Perimenopause: The Demon in Red Undies and Attempts to Vanquish Her

Understanding and Managing Perimenopausal Anxiety

How long does perimenopause anxiety last?

Asking ‘how long does perimenopause anxiety last’ is a bit like asking how long is a piece of string. It’s hard to know when it started, and it’s hard to say if it will stop when you get to ‘true’ menopause.

I guess what most of us really want to know though, is what do I do about it?

If this anxiety is temporary and will just go away, should I even try and treat it?

And that goes for all perimenopause symptoms.

It’s enough to drive anyone mad to be honest.

As if juggling career, relationships, the state of the world, and personal growth weren’t enough.

Perimenopause hurls itself into the mix.

At this time of writing, I’m 44 years old and it’s the year 2024. That sounds like the intro to a science-fiction novel, but context is everything so… that’s the context. I have personal experience with perimeno as do my friends of similar age (i’m also Australian, and as such perimenopause may be referred to as ‘perimeno’ occasionally).

I have PCOS (poly-cystic ovarian syndrome), which tends to complicate all things hormonal. My fellow cysters- you get it.

I’m also an online counsellor and online life coach, so I talk to lots of women and couples for whom this impacts.

All of us have experienced numerous perimenopause symptoms that don’t often get talked about, including:

• perimenopausal anxiety
• perimenopausal mood swings
• shorter cycles with much more painful periods
• heavy bleeding
• reduced sex-drive
• insomnia
• feeling ‘crazy’
• bad skin/breakouts/cold sores etc…
• Itchiness

And the hot flashes haven’t even kicked in yet.

A big problem is that it is extremely difficult to ‘diagnose’ when you are in perimenopause. Unless you have obvious vasomoter symptoms (hot flushes, night sweats) you and/or your health professionals will just be making educated guesses based on your personal history, your body, and your mother’s history. You can get an FSH test, but it’s not conclusive.

The menopausal change is a gradual process that generally starts in your mid-40’s but can even begin in your 30’s.

Typically, perimenopause lasts 4-8 years before menopause. Menopause is said to have occurred when you haven’t had a period at all for one year. The average age of menopause is 51. For some folks, I guess that’s the answer to the question ‘how long does perimenopause anxiety last?’

The frustration, though, is in the not-knowing. Plus, the ‘end of anxiety’ is not guaranteed, as menopause can come with it’s own set of issues.

But then again, does it really matter?

Would you treat perimenopausal anxiety any differently if you ‘knew’ it was the perimeno?

The truth is, you can do a lot of things without a diagnosis. Even without a diagnosis, many women’s health specialists can and will prescribe things like HRT.

If you know you’re suffering and it’s not just ‘going away’, then my love, be as kind to yourself as you possibly can be, accept the change, and find what works for you.

As someone who has lived with hormonal anxiety since puberty (did I mention I have PCOS?) I’ve had endless run-ins with the medical, physical, and mental health side of it all. I don’t have concrete answers or miracle cures, but there’s so much I want to share with you.

In fact, i’ve got a huge bunch of ways you can try and help yourself, most of which I have tried myself or heard personal experiences of.

This article is going to cover LOADS of possible treatment options for perimenopausal anxiety

(and other less-obvious perimenopause symptoms).

I’m not kidding- it is thorough.

It includes a whole range of research, knowledges and lived experiences. It explores medical, naturopathic and emotional treatments.

There are also a few carefully chosen perimenopause book recommendations at the bottom of the post.

Read on to find out what might help you, or your partner.

Vanquishing the demon: understanding and managing perimenopausal anxiety

How long does perimenopause anxiety last?

Medical Approaches

Hormonal Therapies

Hormone replacement therapy (HRT) can help stabilize hormones during peri-menopause and menopause. For some women, HRT is a lifesaver. Not so much for others.

There are doctors that will just prescribe oestrogen and not tailor HRT to your particular needs. And HRT can be dangerous (especially if you don’t have vasometer symptoms indicating a dive in oestrogen). Some women have reported abnormal bleeding, pain, dramatic mood swings and other issues. If you try it, it needs to be managed well.

For example, if you have PCOS (like me) you might not respond well to oestrogen. But you might respond really well to progesterone. Progesterone helps with sleep and feeling calm. It’s an important hormone for all women, and is often already lacking in women with PCOS who don’t ovulate much. There are new forms of progesterone that closely mimic the bodies natural production, such as Prometrium. These medications are different from the ‘progestin’ in most versions of the birth-control Pill, so are worth discussing even if you had a bad experience with The Pill.

