Why Anxiety Can Spike In Women Over 40 — And What You Can Do About It

Anxiety After 40: Why It Happens and How to Heal Naturally

"I thought by 40 I’d have it all figured out. Instead, I found myself lying awake at 3 am, heart racing over things I couldn’t even name. I'd never experienced anxiety in my life. And yet... there I was — not sleeping properly, nervous, exhausted, and reactive."

Fast forward to today: I’m older, wiser, and stronger. I've come out on the other side. Now, I use that experience — and my determination to heal naturally, in tune with my emotions and body — to help others.

It is absolutely possible to overcome and calm the anxiety that spikes for many women between their 40s and late 50s. In fact, my practice, My Mindful Counsellor — affectionately described by one client as The Malvern Anxiety Fairy — has supported many women through exactly this journey. You're not imagining it, and you're definitely not alone.

Understanding the Spike in Anxiety

Many women notice anxiety increasing after 40. This phenomenon isn't just about leading a stressful life. Midlife anxiety often results from a combination of hormonal changes, emotional shifts, and life transitions. When these changes go unsupported, anxiety can become chronic or even traumatic, especially if multiple stressors hit closely together. I experienced this firsthand.

Recent research highlights what countless women feel intuitively: midlife brings unique emotional pressures. Old coping strategies may no longer work. Women in their 40s and 50s, who previously had no mental health concerns, are now more than twice as likely to seek help for anxiety compared to those in their 20s. Additionally, women undergoing menopause face heightened risk for depression. Here’s why:

Three Major Reasons Anxiety Rises After 40

1. Hormonal Shifts

Hormonal changes during perimenopause and menopause significantly impact mood regulation. As oestrogen and progesterone levels decline, women become more vulnerable to anxiety. Oestrogen is vital in influencing serotonin and GABA—key neurotransmitters that promote calm. Less oestrogen equals a greater likelihood of experiencing anxiety (Harvard Health, 2023).

2. Life Role Transitions

Many women find themselves in the "sandwich generation," juggling responsibilities for teenage children, aging parents, and career dissatisfaction. This pressure can become overwhelming. Old coping mechanisms may lose their effectiveness as the combination of stressors exceeds available resources and anxiety management skills.

3. Existential Awareness

Midlife often prompts deep questions: "Is this all there is?" "Have I accomplished what I wanted?" "Am I living the life I envisioned?" These unsettling inquiries can significantly contribute to background anxiety.

The Impact of Menopause on Anxiety

“My body changed, my sleep changed — and suddenly, so did my mind.” While we often discuss physical symptoms like hot flushes, the mental health effects are just as important.

A 2023 study from University College London found that 1 in 3 women experience moderate to severe anxiety symptoms during menopause, often without a prior history of mental health issues. Many express that anxiety seems to arise from nowhere. The truth is, it is inherently linked to the shifts in identity, body, and emotions at this stage of life.

Five Anxiety-Related Changes After 40

Body-Based Anxiety

Heightened sensitivity to adrenaline can result in racing hearts, tingling hands, and breathlessness even during restful moments.

Mood Swings to Panic

Hormonal fluctuations can lead to sudden mood drops, which may spiral into panic attacks without any apparent trigger. This experience often results in a diminished sense of control and agency.

Sleep Deprivation

Poor sleep quality reduces resilience. A 2024 Sleep Council UK report found that 65% of menopausal women correlate anxiety directly with sleep disturbances.

Health Anxiety

Symptoms associated with menopause, such as chest tightness, memory lapses, and aches, can be misinterpreted as signs of serious health issues, fueling anxiety and fear.

Identity Shifts

When your career, role, body, and self-perception shift simultaneously, it can create deep emotional unrest and an identity crisis.

The Good News: Anxiety Is Highly Treatable

Dr. Louise Newson, a UK menopause specialist, emphasizes that neuroplasticity—the brain's ability to adapt—continues throughout life.

Recent research highlights the mental health challenges that accompany midlife transitions like perimenopause. A 2024 UCL review revealed that psychosocial interventions, including CBT and mindfulness-based approaches, lead to substantial improvements in anxiety and depressive symptoms among menopausal women. Separately, CBT consistently shows effectiveness, often outperforming medication for various anxiety forms. Though a recent Lancet review did not specify percentages, it stressed the crucial role of proactive support and psychological care during menopause.

Mindfulness-Based Cognitive Therapy (MBCT) is also proving beneficial. A 2022 study published in BMC Psychiatry showed that MBCT and CBT effectively reduced anxiety symptoms in individuals with Generalized Anxiety Disorder. There is also a strong theoretical foundation for its application in menopausal women.

Turning Your Perspective around

When I realized that my anxiety wasn’t a reflection of being broken, but rather a response to natural and inevitable change, I began to shift my mindset. I told myself, "Yes, I’m anxious, and that makes sense." This realization was a turning point. By accepting my anxiety, I stopped being anxious about it. Instead, I learned to ride the wave of change and seek the positives of aging, wisdom, and personal transformation.

“I stopped seeing menopause as something to survive,” says Diane, 53. “I began to view it as a reset button.”

“It’s not about stopping anxiety; it’s about learning not to let it dictate my life.”

Practical Strategies to Manage Anxiety

• Consult a qualified counselor who understands women's issues and can teach effective anxiety management tools.

• Practice mindfulness daily, even if just for five minutes at bedtime or after waking up.

• Embrace change; understand that adapting to this natural phase of life is not a failure.

• Discuss hormone support options with a GP or menopause specialist.

• Accept anxiety as a part of a significant life transition.

• Don't judge yourself; remember, you're still the same passionate, capable, and wise person—just navigating a challenging transition.

  
  

Final Thoughts

Reframe menopause as a new beginning, rather than merely an ending. You don't need to endure it with clenched fists. With the right support, insights, and tools, you can approach this stage of life with strength and even find peace.

If you’d like to explore more tools and strategies for managing midlife anxiety, stay tuned for my upcoming blogs or follow me on Facebook for updates.

You can also find out more about my counselling services.

References

Marsh, S. (2024, May 1). Perimenopausal women have 40% higher risk of depression, study suggests. The Guardian. https://www.theguardian.com/society/2024/may/01/perimenopausal-women-have-40-higher-risk-of-depression-study-suggests

https://www.drlouisenewson.co.uk/ Dr. Louise Newson Menopause Guru

Desai, R., Karavadra, B., Broadbent, E., Denison, F., & Pasupathy, D. (2024). Psychosocial interventions for menopausal symptoms: A systematic review and meta-analysis. Journal of Affective Disorders, 350, 43–55. Available at: https://doi.org/10.1016/j.jad.2024.04.027

Hunter, M. S., & Ayers, B. (2024). Promoting good mental health over the menopause transition. The Lancet, 403(10324), 1343–1345. Available at: https://doi.org/10.1016/S0140-6736(23)02801-502801-5)

Zhang, J., Li, C., Xiao, W., Zheng, X., & Wang, T. (2022). The effects of group MBCT and group CBT on patients with Generalized Anxiety Disorder. BMC Psychiatry, 22(1), 825. Available at: https://doi.org/10.1186/s12888-022-04127-3

Alsubaie, M., Abbott, R., Dunn, B. D., Dickens, C., & Kuyken, W. (2021). Mindfulness-based interventions for mental health students: A randomized controlled trial. Frontiers in Psychology, 12, 667961.