Can perimenopause cause first-time anxiety?

Yes, many women experience anxiety for the first time in their lives during perimenopause, even with no prior anxiety history. This is a confusing experience but understandable from a neurology perspective. Mechanism: estrogen has stabilising effects on serotonin (mood neurotransmitter) and GABA (rest neurotransmitter) - when estrogen fluctuates irregularly in perimenopause, these systems become unstable. Additionally: progesterone (also dropping) has calming effects on the brain. So you lose two emotion-stabilising hormones simultaneously. Common symptoms: anxiety without obvious cause, racing heart, difficulty breathing well, sleep disruption that compounds the problem. For Malaysian women: layered approach. (1) Lifestyle: consistent 7-8 hour sleep, reduce caffeine after 2pm, moderate exercise 30 min 5x weekly - cardio + yoga is optimal. (2) Supplements: magnesium glycinate 200-400mg evening, ashwagandha Sensoril 125-250mg for cortisol reduction, omega-3 for mood. (3) If symptoms severe and disrupt work/relationships: discuss hormone replacement therapy with an obstetrics and gynaecology specialist (restores estrogen stability) or certain low-dose antidepressants (paroxetine, escitalopram). Perimenopausal anxiety typically eases within 1-2 years after official menopause when estrogen stabilises at low level - so this isn't a permanent state.