Is it perimenopause or stress? It can be both, and a hard year hides perimenopause very well. The NHS names anxiety, low mood and mood swings among the symptoms of perimenopause and menopause, and they look a lot like the strain of a divorce, a heavy workload or a house full of teenagers. The best place to start is a record of how you feel, when, and what else was going on, kept over weeks and taken to your GP.
Key takeaways
- It can be both. A hard time in your life and perimenopause can arrive together, and the first hides the second.
- The NHS names anxiety, low mood and mood swings among the symptoms, and says poor sleep can make you feel ‘irritable, stressed and anxious’.
- NICE says GPs can diagnose perimenopause in otherwise healthy women over 45 from hot flushes or night sweats and irregular periods, without a blood test. Hormonal treatments can make it harder to tell.
- Sudden chest pain that does not go away needs a 999 call, whatever else is going on.
Perimenopause or stress? How to tell them apart
One bad day won’t tell you whether it’s perimenopause or stress. The two can bring the same feelings, and they feed each other. The NHS symptoms page says not being able to get to sleep or stay asleep ‘can affect your daily life’, and that ‘it can make you feel irritable, stressed and anxious’. So a hormonal change can feel a lot like stress.
The NHS says symptoms ‘usually last for 7 to 9 years, sometimes longer, and during this time they can change’. Our suggestion is to look at the weeks, not the days. If the anxiety is still there on the calm days, after the deadline or the hearing has passed, tell your GP, or go sooner if you’re worried.
Can perimenopause cause anxiety?
Yes. The NHS says hot flushes can ’cause palpitations or anxiety’, and that over time they ‘may improve and be replaced by other symptoms such as low mood and anxiety’. Women’s Health Concern, the patient arm of the British Menopause Society, says in its emotional wellness factsheet that ‘feelings of anxiety, low mood and difficulty concentrating are all common symptoms of menopause’.
On Mumsnet, women describe perimenopause anxiety for no reason they can name. One wrote that hers was ‘for no real reason if that makes sense?’.
The NHS symptoms page doesn’t mention panic attacks by name, but the Women’s Health Concern factsheet lists them among other emotional and cognitive symptoms. I had my first one before I knew I was perimenopausal, and I’ve written about it in why perimenopause is so often missed. My advice: tell your GP if you’re having them.
Why a hard year hides perimenopause so well
In 2017 I did a power pose in a toilet cubicle at the NEC. I was running a big competition over four days at The Photography Show and was due to speak on stage. In the middle of it all, I had to leave and drive to court for a hearing in my divorce.
Just before my talk I was so anxious and exhausted that I locked myself in a cubicle in the ladies’, planted my feet wide, put my hands on my hips, lifted my chin and pushed my shoulders back. I’d watched Amy Cuddy’s TED talk on power posing, and I needed every bit of help I could get. I remember thinking how ridiculous I must have looked, standing like Superman in a toilet cubicle.
I walked out, gave the talk and got through it. Afterwards I asked myself whether any of it was worth it. What I didn’t ask was whether something else was going on.
For at least two years I had an explanation ready: ‘It’s the divorce. It’s work. Teenagers.’ It explained the irritability, the nerves about speaking that had never been there before, and not being able to cope with life in quite the same way. I spent those years not feeling like myself, and I never once asked whether it was perimenopause or stress. It was always stress. Some of it was. But not all of it.
Two friends in the thick of perimenopause could see I wasn’t myself and guessed hormones long before I did.
Perimenopause irritability, anger and rage
The anger was the part I found hardest to explain. It came too quickly, over things that wouldn’t have bothered me five years earlier. Some women call it perimenopause rage, and the Women’s Health Concern factsheet lists anger and irritability among the emotional symptoms.
The NHS lists mood swings among the symptoms and links feeling irritable to broken sleep. Writing down what happened just before can show whether it follows the situation or turns up regardless.
How do I know if it’s perimenopause?
For many women over 45, a GP can tell from symptoms. NICE guidance says to diagnose perimenopause ‘without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms’, based on vasomotor symptoms (hot flushes and night sweats) and irregular periods. If you’re 45 or under, ask your GP how they’ll assess you.
