Panic & The ‘Pause
You know that sudden jolt of panic—like when you’re convinced you left the iron on, only to remember you don’t even own an iron? That kind of irrational, out-of-nowhere fear is a surprisingly common experience during perimenopause. And no, it’s not all in your head.
Welcome to the rollercoaster of hormonal changes. As estrogen and progesterone begin their unpredictable dance, you might find yourself feeling anxious or overwhelmed with no clear trigger. For some, these moments pass quickly. For others, they escalate into panic attacks that feel like they come out of nowhere—and stay longer than welcome.
So, what’s really happening?
Let’s start with estrogen. This hormone helps regulate the production of serotonin, one of the key neurotransmitters that stabilizes mood and keeps anxiety in check. When estrogen levels drop, serotonin levels can dip too, making your emotional baseline more sensitive and your stress response more reactive.
Then there’s progesterone, which has a natural calming effect on the brain. Think of it as your body’s built-in chill factor. When progesterone declines or swings, that soothing balance disappears, leaving you more vulnerable to tension, worry, and the kind of nervous energy that can spiral into panic.
For some women, these changes cause mild but noticeable anxiety. For others, the shifts can trigger deeper physical symptoms like racing thoughts, tightness in the chest, difficulty breathing, or panic attacks that feel completely disconnected from the moment.
There’s something else worth noting. Research shows a link between panic attacks during menopause and a slightly increased risk of cardiovascular events such as heart attacks or strokes. That doesn’t mean every panic attack is dangerous—but it does highlight the importance of speaking to a healthcare professional, especially if your symptoms are new, frequent, or feel severe.
The good news? There are effective ways to support both your body and mind through this phase. You don’t have to simply grit your teeth and get through it.
Just Breathe.
One of the simplest and most immediate tools is breathwork. Slow, intentional breathing helps regulate the nervous system and can shift your body out of panic mode. A simple technique: inhale for four counts, hold for four, and exhale for six to eight counts. Repeat this for a few minutes and you may feel your system begin to settle.
Clear Your Thoughts.Mindfulness and meditation are also powerful tools. These don’t have to be complicated or time-consuming. Whether you sit quietly, listen to nature sounds, follow a short guided session, or take a slow walk with intention, carving out small moments of stillness can help re-center your mind.
Talk About It.If you’re finding it hard to cope on your own, working with a therapist can be incredibly valuable. A good therapist can help you identify patterns, reduce anxiety triggers, and develop practical strategies to navigate the emotional ups and downs of hormonal shifts. More importantly, they can help you feel supported—and remind you that what you’re going through is both real and manageable.
Hormones.Hormone replacement therapy (HRT) may also be worth considering. By supplementing estrogen and progesterone, HRT can help restore balance to your brain chemistry. This isn’t a one-size-fits-all solution, but for many women, it can significantly reduce both emotional and physical symptoms.
Medication.In some cases, medication may be the right choice. Anti-anxiety or antidepressant medications can help regulate mood and ease persistent symptoms. These treatments don’t mean you’ve failed or that you’re not coping—they’re tools designed to help your brain function at its best during a challenging time.
Perimenopausal anxiety and panic are more common than many people realize. And while it can feel frightening or isolating. With the right combination of self-care, medical guidance, and emotional support, it’s entirely possible to find your footing again.
Kelly Rigo is the creative force behind Menopause Evolution.