Perimenopause and Anxiety: When Hormones Hijack Your Nervous System

Does your mind race?

Do you feel tightness in your chest or lie awake at night with anxiety since entering perimenopause? You’re not alone. Around four in ten women experience mood symptoms during this hormonal transition. Perimenopausal anxiety can catch anyone off guard, even women who’ve never struggled with anxiety before.

Many of my clients are surprised by these mood changes and relieved to discover they’re not “just in their head.” These feelings often stem from shifting hormones and changes within the nervous system.​

Falling oestrogen and progesterone lower serotonin, your “feel-good” brain chemical.  While cortisol, the stress hormone, rises with age. These combined effects can leave your body and mind in a heightened state of tension.

Your anxiety isn’t imaginary, it’s a physiological response to hormonal imbalance. Let’s explore how these changes affect your nervous system, and how naturopathic approaches can help you regain calm and control.

Why Hormones Disrupt Calm During Perimenopause

Perimenopause involves more than hot flashes and sleep changes, it rewires your brain chemistry. As hormones fluctuate, they influence how your nervous system regulates stress, calm, and emotional balance.

Q.  Can perimenopause cause anxiety?
A.  Yes. Fluctuating oestrogen and progesterone levels affect neurotransmitters like serotonin and GABA, disrupting your nervous system and triggering anxiety.

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How Oestrogen Affects Serotonin and Mood

Oestrogen helps regulate serotonin and dopamine, two key neurotransmitters that stabilise mood. During perimenopause, oestrogen rises and falls unpredictably before eventually declining. Research shows women in perimenopause have up to 34% more monoamine oxidase A (MAO-A) in the brain, an enzyme that breaks down serotonin. With less serotonin available, irritability and anxiety can appear unexpectedly.

The Calming Role of Progesterone and GABA

While oestrogen fluctuates, progesterone steadily declines. This matters because progesterone converts into allopregnanolone, a neurosteroid that enhances GABA, the brain’s main calming neurotransmitter. GABA acts like a brake pedal, slowing racing thoughts and promoting relaxation. Lower progesterone means less GABA activity, which can lead to anxiety, sleep problems, and increased stress sensitivity.

Cortisol and the Adrenal Connection

Cortisol, your primary stress hormone, also shifts during perimenopause. As ovarian hormone output decreases, the adrenal glands take on a greater role, often leading to cortisol imbalance. The hypothalamic-pituitary-adrenal (HPA) axis becomes more reactive, creating a feedback loop: hormonal symptoms raise stress levels, which in turn elevate cortisol, further intensifying anxiety and other perimenopausal symptoms.

How the Nervous System Responds to Hormonal Shifts

Your nervous system doesn’t simply observe hormonal changes, it responds to them. As oestrogen drops, the sympathetic nervous system (“fight or flight”) becomes overactive, while the parasympathetic system (“rest and digest”) weakens.

This imbalance keeps the body in a state of hyper-alertness: faster heart rate, tense muscles, shallow breathing, all of which mimic or amplify anxiety symptoms.

External triggers can worsen this imbalance. Caffeine on an empty stomach, poor sleep, and fluctuating blood sugar levels all provoke adrenaline surges and heighten stress responses. Everyday frustrations, like losing your keys, can feel overwhelming when the nervous system is already on edge.

The Vagus Nerve and Calming the System

The vagus nerve, a key component of the parasympathetic system, helps restore calm by slowing heart rate and lowering blood pressure. Oestrogen naturally supports vagal tone — its ability to activate this “rest” response — but as oestrogen declines, vagal tone weakens. The good news: specific practices such as deep breathing, yoga, singing, or humming can stimulate the vagus nerve, helping re-establish nervous system balance.

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Naturopathic Foundations for Calming Perimenopausal Anxiety

Naturopathic care looks beneath symptoms to identify the root causes of anxiety — hormonal, nutritional, or adrenal.

Testing Hormone and Adrenal Levels

While diagnosis often relies on symptoms and age, functional testing (such as bloodwork or the DUTCH hormone test) can provide a detailed picture of oestrogen, progesterone, cortisol, and adrenal function. These insights guide targeted treatment for better hormonal balance.

Gut Health and the Serotonin Connection

Your gut produces around 90% of your serotonin. As oestrogen declines, beneficial bacteria like Lactobacillus and Bifidobacteria decrease, affecting both digestion and mood. A healthy microbiome supports serotonin production and can help stabilise mood.