It’s worth noting HRT patches are probably the most popular form of treatment (ease of use + dosage). Did you know that is actually a global shortage of HRT patches? I guess awareness of menopausal symptoms and management options have improved dramatically the last few years!

Testosterone is also a super-important hormone for many women, but there can be a phobia-level fear of prescribing it, even in small doses. There is some evidence to show it can improve low-sex-drive associated with perimenopause. And in the anecdotal evidence i’ve heard from transgender folks who bleed (and some women with and without PCOS) testosterone can also improve mood. In Australia women can be prescribed AndroFeme 1% which is the only approved gel specifically for women, but in other countries you can be prescribed other brands to be used very sparingly.

Read up (via the books below perhaps, or reputable menopause websites). Be sure to explore HRT in-depth with a specialist in women’s health before taking anything.

The Contraceptive Pill

As I’ve referenced a bunch of times, I have not had good experiences with Diane 35ED and her sisters. But you might. Certainly I know a few women with endometriosis for whom the Pill has been extremely helpful, especially coming into perimenopause. Talk to a women’s health specialist doctor and keep track of your emotions if you try the contraceptive Pill to treat menopausal anxiety and other hormonal symptoms.

Medications

SSRIs or other antidepressants can help manage mood swings, anxiety and depression associated with perimenopause. I am defo pro-meds if they help, but also suggest you tread carefully when it comes to SSRI’s. Sometimes the side-effects are problematic, their efficacy is somewhat questionable (do they actually FIX the problem?), and they’re easy to start but super-hard to come off.

There are now anti-anxiety/antidepressant medications such as Agomelatine that don’t have the same side-effects as SSRI’s and can improve sleep patterns. So far, I have heard positive things about this drug. But everyone is different.

You can also talk to a doctor about beta-blockers as a treatment for anxiety. They’re basically heart medications that are sometimes prescribed ‘off-label’ for anxiety because they can slow down/stop the physical reactions of the body (racing heart, trembling, sweating). They don’t make you drowsy (usually), so people tend to use them for performance anxiety, exams, flying- those kinds of stressful situations. Note you should not exercise after you’ve taken a dose. They’re not a long-term solution, but they work immediately and can help in a pinch or for specific scenarios. They’re also non-addictive and quite cheap.

Medications are always changing, so don’t assume whatever you know from 5 years ago is the same.

For some folks, antidepressants in whatever form, are unquestionable lifesavers. Do some research if you’re struggling mentally and emotionally (like you are now, by reading this- how fabulous are you). They enable some people to get on with happy, satisfying lives and function in ways that weren’t otherwise possible.

The key is to talk with a good psychologist and/or mental health specialist doctor who could refer you to a psychiatrist for a thorough assessment. 15 minutes is not enough time to decide your state of mind and then put you on medication.

You should never be a medical guinea pig, so make sure you book the time to discuss these options in-depth. If you don’t understand or don’t like the options, find another professional. I hate it when people criticise folks for shopping around when it comes to doctors and/or mental health. This is your life and it’s your health! Treating it with reverence is awesome.

How long does perimenopause anxiety last?

Naturopathic Solutions

Confession: I do like to try supplements and herbal remedies, and prefer to go down these routes before trying medication. It is ALWAYS recommended to do this with the help of a qualified naturopath or a dietician. If that’s not an option, then buy them from a good chemist and have a chat with the pharmacist or a natural health expert.

Do your own research as well. As supplements are not regulated they are not all made equally, and you need to know what you’re taking.

Herbal Remedies

• Vitex Agnus-Castus (Chasteberry): Can help balance hormones and regulate cycles. I have been taking Vitex for awhile now, and this is my experience: It’s helped push my cycle back out to around 30 days (which was normal for me. 25 day cycles or less were not normal). It’s helped reduce mood swings, particularly perimenopausal anxiety. And it’s helped reduce painful periods. Plus the itchy skin has stopped- phew, that was a weird perimenopause symptom. You take it daily first thing in the morning, and you stop for the days you are bleeding. If you forget one or two, it’s not a big deal, but try to make it a habit in the first half of your cycle in particular.
• Black cohosh: has helped some folks alleviate peri-menopausal symptoms like hot flashes.

