Perimenopause can be a confusing time can’t it? One minute you’re getting on with your day and the next you’re convinced a headache means something catastrophic, your heart is beating like you’ve just run a marathon despite the fact you’ve been lying in bed Googling “why does my left eyebrow feel weird?” at 2am, because who needs sleep anyway, right?
It’s a hormonal rollercoaster that nobody really prepares women for.
A lot of women come to therapy during perimenopause feeling scared of their own bodies. They will often say things like, “I don’t recognise myself anymore,” or “I feel like I’m constantly waiting for bad news.” Believe me, I hear you! Perimenopause and menopause can create the perfect conditions for health anxiety to quietly sneak in, pull up a chair and make itself comfortable and it’s really very good at convincing you there’s something wrong, especially when you’ve asked Google and ChatGpt and they seem to have both confirmed your fears. Actually, have they? Or are you interpreting what you read in that way, because you have already decided there must be something wrong?
Sometimes we need a reality check or a bit of science to gain some perspective. Hormones play a huge role in our emotional regulation, how we respond to stress, sleep quality, memory (or lack of!), and anxiety levels. Oestrogen doesn’t just affect periods and turn on the hot flushes, it also influences neurotransmitters like serotonin and dopamine. So when our hormones start fluctuating, the nervous system can feel more reactive, sensitive, and unpredictable. Our bodies suddenly feel louder. We notice things more. Every ache gets your attention, every symptom feels suspicious and every sensation becomes a potential “what if?”
Unfortunately, perimenopause is also the phase of life where bodies genuinely do start changing. Sleep changes, weight changes, energy changes, breasts change, digestion changes, skin changes. Your joints suddenly sound like a bowl of Rice Krispies, snap, crackle and pop, when you stand up. Is it any wonder we send ourselves stir crazy worrying about what is going on in our bodies? It can become difficult to know what is a “normal” hormonal shift and what needs checking medically. That uncertainty is often where health anxiety grows.
The brain hates uncertainty. It would much rather catastrophise than sit calmly in the unknown. So it starts scanning, monitoring, Googling, double checking and reassuring itself temporarily before finding a new thing to worry about three hours later.
Quite frankly, it’s exhausting.
There’s also a bigger emotional layer to this stage of life that often gets overlooked. Perimenopause can bring women face to face with ageing, identity shifts, children growing up, caring responsibilities, grief, relationship changes, or worries about parents becoming older. Sometimes health anxiety isn’t only about fear of illness, it’s sometimes about fear of vulnerability, loss of control, or the realisation that we cannot completely protect ourselves from life.
Cheery little topic, isn’t it?
Genuinely though, it’s really important to understand that health anxiety during menopause is not you being dramatic, or irrational. Your body is changing in noticeable ways while your nervous system is more sensitive than usual. That combination can make you hypervigilant very quickly.
Of course, it’s still important to get symptoms checked medically. Please don’t read this and decide your newly found mysterious lump, chest pain, or persistent symptom is “just hormones.” Health anxiety and genuine health concerns can exist together and getting reassurance from the right medical professionals is very important.
The difficulty comes when that reassurance never lasts. You get the all clear, feel calmer for approximately 5 minutes, and then your brain says, “Yes, but what if they missed something or they got it wrong?” Health anxiety tends to work like a faulty smoke alarm. It’s trying to protect you, but it becomes over-sensitive and starts reacting to burnt toast instead of actual fire. One of the most helpful things can be learning how to calm the nervous system rather than trying to “think” your way out of anxiety, because when the nervous system is activated, your ability to apply logic often leaves the building entirely. This is why telling yourself “I’m probably fine” rarely works when you’re spiralling at midnight while poking your lymph nodes for the umpteenth time.
Getting good quality sleep, moving your body, reducing stress overload, engaging in therapy, practicing mindfulness, using breathing techniques, reducing compulsive Googling, and learning to tolerate uncertainty can all genuinely help. So can simply talking openly about it to friends, peers, the woman next to you in the supermarket (well ok maybe not, but you get the idea). So many women quietly believe they’re the only person suddenly terrified by every bodily sensation, when it’s incredibly common during this phase of life.
And honestly, menopause deserves a much better public relations team in my opinion! We need to understand all that it comes with.
Women are often warned about hot flushes, but nobody tells you about the strange emotional experience of feeling disconnected from your own body. Nobody really explains that hormonal fluctuations can make anxiety louder (so loud), emotions more intense, and your brain suddenly behave like an overenthusiastic detective searching for evidence to prove the inner narrative right.
The good news is that it does not have to stay this way forever.
With support, understanding, and nervous system regulation, many women find they stop living in constant fear of their bodies and start rebuilding trust in themselves again and that’s important, because your body is not your enemy, even when it feels like it’s fighting against you sometimes.
Although maybe still stop Googling symptoms at 2am, really, it’s not helping and to be honest, nothing good will ever come from the “rare aggressive disease forum” before bed!
Hayley McAuley
Psychotherapist
Curious Counselling & Psychotherapy