Panic attacks and perimenopause

10 Things To Know About Panic Attacks and Perimenopause

Are Panic Attacks and Perimenopause a Thing?

Perimenopause is characterized by hormonal fluctuations that can profoundly affect both your physical and mental well-being. It’s not uncommon for you to experience increased anxiety in perimenopause. During this time some may also experience panic attacks. According the the online menopause clinic, Stella:

  • 1 in 4 women experience anxiety symptoms during menopause, including panic attacks.
  • For many women, they’ll experience a panic attack for the first time in their life during the menopause.

While panic attacks aren’t often listed as a symptom of perimenopause, anxiety is widely acknowledged to be one of the menopause transition’s more sinister symptoms. Erratically fluctuating hormones as a result of your changing ovarian function can lead to any of the 30+ recognized symptoms, including new or increased anxiety and even panic attacks.

We’ve pulled together the 10 things you need to know about panic attacks and Perimenopause. Let’s dive in.

1. What Is a Panic Attack?

A panic attack is defined as an episode of intense fear with severe physiological reactions; things like crying, dizziness, heart pounding uncontrollably, inability to catch your breath, hot flashes, and nausea. Often accompanied by an impeding sense of doom, it can feel like you are having a heart attack or even dying. On the anxiety spectrum panic attacks are at the top in terms of severity. Panic attacks may be expected, like when you encounter a feared object or situation. They can also be completely unexpected with no apparent cause or trigger.

2. Panic Attack Symptoms

According to the Mayo Clinic, symptoms of panic attacks can include:

  • Sense of impending doom or danger
  • Fear of loss of control or death
  • Rapid, pounding heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath or tightness in your throat
  • Chills
  • Hot flashes
  • Nausea
  • Abdominal cramping
  • Chest pain
  • Headache
  • Dizziness, lightheadedness or faintness
  • Numbness or tingling sensation
  • Feeling of unreality or detachment

The symptoms experienced during a panic attack vary from person to person. Typically they are very short in duration with symptoms peaking after a few minutes. And while they aren’t life threatening, they can be very scary.

3. Panic Attack vs. Anxiety

Characterized by feelings of tension, apprehension, and self-doubt, as well as physical changes like sweating and increased blood pressure, anxiety is in fact beneficial. It helps us identify dangerous situations and react accordingly. Anxiety is how we respond to feeling stressed, under pressure, or threatened. It can make you more alert, motivated, and better able to problem solve. However, for some this emotion can become chronic and negatively affect your well-being.

A panic attack is a severe form of anxiety that happens very suddenly and typically resolves within minutes. You may never experience a panic attack, or perhaps only one or two in your lifetime due to a major stress. And once that stress is resolved, the panic attacks stops. For some people both anxiety and panic attacks can become persistent and problematic.

4. What Are Anxiety Disorders?

Anxiety is a normal reaction to stressful events. While we all get stressed or anxious from time to time, most of us recover when the trigger or stress is resolved. But sometimes anxiety endures. And rather than being protective or useful, it’s frequency and intensity negatively impacts our daily life. When anxiety becomes uncontrollable it may be a sign of an anxiety disorder. Examples include:

Generalized Anxiety Disorder (GAD): Persistent and excessive worry that interferes with your daily activities is the defining characteristic of GAD. This worry is out of proportion with your actual circumstance and can’t be controlled. Physical symptoms may also present with this disorder. Sufferers may experience restlessness, irritability, fatigue, difficulty concentrating, muscle tension, or problems sleeping.

Specific Phobias: If you experience excessive and persistent fear of a specific object, situation, or activity that isn’t generally harmful, you likely have a specific phobia. You may go to great lengths to avoid what you fear due to the level of distress it causes. Fear of flying, enclosed spaces, and spiders are all examples of phobias.

Panic Disorder: This anxiety disorder involves multiple unexpected panic attacks. Unexpected is a defining characteristic of a panic disorder, where the attacks don’t have a specific trigger and come on without warning. In addition to frequency and not having a specific trigger, a panic disorder would also involve ongoing worry about having another panic attack. Having a panic attack does not mean you will develop a panic disorder.

According to a study published in Focus, A Journal of the American Psychiatric Association, ‘women experience markedly greater prevalence of anxiety disorders than men, including generalized anxiety disorder (GAD), panic disorder, and specific phobias’. In fact women are twice as likely to be affected by these disorders than men. For many women anxiety disorders happen during periods characterized by hormonal fluctuations like pregnancy and postpartum, as well as perimenopause. Even women with low levels of anxiety are likely to experience an increase in anxiety symptoms during the menopausal transition.

5. What Do Panic Attacks Feel Like?

In addition to being very scary, they are also exhausting. The memory I have of my one and only panic attack is vivid. While there was obvious stress, the sudden feelings I had made no sense. Uncontrollable crying happened instantaneously. I felt dizzy and was having trouble walking. Eventually I had to lean against a wall because I was afraid I was going to fall over. My heart was pounding so hard it felt like it was going to jump out of my chest. There is a vivid sensation of overheating when I remember this episode. I was shaking. It didn’t last long, maybe 3 minutes. However the effects lingered for hours; shaken, unable to think clearly, and extreme fatigue persisted.  I didn’t know it at the time, but in hindsight, I was indeed in perimenopause.

6. Are Panic Attacks a Symptom of Perimenopause?

According to The Menopause Society, ‘few scientific studies support the idea that menopause contributes to true clinical depression, severe anxiety, or erratic behavior’. And most women transition into menopause without experience a major mood disorder. However, studies do show that mood changes such as anxiety, nervousness, panic, and worry are reported more frequently once a women enters perimenopause.

It’s important to note that the cause of these increased mood symptoms is complex. More research is needed to understand hormone-related mood variations. In addition to fluctuating hormones, there are many other factors that can lead to anxiety or even a panic attack during perimenopause. Relationship challenges, caring for children and/or aging parents, career pressures, aging, waning fertility, and perimenopause symptoms like trouble sleeping and hot flashes can all contribute to unprecedented levels of distress.

7. Panic Attacks and Hot Flashes

Hot flashes caused by changing hormones can feel like a panic attack. Intense heat on your face and upper body that comes out of nowhere, sweating, nausea, dizziness, heart palpitations, and feeling like you are going crazy. Sometimes the unsettling feelings that precede a hot flash can actually trigger a panic attack. Studies have shown that hot flashes increase the odds of having increased anxiety during perimenopause.

8. What Causes Panic Attacks?

What causes a panic attack to happen is not well understood. These factors are believed to play a role and increase your risk:

  • Genetics
  • Major stress or life changes
  • Past trauma
  • Being sensitive to stress or prone to negative emotions
  • Certain changes in the way parts of your brain function
  • Certain medications
  • Substance abuse
  • Excessive caffeine consumption
  • Smoking

9. What To Do During Panic Attacks

Remember that the feelings you’re experiencing won’t last and that panic attacks aren’t life threatening. Focus on your breathing. If you are able, try to use the 333 rule. This is a grounding technique where you focus on three things you can see, hear, and touch.

10. When To Get Help

If you are experiencing persistent anxiety and/or panic attacks, particularly ones that have no apparent trigger, get help. Constant worry, particularly about routine things, is a sign that you need help. So is worrying about having another panic attack. Left untreated, these challenges can spiral and have a significant impact on your quality of life. There are various management strategies and treatment options, like therapy and medications, that are effective. A qualified medical professional can help create a plan that works best for you.


The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.