The Anxiety Nobody Told Us Was Hormonal

In 2019, I had a panic attack on live television. Heart racing, words gone mid-sentence, had to leave in the middle of a newscast. My doctor told me it was stress, suggested meditation and yoga, and never once asked about my hormones.

I did not know that was the wrong answer, and I spent the next several years managing symptoms that had a name I was never given.

This is not an unusual story. 

Almost half of all women who go looking for help with hormone-related symptoms report having a negative experience. 29% of women between 18 and 64 say they have been dismissed by their doctors. Most of them heard some version of what I heard. “It is just stress.” “Try to calm down.”

Here is what none of those doctors explained…

Two hormones do most of the work on your mood, and when they drop things get hard fast.

Estrogen is fuel for your brain. When it is there you feel resilient, sharp, capable. When it drops your brain has less to run on and what used to feel manageable starts to feel impossible. Estrogen is also tied to serotonin. When estrogen drops serotonin drops with it. That is where the low-grade dread comes from. 

Progesterone is your calming hormone. It binds to the same receptors in your brain as anti-anxiety medication. When it drops, that calming effect goes with it. You wake up at 3am with your heart racing and you cannot settle your nervous system no matter what you try.

Here is the part that changed everything for me: progesterone is one of the first hormones to drop in perimenopause. Often years before hot flashes start. So you can be in your late 30s or early 40s feeling anxious and not yourself and nobody connects it to your hormones because from the outside nothing looks wrong yet.

Women are twice as likely as men to suffer from panic disorder. A significant portion of that gap shows up specifically in the perimenopause years.

Here’s what it actually looks like…

Anxiety in midlife does not always look like a panic attack.

Sometimes it looks like avoidance. Quietly stopping doing things you used to do without thinking twice. I had not driven my car in LA for years without fully realizing why. Thousands of women told me the same thing. Avoiding driving, flying, events, plans. Your nervous system telling you something is not safe even when logically nothing has changed.

Sometimes it looks like rage. Patience evaporating. Things that would not have registered before setting you off immediately. Snapping at people you love and then feeling terrible about it which makes everything worse.

Sometimes it looks like morning dread. Waking up before your feet hit the floor with a feeling that something is wrong but you cannot name it.

Sometimes it looks like brain fog that feeds the anxiety. You forget a word in a meeting and instead of brushing it off your whole nervous system spikes.

None of it felt like anxiety to me… it just felt like life.

What you can actually do about it…

1. Hormones first because they are the option most likely to get skipped.
2. Bioidentical progesterone is often the missing piece for the anxiety side specifically because of the calming effect it has on the brain and the way it allows you to actually sleep without your thoughts spiraling. Estrogen addresses the mood side, the serotonin piece, the low-grade dread. Most menopause specialists prescribe both together.
3. SSRIs have a place. They are not the wrong answer, but they are often the wrong first answer when hormones have not been part of the conversation. Sometimes hormone therapy alone is enough. Sometimes you need both. The critical thing is that the hormone conversation has to happen first.
4. Therapy, specifically CBT and EMDR. Cognitive behavioral therapy teaches you to catch the anxious thought loops, examine which ones are actually true, and interrupt the spiral. It is practical, skills-based, and well-researched for this type of anxiety.
5. EMDR, eye movement desensitization and reprocessing, is something I did when old experiences came back to the surface in ways I was not expecting. Hormonal changes can pull things out of your nervous system that you thought you had already processed. EMDR helps your brain file those memories differently so they stop hijacking you. The science is real and for trauma-based anxiety it is remarkably effective.
6. Exercise moves anxiety through your body in a way nothing else does. A walk is enough. Magnesium glycinate can help with sleep and the low-grade background hum. Sleep is the foundation under everything else. Alcohol and caffeine both amplify anxiety more than most people realize after 40.

How to talk to your doctor…

Come with a symptom log. When did they start, what time of day are they worst, how often are they happening. Specific data is harder to dismiss than a general feeling that something is off.

Ask specifically whether bioidentical progesterone could help, especially if anxiety, racing thoughts, and night waking are your biggest symptoms. Ask about estrogen if mood and dread are the primary issues. Ask for your hormones to be checked.

If you have been on an SSRI and still do not feel right, bring that up. The conversation needs to stay open.

If your doctor tells you it is just stress and will not engage with the hormone conversation, find a different doctor. The Menopause Society has a provider search for certified specialists. Telehealth platforms like Midi Health are also an option if access is a barrier.

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When I finally understood that what I was experiencing was hormonal, that there was a biological reason for it, that I was not failing or broken, something released. The shame went down and the fear went down. Not all of it, but enough that I could actually start doing something about it.

You are not making this up, you are not alone, and you do not have to keep suffering through something that has real options.

Listen to Anxiety 101: What I Wish I Knew Before I Hit Perimenopause + How I Got My Life Back here or you can watch it here.