Key Nutrients: Magnesium, B Vitamins, Zinc

Magnesium supports the nervous system, improves sleep, and helps regulate melatonin. Combined with vitamin B6, it can reduce anxiety and PMS-like symptoms. B6 and B12 also assist serotonin synthesis and nerve health, while zinc supports brain function and reduces irritability.

Daily Habits that Support Balance

Exercise, restful sleep, and nutrient-rich foods create a foundation for hormonal stability. Aim for 7–9 hours of uninterrupted sleep and include tryptophan-rich foods (ie; eggs, turkey, salmon, pumpkin seeds, quinoa and tofu), to aid serotonin production. Gentle movement such as walking or yoga can lower cortisol and boost GABA activity naturally

Q.  What are the best natural remedies for perimenopausal anxiety?
A.  Naturopathic options include adaptogenic herbs like Ashwagandha, nervines such as Lemon Balm, and nutrients like magnesium and B vitamins.

Herbal and Nutritional Allies for Hormonal Calm

Lifestyle adjustments are essential, but herbal and nutritional therapies offer additional support to rebalance hormones and soothe the nervous system.

Adaptogens for Adrenal Support

Adaptogens like Ashwagandha, Rhodiola, Siberian Ginseng, and Schisandra help the body adapt to stress and reduce cortisol spikes. These herbs restore resilience, improve energy, and support emotional balance during hormonal transition.

Nervines to Soothe the Mind

Nervine herbs such as Chamomile, Passionflower, Lemon Balm, and Valerian work directly on the nervous system to calm restlessness and support sleep. St. John’s Wort can ease mild to moderate anxiety, while Saffron helps lift mood and reduce anxious feelings by supporting healthy brain chemistry

Symptom Relief

Poor sleep, night sweats, and hot flushes can intensify anxiety, so addressing these symptoms is a key part of calming the nervous system. Certain herbs, like Zizyphus, are particularly effective.  They help promote restful sleep while also reducing night sweats. By easing these disruptive symptoms, you support both physical comfort and emotional balance during perimenopause.

Hormonal Modulators: Vitex and Black Cohosh

Vitex (Chaste Tree) influences pituitary signalling, helping balance oestrogen and progesterone levels. Black Cohosh is best known for easing hot flashes but may also support mood stability and reduce anxiety in some women.  

Magnesium and Omega-3s for Brain Health

Magnesium activates the parasympathetic nervous system and promotes deep relaxation. Omega-3 fatty acids, especially DHA, are critical for brain structure and mood regulation. Studies show they may reduce depression and anxiety after menopause.

Why Practitioner Guidance Matters

Herbal and nutritional therapies can be powerful but should be used under professional guidance. A qualified naturopath or herbalist can tailor formulas, ensure safety with existing medications, and source high-quality practitioner-grade supplements.

Conclusion

Perimenopausal anxiety isn’t a sign of weakness, it’s your body’s response to profound hormonal and neurological change. By understanding how oestrogen, progesterone, serotonin, and cortisol interact, you can take steps to restore calm and resilience naturally.

A naturopathic approach addresses root causes — supporting adrenal function, gut health, and nutrient balance while incorporating calming herbs and lifestyle shifts. With the right guidance, these strategies can transform your perimenopausal experience from one of anxiety to empowerment.

You don’t need to simply endure this transition.</strong> Work with a qualified naturopath to create a personalised plan, integrate safe natural remedies, and support your nervous system as your hormones find their new balance.

About SmartGENES Naturopathic Clinic

​​​Vanessa Winter
​Naturopath & Medical Herbalist
BHSc (Deans Award for Academic Excellence), BED, Adv.Dip.Nat., Adv.Dip.Herb.Med., NMHNZ
​Registered with Naturopaths and Medical Herbalists of NZ (NMHNZ)

References
https://pmc.ncbi.nlm.nih.gov/articles/PMC10249373/
https://www.hopkinsmedicine.org/health/wellness-and-prevention/perimenopause-and-anxiety
https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/herbal-remedies-and-complementary-medicines-for-menopause-symptoms/
https://www.drlouisenewson.co.uk/knowledge/why-am-i-so-stressed
https://www.healthline.com/health/perimenopause-anxiety
https://pubmed.ncbi.nlm.nih.gov/28178022/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12209554/
https://www.healthline.com/health/natural-remedies-for-perimenopause