The NHS says to contact your GP if ‘you think you have symptoms of menopause or perimenopause and want to know what your options are’. If you don’t have periods to go on, because of a hormonal coil or a hysterectomy, say so: NICE notes that ‘it can be difficult to diagnose menopause in women who are taking hormonal treatments’. There’s more on how to prepare for a menopause appointment.
What to track before you see your GP
I’ve learned that patients are bad historians, especially when they’re anxious and exhausted. Women’s Health Concern says ‘it’s useful to keep a record of symptoms to discuss with your healthcare professional’. Log things as they happen:
- how you feel, and how bad it is
- when it happens, and how often
- what else was going on: a bad night, a hard day at work, a row, alcohol
- physical symptoms such as hot flushes, night sweats and changes to your periods
After a few weeks you have a pattern instead of a blur. There’s more on why tracking symptoms over time makes a difference.
I still get a knot of anxiety in my chest some days, with no obvious cause. The difference now is that I don’t go looking for a reason. I tell Brent, ‘I’ve got that knot again’, and I get on with my day. For me it’s a knot of worry, not pain. If you ever have chest pain, don’t assume it’s anxiety: read the next section.
With TALIA you log symptoms in seconds, grouped by area. The Emotional & Cognitive group includes anxiety, irritability, feeling overwhelmed and panic or sudden intense fear, each rated mild, moderate or severe. You can tag possible triggers alongside, such as stress, emotional strain and work pressure, and see patterns between them over time. TALIA can’t tell you whether it’s perimenopause or stress. It keeps a record you can share with your GP, privately on your phone, and turns it into a report you can take to your appointment. Download TALIA for iPhone or Android.
When to get help straight away
The NHS chest pain page lists anxiety and panic attacks among the causes of chest pain, but don’t assume that’s what it is. The NHS says to call 999 if:
- you get sudden pain or discomfort in your chest that does not go away
- you get pain that spreads to your left or right arm, or your neck, jaw, stomach or back
- you have chest pain and you feel sweaty, sick, light headed or short of breath
If you need urgent help for your mental health, the NHS says to call 111 and select the mental health option, or ask for an urgent GP appointment. In Wales, call 111 and press 2. Call 999 or go to A&E if ‘you do not feel you can keep yourself or someone else safe’. Outside the UK, use your local emergency number.
Frequently asked questions
How can I tell if it’s perimenopause or stress?
Look at the pattern over weeks, not one bad day. Note how you feel, when, and what else was going on, along with physical symptoms such as hot flushes, night sweats and changes to your periods. It can be both at once, so take the record to your GP.
Can perimenopause cause anxiety and nothing else?
The NHS names anxiety among the symptoms of perimenopause and says symptoms can change over time. NICE’s diagnosis without tests for women over 45 is based on hot flushes or night sweats and irregular periods, so tell your GP about every change you’ve noticed, not just the anxiety.
Can HRT help with perimenopause anxiety?
NICE says to ‘consider CBT to alleviate low mood or anxiety that arise as a result of the menopause’ and to ‘consider HRT to alleviate low mood that arises as a result of the menopause’. Its HRT recommendation names low mood, not anxiety. Women’s Health Concern says HRT ‘can help with many cognitive and emotional symptoms of menopause’. Your GP can talk you through CBT and HRT.
Can a GP diagnose perimenopause without a blood test?
Yes, in many cases. NICE says GPs can diagnose perimenopause without laboratory tests in otherwise healthy women over 45 with menopausal symptoms, based on hot flushes or night sweats and irregular periods. If you’re 45 or under, or have no periods because of a coil or a hysterectomy, ask your GP how they’ll assess you.
Should I worry about a tight chest with anxiety?
Don’t assume it’s anxiety. The NHS says to call 999 if you get sudden chest pain or discomfort that does not go away, pain that spreads to your arm, neck, jaw, stomach or back, or chest pain and you feel sweaty, sick, light headed or short of breath. If chest pain comes and goes, see a GP.
Once I stopped explaining everything away, I was kinder to myself. TALIA keeps your symptoms, triggers and notes together in one record, and it stays on your phone. Download TALIA for iPhone or Android.
