Female Anxiety - A Functional Medicine Approach

In my practice women ask me regularly:
‘Why Does My Anxiety Get Worse Before My Period or During Perimenopause?’

You feel absolutely fine for most of the month.

Then suddenly, you're anxious.

You're overthinking things you wouldn't normally give a second thought to. You're more emotional, less resilient, perhaps struggling to sleep or waking with that horrible feeling of anxiety already sitting in your chest.

And then, a few days later, your period arrives.

Or perhaps you're in your late 30s or 40s and you've started noticing something similar, but there doesn't seem to be a predictable pattern anymore.

You just don't quite feel like yourself.

If this sounds familiar, your hormones may be part of the picture.

But they're probably not the whole picture.

The relationship between hormones and anxiety

Hormones are chemical messengers carrying information around the body.

They are constantly communicating with our brain, nervous system and immune system.

During the second half of the menstrual cycle — known as the luteal phase — progesterone rises after ovulation and then falls before your period.

Progesterone and some of its metabolites interact with the brain's GABA system, which plays an important role in feelings of calm and nervous system regulation.

At the same time, oestrogen is changing too.

Oestrogen interacts with several of the chemical systems involved in mood, including serotonin and dopamine.

For some women, these hormonal shifts can noticeably change how they feel.

You might experience:

Anxiety or a feeling of impending doom
Racing thoughts
Irritability
Feeling much more emotional
Reduced tolerance for stress
Difficulty sleeping
Palpitations
Brain fog
Fatigue
Feeling overwhelmed by things you'd normally cope with

Then your period arrives, your hormones change again, and suddenly you feel more like yourself.

And then there's perimenopause...

Perimenopause can make this relationship even more noticeable.

One of the misconceptions about perimenopause is that your hormones simply begin to decline in a nice, predictable way.

They don't.

Hormone levels can fluctuate considerably during this transition.

And for some women, anxiety is one of the first things they notice.

I've spoken to women who have spent their entire lives considering themselves calm and resilient, only to suddenly find themselves experiencing anxiety, disrupted sleep or feeling unable to cope with the same amount of stress.

Sometimes they don't initially connect those changes with perimenopause at all.

But I don't think we should only look at hormones

From a functional medicine perspective, one of the questions I find much more useful is:

What else is happening in the body that could be making these hormonal fluctuations harder to tolerate?

Think of your hormones as the messenger and your nervous system as the receiver.

If the receiver is already struggling, the message can feel much louder.

Quite simply, any challenge to the body (emotional or physical) is stress for the body. Poor sleep, blood sugar instability, nutrient deficiencies, inflammation and digestive health can all influence how resilient we feel.

That's why two women experiencing similar hormonal changes can have completely different symptoms.

And it's also why simply being told "it's your hormones" isn't particularly helpful.

There is much more we can explore.

Your blood sugar might be contributing too

One area I look at is blood sugar regulation.

If you're skipping meals, eating too little protein or relying heavily on caffeine, your blood glucose can fluctuate considerably throughout the day.

When blood sugar drops, the body has mechanisms designed to bring it back up — including the release of stress hormones.

If you're already more sensitive to stress during the luteal phase or perimenopause, this can sometimes feel remarkably similar to anxiety.

You may feel shaky, irritable, light-headed, wired or suddenly overwhelmed.

This is why some of the simplest changes — such as eating regularly and including enough protein — can make a surprising difference for some women.

There's another piece of the puzzle you might not have considered

Histamine.

Most people associate histamine with allergies.

But histamine does far more than make your nose run during hay-fever season. It also acts as a signalling molecule within the body and brain.

There is an interesting relationship between histamine and female sex hormones, and some women notice symptoms such as headaches, flushing, digestive problems, palpitations, poor sleep or anxiety alongside their hormonal changes.

This doesn't mean everyone experiencing hormonal anxiety has a histamine problem.

But when we look at the body as interconnected systems rather than individual symptoms, it gives us more places to investigate.

So what can you actually do about it?

This is the important part.

There isn't one supplement that every woman experiencing hormonal anxiety should take.

And I don't believe there should be.

Everybody is different, and everybody’s body is different. There may be nutritional or medical factors worth discussing with your healthcare practitioner.

There are, however, supplements and adaptogenic herbs that may be useful for some women.

But natural doesn't automatically mean safe or appropriate.

For example, ashwagandha can lower blood pressure in some people. Some herbs and supplements can interact with antidepressants and other medications.

The aim isn't to take everything.

It's to understand your body well enough to make more informed choices about what you might need.

I've put everything together for you

I've created a free Luteal Phase & Perimenopausal Anxiety Guide to help you understand what's happening in your body and start identifying your own patterns.

Inside, I go much deeper into:

Why anxiety can change throughout your menstrual cycle
What happens during perimenopause
The relationship between your hormones and nervous system
Blood sugar, nutrition and lifestyle foundations
Histamine and hormonal symptoms
Supplements and adaptogens that may help
Important supplement and medication considerations
Tests worth discussing with your healthcare practitioner
When symptoms warrant speaking to your GP
A symptom and menstrual cycle tracker
A personal plan to help you work out your next steps

Most importantly, I've included practical tools to help you stop guessing and start noticing what your body is telling you.