Anxiety

What is actually happening

Progesterone breaks down into allopregnanolone, which acts on the same receptors in your brain that anti-anxiety medication acts on. It is, in effect, your body’s own calming chemistry — and in perimenopause it does not fall smoothly, it lurches. The drops are what you feel. Estrogen is also part of how serotonin is regulated, so both of the systems that hold mood steady are moving at once, and broken sleep lowers the threshold for all of it.

How common this is

Anxiety and mood symptoms rise measurably during perimenopause compared with the years before it, including in women with no history of either.

SWAN; The Menopause Society

If you try one thing

Gentle mobility

For the mornings when everything is stiff and strength training is not happening.

Not because you need to exercise. Because anxiety in a body is physical before it is anything else — the heart, the chest, the held breath — and slow movement is the fastest way to tell that system nothing is chasing you. It works inside the ten minutes rather than in six weeks, and it costs nothing.

Fifteen to twenty minutes of slow, controlled movement — hips, spine, shoulders. Follow along with a video rather than inventing a sequence; the decisions are the hard part.

Roll the mat out before you make coffee, so it is already waiting.

On a hard day: Two minutes of standing and reaching overhead, still in your pajamas.

The rest for this

• Magnesium glycinate

  The form of magnesium that calms rather than loosens. For nights that will not settle.

  Some women notice a difference the first week. Give it three before deciding. · about $8 a month

• Saffron extract

  One of the very few botanicals with antidepressant-level evidence in trials.

  Four to six weeks. Judging this one early is the most common mistake with it. · about $25 a month

What to say to a doctor

Bring the timing, not only the feeling: whether it clusters in the week before your period, and whether it started when your cycle changed. That pattern is what points at hormones rather than at generalized anxiety, and it changes what gets offered. Hormone therapy and low-dose antidepressants are both used here, and it is reasonable to ask about each by name.

Guía is not a doctor. This is what to bring so the appointment goes somewhere.

Living with this is hard on the people close to you, and explaining it is its own job.

Something else bothering you

• Can't sleep
• Hot flashes
• Night sweats
• Brain fog
• Low energy
• Mood swings
• Weight changes
• Joint pain
• Skin changes
• Hair thinning
• Low libido
• Irregular periods