Perimenopausal Anxiety vs. General Anxiety: How to Tell the Difference

It’s one of the most common questions women ask in therapy around midlife:
“Is this anxiety… or is this perimenopause?”

And the truth is, it’s often both — but not in the way most people assume.
Perimenopause doesn’t create anxiety out of nowhere. It changes the internal environment of your nervous system so dramatically that old, manageable patterns suddenly feel bigger… or brand-new patterns appear for the first time.

If you’ve found yourself more on edge, more reactive, or constantly bracing for something — even when nothing is wrong — you’re not imagining it. And you’re definitely not alone.

This post will help you understand why anxiety feels different in perimenopause, how to distinguish it from general anxiety, and what actually helps.

Why Anxiety Feels Different in Perimenopause

Perimenopause brings shifting levels of estrogen, progesterone, and testosterone — and each one plays a role in how your nervous system processes stress.

• Progesterone, which has a naturally soothing, GABA-enhancing effect, begins to decline.

• Estrogen fluctuates wildly, affecting serotonin, dopamine, and stress circuits in the brain.

• Cortisol rhythms change, often rising earlier in the morning or spiking more intensely under pressure.

Combined with the mental load most women carry by midlife, these changes create a nervous system that is more sensitive, more alert, and more easily overwhelmed.

This is why so many women say things like:

• “I’ve always managed my anxiety before, but now it’s constant.”

• “My reactions feel disproportionate to the situation.”

• “I get jolts of panic for no reason.”

• “I wake up already stressed.”

It’s not weakness.
It’s not “being dramatic.”
It’s physiology.

If you want a deeper understanding of the emotional and cognitive shifts that make this stage feel so destabilizing, you can read my comprehensive guide: The Emotional Symptoms of Perimenopause: A Therapist’s Guide

How Perimenopausal Anxiety Feels (and Why)

While general anxiety tends to have recognizable patterns — chronic worrying, tension, rumination — perimenopause anxiety often feels more physical and sudden.

Women describe:

• a buzzing or vibrating sensation under the skin

• adrenaline surges that seem to come out of nowhere

• heart racing or chest tightness

• feelings of dread with no obvious trigger

• an inability to calm down even when nothing is wrong

• startling more easily

• panic attacks (sometimes first-time onset in midlife)

This is because fluctuating hormones disrupt how the brain modulates fear, stress, and safety. The system that once filtered out minor stressors is now reacting as though every stressor is major.

It’s not that there’s more danger — it’s that your body has lost some of the internal cushioning that used to tell you you’re safe.

How General Anxiety Typically Shows Up

Generalized anxiety is more patterned, predictable, and mentally driven. It often includes:

• excessive worrying about multiple areas of life

• difficulty controlling thoughts

• tension that builds gradually

• chronic overthinking

• perfectionism or fear of making mistakes

• catastrophizing

• sleep disruption caused by rumination (not hormones)

General anxiety tends to build; hormonal anxiety tends to spike.

Both are real. Both deserve compassion. And many women have a combination of the two.

So How Do You Know Which One You're Experiencing?

Here’s a simple way to think about it:

Perimenopause anxiety is typically:

• sudden

• physical

• unpredictable

• intense but short-lived

• worse before your period

• worse with poor sleep

• tied to hormonal fluctuations

Generalized anxiety is typically:

• persistent

• thought-driven

• looping or ruminative

• gradually escalating

• tied to fears, themes, or patterns

• influenced by life stressors

But the most important truth?
Both types feel real. Both create distress. And both are treatable.

Why This Distinction Matters

When women assume all their anxiety is “just hormones,” they may miss real, treatable patterns of general anxiety.
When women assume it’s “just stress,” they may miss the significant physiological impact of perimenopause.

Understanding the difference allows for the right support at the right time.

And for many women, the biggest relief comes from recognizing that:

You’re not failing. Your nervous system is recalibrating.

What Actually Helps

Most women need a blended approach — addressing both the physiology and the psychology.

Things that help hormonal anxiety:

• sleep stabilization (CBT-Insomnia, sleep hygiene)

• nervous system regulation (exercise, sleep)

• reducing emotional labour

• HRT (for some women)

• possible dietary changes

• grounding practices that soothe the body (mindfulness, breath work, etc.)

Things that help generalized anxiety:

• CBT, ACT, or IFS-informed therapy

• cognitive reframing

• exposure to feared situations

• reducing avoidance loops

• boundary-setting

• addressing perfectionism or overfunctioning

When you treat the body and the mind, anxiety softens — sometimes dramatically.

You’re Not Losing Yourself — You’re Navigating a Transition

Anxiety in perimenopause is not a sign of weakness. It’s a sign that your internal scaffolding is shifting, and your system is asking for care.

The truth is:
You’re not broken. You’re adapting. And you don’t have to do it alone.

The information on this website is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment or to replace your relationship with your health care provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this site.