Supplements

• Omega-3 fatty acids (fish oil): Please note the active ingredient in fish oil is EPA, so read the bottle. These tablets can be expensive as they’re popular these days, but there is quite a lot of evidence that they help prevent osteoporosis and promote hormonal regulation. You can also just eat a lot of nuts, seeds and oily fish such as salmon or mackerel. If you do eat a lot of omega-3 rich foods then you can try the minimum recommendation of 600mg EPA, but in trials the effective amounts were more like 1200mg EPA.
• Ashwagandha: I am a HUGE fan of this supplement. There are numerous studies that show it can help with anxiety and insomnia, and my personal experience is very good results in both areas. 500-600mg/day is the general recommendation for best outcomes.
• Magnesium glycinate: Magnesium is being hailed as an anxiety and sleep miracle at the moment. As a lifelong insomniac (hello PCOS my old friend + perimeno my new one) anything that helps a gal sleep is welcome. My personal experience of Magnesium is, sadly, neutral. But look, you can try it for yourself. Read this Guardian article for more info. Magnesium glycinate is used to treat a range of things, it’s not a sleeping pill, so no need to take it at night. It’s suggested to take 300-400g in the morning, with food (as it can take awhile for your gut to adjust to the change), and not with other medications. You can also up your intake of nuts, seeds, fatty fish, leafy greens (so the usual things we know are good for us).
• Vitamin B6: can reduce inflammation, improve mood/serotonin, and ease PMS symptoms.

How long does perimenopause anxiety last?

Other stuff

Life coaching or personal coaching

So this is where I suggest you talk to someone, like myself, an online personal coach, because it’s nuts going through this alone. And it does feel lonely, even when you know 50% of the world has the same issue. As a life coach with a counselling background personal experience of perimenopausal anxiety, I can offer you support and understanding. As well as advice and action points to help yourself through this huge life transition.

I’ve been described as a body warrior, a label I humbly and wholeheartedly accept. So if you’re feeling unhappy about putting on weight with perimenopause, I can help you start to accept your new lovely curves as they are.

There are so many added pressures and journeys of life at this age (being part of the ‘sandwich generation’ – raising kids while managing elderly parents; dealing with grief as those older loved ones die; workplace and career issues; relationships changing or getting stagnant; paying mortgages; health struggles etc…).

You might have held back from getting help because ‘it’s not bad enough’, but before you know it you’ll be in your 50’s and it will be bad enough.

The habits we form when we’re struggling can impact our lives and relationships significantly. You and your wellbeing as soooo important, don’t put them on the back-burner.

Organise your schedule around your period cycle

It is deeply unfortunate that we don’t live in a world that functions like The Matida’s training schedule. Some workplaces are changing things up and incorporating the fact that 50% of the world don’t function the same day-in, day-out. If you’re in a position of power, perhaps this is something you can look into for your own workplace. If not, you’re kind of stuck with the 9-5. Your time is largely governed by external forces.

But try this.

IF it is possible, schedule as little as possible around the hardest times for you during your cycle, as unpredictable as it is with perimenopause. Long gone are the days of the tampon ads which shows ‘girls can do anything’ when they’re bleeding. You can, but you don’t have to. You can even call in sick if you can’t plan for the hardest days. If you rest when you need to, you will benefit through your whole cycle.

Pay attention to how often you’re expected or asked to give up your time. Compare that to your partner or other folks in your life. Is it fair? Even if it is equal- is it fair?

If you’re not well or you need time to rest your brain/body/heart more than you used to when you were younger because you’re going through freakin’ perimenopause, then take it. Your time is YOURS.

You’re still a good mum or a good partner or a good employee if you aren’t at 100%, giving all the time. You’re still an adventurer or a nomad or a wild woman, even if you can’t be bothered getting on a plane next month or you need to lie by a beach instead of volunteering in a developing nation.

How long does perimenopause anxiety last?

If you’re queer and experiencing perimenopause

If you’re in a lesbian same-sex relationship and going through perimenopause together, or you’re non-binary or transgender and with a person who also bleeds, then it’s about talking. Talking and some more talking. Which I doubt is unfamiliar to you.

Figuring out who needs what and when is important. It can even be kinda exciting (if you’ve got a good relationship with your partner), to work out new ways to care for one another as you change together. Rediscover or redefine your love languages. Find out how to tag team doing the ‘bare minimum’ when it comes to household chores. Howl like wolves into the night when it all gets too much. Try and be kind, to yourself and each other.

