoms like a rapid heart rate, sweating, and heavy breathing. But there’s good news: as hormones even out AFTER menopause, the increased anxiety can subside.

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    The science

    As we approach perimenopause and menopause, we’re juggling a lot!

    We may be caring for kids or aging parents, busy at work in peak career years, or all of the above. So it’s natural that we’d have a lot on our plates and feel overwhelmed sometimes (or even most of the time). But it’s important to recognize that there are physiological factors at play here as well.

    Anxiety, which may (but doesn’t always) go hand-in-hand with depression, is thought to be influenced by fluctuating and declining hormone levels, including:

    • Serotonin: the “happy hormone” that stabilizes our mood and fluctuates with age and decreasing estrogen levels
    • Estrogen: results in increased serotonin levels and increased serotonin receptors. More serotonin = less anxiety and depression. The relationship between these two hormones is complex though and we are just starting to scratch the surface!
    • Progesterone: the “calming hormone” that may also influence GABA
    • Gamma-Aminobutyric acid (GABA): a neurotransmitter that produces a calming effect when it binds to its receptors, which may support a reduction in stress, anxiety, and sleeplessness. With lower progesterone levels, GABA’s receptors don’t bind as well, thereby prolonging the stress response and increasing anxiety.

    The most common anxiety symptoms are tension, nervousness, panic, and worry, and some may feel physical signs too, like an upset stomach, headaches, racing heart, sweating, etc. Some women may experience panic attacks, which are an extreme version of anxiety, with the inability to think clearly and accompanied by intense physical symptoms like heart palpitations, shortness of breath, even chest pain.

    PMS and PMDD

    In early perimenopause, mood fluctuations are typically concentrated in the premenstrual period (PMS) while late perimenopause/early postmenopause is marked by more prominent feelings of general anxiety. The risk of menopause-related depression and anxiety is higher for those with a history of PMDD (premenstrual dysphoric disorder, a more serious form of PMS where symptoms are more intense, which affects 5-7% of menstruating women) and postpartum depression.

    Hot flashes and anxiety

    There is one interesting connection between hot flashes and anxiety. Research has shown that women who experience anxiety are 3-5x more likely to have hot flashes. Another study found that women who experienced anxiety with physical symptoms (upset stomach, racing heart, etc.) had a strong tendency to have hot flashes.

    It’s not clear which comes first: anxiety or hot flashes, but we do know there is a link.

    Can the cause of anxiety, mood swings, and depression be independent of menopause? Certainly. That’s why it’s imperative to consult your healthcare provider, especially if you’re experiencing intensive, excessive, and persistent worry or fear about everyday situations that’s difficult to control, interferes with your day-to-day life, and/or peaks within minutes (panic attacks). For help finding a psychologist, we recommend the American Psychological Association’s Locator, as well as the National Register.


    “I experienced anxiety and incredibly low moods. When I learned that these were all symptoms of menopause, it all started to make sense.”

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    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.


    The effect of lifestyle interventions on mood disorders has been extensively studied, with positive results to show for it. We’re talkin’ everything from meditation to exercise, exposure to nature to improved sleep.

    Nutrition & Diet

    There is a strong positive correlation between a plant-based Mediterranean diet and a lower risk of anxiety and depression.

    The diet is low in saturated fats and animal proteins, rich in antioxidants and fiber, and loaded with B vitamins (which have been clinically proven to impact depression symptoms, anxiety, and stress). It’s anti-inflammatory, veg-heavy, low-carb, low-sugar, and includes brain-healthy fats. And because it kicks most refined and concentrated sugars to the curb and focuses instead on non-starchy veggies, beans, fruits, and whole grains, it’s considered a “low-glycemic index” diet — meaning it won’t dramatically spike our blood sugar. This is what we want!

    For more information, refer to our full guide to nutrition during menopause.

    Holistic Practices

    Get out in nature

    Routine, frequent exposure to the great outdoors has been shown to reduce anxiety and depression while improving an overall sense of well-being.

    Never underestimate the power of Mother Nature (aka vitamin N) to boost your mood!

