Audrianna J. Gurr

July 3, 2025

Understanding Anxiety in Perimenopause: You're Not Alone

If you’ve ever felt like anxiety came out of nowhere—or that it intensified during certain chapters of your life—you’re not alone.

I’ve been there too.

After experiencing multiple pregnancy losses and finally welcoming my first child, I thought I’d feel nothing but relief and joy. But instead, I found myself spiraling with anxiety. It wasn’t just worry—it was relentless.

“Moments of love... and silent fear.” - Even surrounded by love, joy, and milestones, anxiety had a way of creeping into everyday moments. I look back on this photo with tenderness and deep compassion for my younger self.

I had what I now recognize as a touch of postpartum OCD and a full experience of postpartum Generalized Anxiety Disorder (GAD). I spent countless hours checking SIDS statistics, terrified that something awful might happen to my baby. Even more distressing were the intrusive thoughts—vivid, graphic mental images that felt almost real, playing out my worst fears in my mind. I felt ashamed, frightened, and emotionally drained from fighting an invisible battle inside myself every single day.

And here’s the part that still surprises me: I was a licensed mental health provider at the time… and I didn’t recognize what was happening to me.

There wasn’t nearly enough conversation or education about postpartum anxiety back then. I thought I was losing control, and I didn’t know how to ask for help—or that help even existed for what I was experiencing.

Eventually, with the support of therapy and (for a time) antidepressant medication, I began to heal.

Why I Now Focus on Women’s Midlife Mental Health

That experience stayed with me. It became one of the reasons I chose to specialize in women’s mental health, particularly focusing on the often-overlooked challenges of both perinatal and perimenopausal mental health.

Now, in midlife, as I navigate perimenopause myself and work with women going through these hormonal transitions, I see the patterns so clearly. Life stage plus hormonal shifts equals real emotional vulnerability.

At the 15th European Congress on Menopause and Andropause in Spain this May, I sat among healthcare providers hearing experts speak openly about how common anxiety is for women in midlife, especially during perimenopause. It was validating to hear what I’ve witnessed clinically—and lived personally—finally getting more global attention.

So today, I’m sharing both what I learned at the Congress and what I wish I’d known years ago: This kind of anxiety isn’t weakness. It’s not a personal failure. It’s a biologically driven, emotionally complex experience—and you deserve support.

“Smiling on the outside, struggling on the inside.” - This photo was taken during a time when I was battling intense postpartum anxiety and intrusive thoughts—but you wouldn’t know it just by looking.

Why Anxiety Can Intensify During Perimenopause

Hormonal shifts in estrogen and progesterone affect key neurotransmitters like serotonin and GABA, increasing vulnerability to anxiety.

Common Causes of Anxiety in Women:

Hormonal changes
Demands of modern life
Excessive stress
Childhood neglect or trauma
Family history of mental illness

Recognizing the Symptoms of Perimenopausal Anxiety

When Anxiety Becomes a Disorder: GAD in Focus

GAD Symptoms Include:

Excessive worry
Fatigue
Muscle tension or aches
Restlessness
Difficulty concentrating
Irritability
Sleep disturbance

The Real-World Impact

Unmanaged anxiety can negatively affect quality of life and work performance. It often co-occurs with conditions like depression, somatoform disorders, personality disorders, and substance abuse.

Is Mindfulness-Based Stress Reduction (MBSR) Effective?

A 2023 study by Huang et al. found a positive correlation between the severity of menopausal symptoms and the severity of anxiety. MBSR was shown to alleviate anxiety symptoms, although the study had limitations (small sample size and single-center design).

Reference: Huang S, et al. Anxiety disorder in menopausal women and the intervention efficacy of mindfulness-based stress reduction. Guangdong Medical / Am J Transl Res. 2023.

Closing Thoughts

“Hiding in plain sight.” - Even surrounded by love, joy, and milestones, anxiety had a way of creeping into everyday moments. I look back on this photo with tenderness and deep compassion for my younger self.

If you’re finding yourself more anxious lately—whether it’s persistent worry, irritability, panic attacks, or intrusive thoughts—you’re not alone.

Hormones, life stress, trauma history… it all plays a role. But more importantly: healing and support are possible.

There are evidence-based treatments that can help, whether that’s therapy, medication, mindfulness practices, or a mix of all three.

If you want to share your experience, or if you have questions, just hit reply.

We don’t have to go through this alone.

With care and understanding,
Audrianna Joy

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