For many women, perimenopause and menopause is expected to bring hot flushes, night sweats and irregular periods. But one of the most common (and often surprising) symptoms is anxiety. 

Women who have never previously struggled with anxious feelings may suddenly notice racing thoughts, panic, irritability, or a sense of being constantly ‘on edge’. In fact, anxiety is one of the most common psychological symptoms reported in perimenopause, with some studies showing prevalence of over 50%.

The menopause transition is a time of major biological change and mental health often shifts alongside it. In this blog we will explore menopause-related anxiety, why it may present and how you can support it with the right nutrition, lifestyle and supplement strategies. 

The years leading up to menopause (perimenopause) and menopause itself involve significant hormonal changes, particularly fluctuations and eventual decline in oestrogen and progesterone. These hormones do far more than regulate the menstrual cycle - they also play an important role in brain function, mood and emotional resilience. 

Oestrogen helps influence the production, release and sensitivity of neurotransmitters such as serotonin and dopamine, which are involved in feelings of wellbeing, motivation, pleasure and emotional stability. It also supports blood flow and energy metabolism in the brain, which may partly explain why some women notice brain fog, low mood or reduced concentration during this transition.

Progesterone, meanwhile, is often thought of as the body’s natural calming hormone. It can be converted into allopregnanolone, a neuroactive compound that interacts with GABA receptors in the brain, the same calming pathway involved in relaxation and sleep. Healthy progesterone levels can help promote a sense of calm, steadier mood and better sleep quality.

Symptoms vary from woman to woman, but common signs include:

• Racing thoughts or excessive worry

• Feeling tense, restless or unable to relax

• Heart palpitations or a pounding heart

• Panic attacks

• Irritability or feeling emotionally reactive

• Trouble concentrating (‘brain fog’)

• Difficulty sleeping

• Feeling overwhelmed by everyday tasks

• Loss of confidence or social anxiety

Sometimes these symptoms appear before obvious physical menopause symptoms, which is why many women do not immediately make the connection between anxiety and hormonal changes.

Whilst food cannot ‘cure’ menopausal anxiety, it can play a powerful role in supporting mood, hormones and nervous system resilience. Here are my top strategies to focus on: 

Blood sugar crashes can mimic or worsen anxiety symptoms, causing shakiness, irritability and adrenaline surges. To prevent this happening, aim for regular meals built around:

• Protein (eggs, Greek yogurt, fish, chicken, tofu, beans)

• Fibre-rich carbohydrates (oats, quinoa, lentils, whole grains, sweet potato)

• Healthy fats (olive oil, avocado, nuts, seeds)

• Plenty of colourful plants

Skipping meals and relying on caffeine or sugar will only create a ‘blood sugar rollercoaster’ and can intensify anxious feelings.

Oily fish, walnuts, chia and flax seeds support brain function and help dampen inflammatory processes that can affect mood and stress sensitivity. Include oily fish like salmon, mackerel, anchovies, sardines or herring twice per week and include plant-based sources such as chia and flax regularly for their added fibre boost. 

The gut and the brain are in constant communication via the gut-brain axis. Including a colourful variety of plant foods helps feed your gut microbes, particularly the beneficial bacteria that thrive on fibre and polyphenols. Emerging research suggests that when the gut microbiome is healthier and more diverse, it may better support emotional resilience during the perimenopause and menopause transition.

Magnesium is involved in hundreds of processes in the body, including relaxation, sleep and stress regulation. I often refer to it with my clients as ‘nature’s tranquiliser’. Many women fall short on their magnesium needs through stress, poor diet or digestive issues.

Focus on adding in magnesium-rich foods regularly such as leafy greens, pumpkin seeds, nuts, beans and dark chocolate (70% cocoa solids or above). Extracted’s Magnesium complex can also be a useful addition where extra support is needed.

During menopause, many women become more sensitive to stimulants. Excess caffeine may worsen feelings of anxiety and impact sleep quality. Whilst caffeine tolerance is individual to each person, stick to no more than two caffeinated drinks per day and ideally before midday. 

Alcohol can worsen menopause-related anxiety, sleep disruption and hot flushes, so it’s sensible to keep intake modest. Many women find reducing alcohol helps, and if symptoms are significant, a short alcohol-free trial can be a useful way to see whether cutting it out entirely makes a difference.

With the nutritional strategies covered, it's now time to consider introducing more general lifestyle habits that can help you manage anxious feelings during the menopause transition. 

Sleep is a fundamental pillar of wellbeing and better sleep often means calmer days. Whilst sleep issues can be complex, make sure you are covering all of the basics to promote a better night’s rest: 

• Create a wind-down routine to calm your nervous system such as reading, a warm bath, or listening to calming music

• Don’t eat within two hours of bedtime, so you allow your body to properly digest your food

• Keep the bedroom cool and dimly lit

• Avoid devices as much as possible in the run up to light’s out 

If sleep issues are persistent then you should consider targeted support such as Sleepee, designed to support restful sleep and recovery.

Research shows that exercise is one of the most effective natural tools for anxiety. It helps regulate stress hormones, supports sleep and boosts mood-enhancing brain chemicals.

Here are some examples:

• Brisk walking

• Strength training

• Yoga or Pilates

• Dancing, cycling or swimming

Consistency matters more than intensity - find something that you enjoy so it is easier to stick to your movement habits. 

Perimenopause and menopause arrive at a time in a woman’s life when her life load is often high: advancing careers, family life, ageing parents, and so on. Prioritising nervous system support during this phase becomes more than just a nice to have - it is essential. Simple daily practices can help signal safety to the body and help regulate stress, such as:

• Deep breathing

• Morning daylight exposure

• Gentle stretching

• Time in nature

• Journalling

• Time away from screens

Even five to ten minutes can help you feel calmer but the key again is consistency. And on days when you feel you need a little extra support, there is always Extracted’s Calmee. Calmee contains ingredients selected to support relaxation and a balanced stress response, making it a useful option during busy or emotionally demanding phases.

If anxiety feels persistent, intense or disruptive, support is important and you must seek help from your GP. Talking therapies such as CBT are a great option when needed, too. 

Menopausal anxiety can feel overwhelming, especially if it seems to appear out of nowhere. But it is not ‘all in your head’, and it does not mean you are losing control. Your body is adapting through a major hormonal transition and with the right nutrition and lifestyle support, calm can return. This chapter may feel challenging, but it can also be an invitation: to slow down, tune in and support yourself in a new way.