    Reduce stress

    This is so, SO important — although easier said than done when everything and everyone seems to be competing for our attention. Here are our top techniques:

    • Cultivate a meditation practice
      Over time, you’ll condition yourself to be more present while letting thoughts come and go. We recommend guided meditations on apps such as Headspace, Insight Timer, and Calm. Meditation not your thing? Try Heartmath, a form of biofeedback that can help with anxiety management. It focuses on breathing and heart rate, two physiologic functions that can contribute to that anxious feeling.
    • Cultivate a gratitude and/or journaling practice
      Studies have linked both practices to decreased anxiety, and they can also help improve general feelings of well-being and facilitate mindfulness. Here are some great tips on how to start a gratitude practice.
    • Get high-quality sleep
      Sleep disruptions affect neurotransmitter and stress hormone levels which, in turn, impair thinking and emotional regulation. That’s why it’s so important to prioritize those Zzzzsss. Here’s a handy guide with behavioral, nutritional, and supplemental solutions.
    • Prioritize downtime with family & friends
      While we may be conditioned with a “go-go-go” mentality, it’s important to step back and prioritize rest and downtime with loved ones (pencil it into your calendar!). After all, human beings are social creatures, and we derive comfort from connection.
    • Don’t forget about “me” time
      Call it what you want — self care, alone time, R&R — but you deserve it. There’s nothing “selfish” about taking time for yourself, especially when it supports your mental health and overall wellness.

    Think of “me” time as putting your mask on first in an airplane, so you can be better equipped to help others.

    Cognitive Behavioral Therapy (CBT)

    CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and mindset. It’s ideal for those looking to address underlying causes of anxiety while working towards long-term management.


    Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes your mood, improves sleep, and boosts self-esteem. Not too shabby, right? According to the World Health Organization, 150 minutes per week of moderate intensity movement (a brisk walk counts!) is enough to do the trick and reduce the risk of developing symptoms of anxiety and depression.

    Keep things interesting with a mix of different workouts, including strength training, cardio, and yoga. 150 minutes = about 22 minutes per day — for most of us, that’s very doable!

    Supplements & Over-the-Counter Solutions

    According to some studies, certain supplements and over-the-counter solutions may help reduce symptoms of anxiety…if you choose wisely. We recommend consulting with your healthcare provider first to ensure you’re using something with optimal efficacy and safety (i.e. backed by clinical research) or consulting with Elektra’s providers. Here’s a quick primer from our team on how to go about selecting high-quality supplements.

    • Calm ASAP for Stress Support
      Calm ASAP may provide relief from occasional anxiousness with a blend of passionflower, chamomile, vervain, English lavender, and holy basil, all of which have been shown in studies to help with anxiety.
    • Serenol from Bonafide
      Serenol is formulated with Swedish flower pollen, an extract made from the pollen and pistils of a certain family of grasses that helps resolve menopausal symptoms (e.g., hot flashes) in addition to emotional effects of PMS.
    • True Calm
      True Calm contains a combination of amino acids (GABA, glycine, and taurine) that promote a relaxed, calm state of mind.
    • Metagenics SeroSyn
      SeroSyn features L-theanine, an amino acid commonly found in green and black tea leaves that has been studied for its anxiety and stress-reducing properties. It also contains the amino acid 5-HTP, a precursor for serotonin synthesis. It’s important to note any supplements that contain 5-HTP should not be taken with the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) – because it may increase the risk of serotonin syndrome.



    Before considering hormonal treatments for menopause-related anxiety, it’s critical to consider sleep, nutrition, and stress management — all of which can have a powerful impact on symptoms. If you do opt for hormonal treatments, they should always be coupled with mind-body interventions. In other words, nothing should exist in a silo, especially for something as complex as anxiety.

    Data are mixed about whether HRT helps with anxiety, with smaller studies showing conflicting results or no effect. The relationship is clearer between HRT and depression with more data suggesting a positive effect of hormone (particularly estrogen) therapy on depression especially in perimenopause. Given what we know about progesterone influencing GABA receptors, it might be worthwhile to try progesterone supplementation during the 2nd half of your cycle in early perimenopause to help with anxiety that seems to correlate with your menstrual cycle.

    It is worthwhile to also mention the option of low-dose birth control, which may be used early in perimenopause for those with PMDD (premenstrual dysphoric disorder, a condition similar to PMS that leads to severe emotional symptoms like anxiety, irritability and/or depression in the week or two prior to your period), or moderate PMS.

    To learn more about HRT, refer to our full guide to hormone replacement therapy.


    SSRIs and SNRIs remain the first line of pharmacologic defense for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors — total tongue-twisters! These neurotransmitters are antidepressants that work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (plays a key role in the body’s “fight-or-flight” response to stress). It should be noted that common side effects include weight gain and low libido.

    A note about antidepressants: There is still stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up.

    Examples of SSRIs are:

    • Escitalopram/Lexapro: associated with less weight gain and sexual side effects (i.e. low libido) than others
    • Venlafaxine/Effexor: associated with higher risk of withdrawal symptoms, so proper weaning is important and should be done under the guidance of your provider

    If you’re experiencing an emergency and need immediate help, call 911 or go to the nearest emergency room.

    Suicide Prevention Lifeline
    + 1-800-273-8255

    Crisis Text Line
    Text HOME to 741741

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


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