Is It Anxiety or Perimenopause? How Hormones, Heart Palpitations, and Sleep Problems Interact and Mimic Each Other
If you are in your late 30s, 40s, or 50s and suddenly dealing with anxiety, heart palpitations, or 3 a.m. wake‑ups, you may be wondering: “Is this anxiety, perimenopause, or am I dying?”
Perimenopause—the transition leading up to menopause—is a time of wild hormonal fluctuation, and is a time when women can experience an increase of mood symptoms, sleep disturbance, and cardiovascular sensations like palpitations.
This post will cover:
How perimenopausal hormone changes affect anxiety and mood
Why heart palpitations and sleep problems are so common in this phase
When symptoms are a red flag that needs urgent evaluation
Evidence‑informed ways to support your nervous system while you seek care
How Perimenopause Affects Anxiety and Mood
During perimenopause, levels of estrogen and progesterone fluctuate tremendously and then gradually decline culminating in menopause (the ending of menstrual periods)
We know is that: Estrogen influences serotonin and dopamine, key neurotransmitters involved in mood regulation, and fluctuating or lower estrogen is associated with higher rates of anxiety and depressive symptoms. Progesterone and its metabolites have calming, GABA‑modulating effects in the brain, and declining progesterone can contribute to increased anxiety and difficulty self‑soothing. Large reviews and clinical observations (although limited) confirm that perimenopausal women have an increased risk of first‑onset or worsening mood and anxiety disorders compared with premenopausal women.
In real life these changes feel like:
New irritability or “short fuse” reactions
Waves of anxiety or panic that feel out of proportion to the situation or come out of nowhere
Feeling emotionally sensitive or “not like yourself”
These are not character flaws; they are driven by neurobiological changes interacting with real‑world stressors. And, we are currently living under unprecedented levels of stress.
Heart Palpitations in Perimenopause: Common, but Not Always Harmless
Heart palpitations—sensations of skipped, pounding, or racing heartbeats—are widely reported during the menopausal transition. If you’ve never had them, they can feel concerning and scary. Often they are described as:
Skipped or irregular beats
Sudden episodes of heart racing
Uncomfortable awareness of their heartbeat, sometimes paired with dizziness or chest discomfort.
Palpitations can be triggered or worsened by:
Hot flashes and vasomotor symptoms
Fluctuations in estrogen
Stress, caffeine, dehydration, or lack of sleep
Thyroid dysfunction and other medical conditions
Because cardiovascular disease is a leading cause of death in women, let me be clear: palpitations should not be dismissed as “just hormones” or “just anxiety” without a thorough medical evaluation. While they are uncomfortable much of the time palpitations are not a concern. However, they (and you) should not dismissed as “nothing to worry about” until they have been investigated.
Sleep Problems, Insomnia, and Night‑time Awakenings
Sleep disturbance is one of the most common complaints in the menopausal transition, with many women reporting difficulty falling asleep or frequent nighttime awakenings. This is often one of the first symptoms. It is very common for women to report wakings at 2-4am with difficulty falling back asleep and daytime fatigue/brain fog/mood changes.
Evidence from the SWAN study shows what women already know:
Perimenopausal and postmenopausal women have higher rates of insomnia symptoms than premenopausal women.
Vasomotor symptoms (hot flashes and night sweats) are strongly associated with poor sleep quality and nighttime awakenings.
Newer research also links sleep problems and stressful life events to an increased risk of atrial fibrillation in postmenopausal women, underscoring that sleep is not just a comfort issue but a cardiovascular one. Tying together hormones, sleep, heart health and mental health.
When Anxiety and Palpitations Are Red Flags
Because symptoms of anxiety, perimenopause, and heart disease can overlap, it is important not to self‑diagnose (I know. Easier said than done and you may have already diagnosed yourself with something catastrophic…Take a deep breath)
Seek urgent or emergency medical care if you experience:
Chest pain or pressure, especially with shortness of breath, sweating, nausea, or radiation to jaw/arm
Sudden severe shortness of breath or difficulty breathing
Fainting or near‑fainting episodes
New severe headache with neurologic changes (e.g., trouble speaking, weakness, visual loss)
Arrange a prompt, non‑emergent medical visit if you notice:
Recurrent or worsening palpitations
New or severe anxiety or panic interfering with daily life
Persistent insomnia or sleep disruption
Mood changes that impact work, relationships, or ability to function
Trust yourself that your symptoms are “all in your head”— an thorough evaluation is needed you rule out dangerous conditions and identify treatable contributors such as thyroid disorders, sleep disorders, arrhythmias, or major depression.
Evidence‑Informed Ways to Support Your Nervous System
While you are pursuing proper evaluation, there are lifestyle strategies that can support your nervous system and symptom management. These do not replace individualized medical care, but they can be helpful adjuncts.
Breathing and relaxation techniques Psychological and behavioral interventions such as relaxation training, cognitive‑behavioral therapy (CBT), and mindfulness‑based approaches have shown benefit in reducing stress and anxiety in midlife women.
A simple practice is slow, paced breathing (for example, inhaling for about 4 seconds and exhaling for about 6 seconds) to activate parasympathetic tone.
Blood sugar and nutrition: Dysregulated blood glucose can worsen anxiety symptoms and sleep quality. At Wild Heart and Renegade Health we use balanced meals (protein, fiber, complex carbohydrates) and regular exercise to reduce large glycemic swings.
Sleep hygiene and hot flash management: Addressing hot flashes, minimizing evening caffeine and alcohol, and keeping a consistent sleep schedule are all part of evidence‑informed insomnia management in midlife.
Professional support for mood : Evaluation and treatment for mood and anxiety symptoms at any stage may include psychotherapy, medication when indicated, and, for appropriate candidates, hormone therapy as part of a broader risk‑benefit discussion. Major shout out to therapists, you’re doing amazing work.
You Are Not Imagining It
Without a doubt, perimenopause can increase the risk of anxiety, palpitations, and sleep problems, especially when layered onto a stressful life. And all of these issues can be triggered by or exacerbated by any of the others.
Your symptoms are real signals coming from a nervous system and cardiovascular system that are adapting to major hormonal and life changes. You deserve a careful medical evaluation, compassionate explanations, and a plan that addresses both body and mind.[pmc.ncbi.nlm.nih]
If this resonates with you and you want an integrative, hormone‑informed perspective on what you are experiencing, working with a clinician who understands perimenopause can make a meaningful difference.