Don’t be afraid to reach out for help if things aren’t working though. Extra stress on both bodies, with both people feeling perimenopausal anxiety, is enough to strain even the most solid relationship. You may need A LOT more support than you’ve ever needed before, and that’s ok. Truly it is. You don’t need to be perfect.

Improve your sex life

The fact is, most women’s desire for sex changes with perimenopause. If you’ve got an opposite-sex partner or partners, this can be hard if they don’t understand why everything has changed. I’ll write more on this is a future blog post, but for now I’d say: don’t expect yourself to feel like you used to.

Use lubricant!! Vaginal dryness is not pleasant and can affect even the sexiest human.

As for sex drive, addressing the change in desire is super-hard.

This is a time to discover a new relationship with your sexuality. Use sex toys, read erotic fiction or watch ethical porn, and invite yourself into feeling sexual slowly. It will take more effort, but it is still there.

I also offer online relationship coaching for couples struggling with changes in their sex life due to perimenopause.

Tell people you need more from them

Again, not to bang on and on and on, but I’m tired of people who bleed not getting the right answers. We keep trying to fix ourselves with self-help techniques. And they’re ok, but what about being properly supported as we change by those who love us and/or rely on us? Society encourages this nonsense, and it takes some effort to fight back.

Maybe it’s because we aren’t always great at telling people exactly what we need (as many of us have been socialised). Maybe we don’t KNOW what we need. We just want it to be fixed. How long does perimenopause anxiety last? When will it go away?!

But the answer is, you don’t really know.

So it’s about raising your expectations of others and letting yourself off the hook if you need to slow down. You’re not going to figure it out going 100 miles/hour, pushing yourself beyond your limits. Give yourself time to understand this new, changing body.

Tell people you need more help. Be specific (if you can be). Allocate tasks and don’t just do them yourself when they’re inevitably forgotten. Remind them and expect it. Change takes time and effort, but it’s worth it.

This is also super-healthy for your romantic relationship/s. Women who are stressed, at the end of their ropes, and don’t get enough support, are not only exhausted but build up feelings of resentment. That resentment can spell the death of your love story. So do ask for more and expect better.

You can also ask for things like hugs, kisses, and cups of tea.

Be so bloody lovely to yourself you can hardly believe it.

Symptom Tracking

Keeping a journal of your symptoms can help you and your healthcare provider understand the patterns and triggers. Note how you feel before, during, and after your period, and track any perimenopausal symptoms.

I have personally kept a period diary for a couple of years now, (though often it veers into ‘regular’ journalling- which is a good thing) and I have learned so much about my cycle and how it impacts me. For instance, I’ve realised I suffer more from hormonal anxiety during + post bleeding rather than the usual PMS. I strongly recommend this practice to everyone who bleeds.

Journalling

Try it in the morning. I know, I know, you’ve got enough on your plate. If you can make the time, just give a couple of pages of stream-of-consciousness rambling a crack. You’ll be surprised how much stress you’re bursting into the morning with. Let it out, let it go, breathe, focus on your day. Sometimes journalling at night can bring your attention back to the stress of the day. If that’s why you don’t currently journal, give the morning a try. I love journalling myself, and I’m a big advocate of doing it earlier in the day to ease your mind long before bed time.

Perimenopausal anxiety can bring up old emotional stuff too, or exacerbate other mental health issues, so finding somewhere to let it all out can help.

Acupuncture

This traditional Chinese medicine practice can help regulate hormones, reduce stress, and improve overall well-being. I have not personally had much success with acupuncture to treat perimenopause, but some swear by it, so give it a go if you have a good practitioner in your area.

Lifestyle Modifications

If you’re here you’ve probably read a thousand AI-produced articles with these ideas to help with perimenopausal anxiety, so I’m not going into them in much detail. But if you’re new to the research, here they are:

• Healthy Diet: A balanced diet rich in whole foods, lean proteins, and healthy fats can help stabilise blood sugar levels and manage weight. Avoid processed foods and excess sugar, and eat foods that help reduce inflammation. Make sure you’re getting a lot of iron and omega 3. You know the drill, except it matters more now with perimeno on the scene.
• Yoga: lovely gentle yin yoga practices can be sooooo good for the body, mind and soul. Find some online when you’ve got that crazy feeling- I like ‘yoga with Adriene- and just do it. Try Yoga for Mood Swings or Nervous System Regulation. Or Jessamyn Stanley’s Plus Size Yoga | Beginner Friendly | Lower Back Pain might be more your thing.
• Regular Exercise: This might sound shocking, but I don’t get a lot of mental health benefit from exercise. Yes, I enjoy a bike ride, yoga, swimming, walking in nature, and I like to feel strong. But it’d be disingenuous of me to say exercise is the solution to all your perimenopausal anxiety issues (and annoying if you already know you don’t have ‘that’ amazing response to exercise). However the research, of course, backs up getting that body moving and it is definitely not a bad thing. For some it’s the miracle they need to get past perimenopausal anxiety. Physical activity, particularly strength training and cardiovascular exercises, can improve insulin sensitivity, reduce stress, and boost endorphins.
• Stress Management: Practices like yoga, meditation, journalling and mindfulness can help manage stress levels. Even something as simple as a daily walk or spending time with friends can make a significant difference.
• Vitamin D: Get yourself into the sun, beautiful! I’m convinced we slather on waaaay too much sunscreen these days, as well as spending all our time indoors. Vitamin D is best absorbed through the skin, and getting enough can sometimes mean the difference between feeling slightly bummed VS curled up in the corner shaking with perimenopausal anxiety. If you don’t have access to natural light, you could invest in a quality SAD lamp.

How long does perimenopause anxiety last?

Embrace the Journey

By staying informed, prioritising your health, and seeking support when needed, you can take control of your hormonal health and thrive through these changes. Embrace the journey, and remember that each phase of life brings its own unique strengths and opportunities. This sux, but there’s no point wishing 10-odd years of your life away, or yearning for a younger self you can never be.

Try to pull back a little from asking questions like ‘how long does perimenopause anxiety last?’ and lean into things that maybe you can answer. The things you can take action on.

I know that sounds like a load of wank when you’re going through hell with perimenopausal anxiety and her mean and confusing sisters, but all phases of your life really are special. Don’t rush through, waiting for this crap bit to end, because it might be the ticket to understanding yourself for the entire next half of your life.

Further reading on perimenopausal anxiety and other related hormonal changes

NOTE: I’m a Bookshop.org affiliate, the online retailer that supports independent bookstores in the USA and UK. If you click on these links, I may earn a small commission from them.

What Fresh Hell is This?

By Heather Corinna

This is the most inclusive book about perimenopause on the market I reckon. Corinna is American and nonbinary, combining their experiences with helpful research. They don’t hold back, so you get the raw, the real and the shockingly honest. This book helped me decide it didn’t ‘matter’ if it is or it isn’t perimenopause, I just related to some of the struggles Corinna describes, and then leaned into taking care of myself.

All Fours

By Miranda July

A fictional option. This story about a 45 year old woman’s unplanned road trip will have you in stitches. July is a freakin’ genius- smart, insightful, absurd, hilarious. If you’re more into straightforward narratives about grounded folk, this one is not for you. But if you’re willing to take a trip into the wild and unusual, this unhinged adventure of sexual liberation will speak to you. How long does perimenopause anxiety last? As long as the ride does.

Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond

By Rachel Lankester

So this is more about mythbusting ageist views and embracing your later years, but with a plan. Lankester, American, opens by explaining that she entered (diagnosable) perimeno at age 41, when she’d been hoping to have another baby. Devastated at the time, she’s now sharing her story of embracing age to help others. She also has a podcast. I read somewhere that she’s a bit sweary, but that doesn’t bother me.

The Definitive Guide to the Perimenopause & Menopause

By Dr Louise Newton

This one if a bit of must-have, from the positive responses. It does what it says on the label, and is an excellent guide not just for folks who bleed, but everyone (including doctors and health professionals who treat perimenopause). Newton is one of the UK’s leading experts on menopause, so you can’t really go wrong with this book if you just want the dang information.

Where Did My Libido Go?

By Dr Rosie King

Dr Rosie King is a popular Australian personality who dishes out lots of accessible info on how to have great sex. While this book isn’t about the perimenopause, it seems many folks have found it really useful when going through changes that mean their sex-drive takes a dive. Several reviews said ‘me and my partner are using these exercises…’ which I like to see, because it means it’s an ‘our’ thing, not a ‘me’ thing to address.

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Thanks for reading. You are more than welcome to add your own perimenopause story and juicy tips in the comments below. And if you have a personal answer to this question: ‘how long does perimenopause anxiety last?’ then PLEASE SHARE!

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1st image by engin akyurt on Unsplash; 
2nd image diagram from Jennis; 
3rd image by Fuu J on Unsplash;
4th image by Motoki Tonn on Unsplash; 
5th image by AllGo on Unsplash