Managing Social Anxiety During Perimenopause
Deemed the “F*ck It 40s” across pop culture, women often hear lore that they will reach a magical time when they no longer care what others think. While this may be the experience of some, many find the opposite to occur, especially those with a pre-existing anxiety disorder.
As women reach their 40s and into their 50s, perimenopause and menopause send their bodies into a hormonal transition that can actually increase anxiety, depression, and social discomfort. Poorly prepared for the way hormonal changes impact mood and relationships in middle age, many women find themselves longing for when they will experience this mystical social relief, turning to their medical and mental health providers for guidance.
While these changes have recently garnered far more attention than ever before, there continues to be a significant gap in best practices. Often, symptoms are dismissed or, worse, given cursory recommendations that further the shame and frustration as women try to understand the changes they are experiencing.
Despite the scarcity of research and evidence-based treatment, cognitive-behavioral therapy (CBT) is positioned to be a resource to help women cope with the turbulence during this period and provide a pathway to stability. Keep reading to learn more about what social anxiety looks like during the menopause transition and strategies to navigate this period more effectively.
Social Anxiety During Perimenopause
As defined by The Menopause Society, perimenopause, also known as menopause transition, is “a span of time that begins with the onset of menstrual cycle changes and other menopause-related symptoms and extends through menopause (the last menstrual period) to 1 year after menopause.” While it is well established that depression increases during the menopause transition, very little is known about anxiety disorders, particularly social anxiety. In fact, despite evidence that other sensitive hormonal periods (i.e., menarche, the late luteal phase of the menstrual cycle, postpartum, etc.) may prompt or exacerbate social anxiety, little research has examined social anxiety during this specific phase of women’s lives.
Data thus far show that general anxiety symptoms tend to be greater among women experiencing more symptomatic menopause transitions, those experiencing increased physical discomfort related to vasomotor symptoms such as hot flashes, and those experiencing early menopause due to primary ovarian insufficiency or surgically induced menopause. This latter group is also one of the few areas where social anxiety, specifically, is found to either emerge or exacerbate.
Outside of this data linking early menopause to social anxiety, the most significant findings are in the development of social appearance and body image anxiety related to the changes in physical appearance and social roles that prompt a reduction in what is called social prestige, the social recognition and general respect women receive as they age (Buran & Çankaya, 2023). The consequence often becomes social isolation and withdrawal for many women, which parallels the already shifting social tides and connections that occur in middle age.
As previously mentioned, these symptoms are often dismissed by medical providers so by the time women come into therapy (assuming that they even do), social anxiety has developed and reshaped their sense of self and their social landscape, as well as their sense of self-advocacy. Being able to properly label the relationship between menopause and social anxiety allows for women to begin to understand pathways to relief.
Tools to Manage Anxiety
Cognitive-behavioral therapy (CBT) provides a framework of strategies and tools to help women offset these increases in anxiety, and provide this sense of relief. CBT can help improve coping skills for working through body changes, increases in self-focus, sleep disturbances, and social changes. Most importantly, CBT can help women reengage in their social worlds and reconnect to social supports that are so critical to longevity and healthy aging.
Here are some ways to use CBT to push through this social discomfort:
Cognitive restructuring. Cognitive restructuring refers to challenging and changing our negative thoughts to be more neutral (less emotionally charged) and fact-based. When bombarded by negative thoughts, ask yourself if this is fact or if your mind is telling a story based on your anxiety. For example, when experiencing a hot flash, an automatic thought may be “everyone is going to notice and think something is wrong with me.” Instead, we can tell ourselves “This is going to pass and I am feeling it more than others can see.”
Self-compassion. We can pair cognitive restructuring with self-compassion. Self-compassion is a skill to help us talk to ourselves in a kinder, more accepting stance, similar to how we would talk to a friend. In the above example we may be able to tell ourselves something like “most women are going to experience this. It is hard right now, but this is normal for my age and the changes my body is going through.”
Clarifying your values. Related to social anxiety, CBT can help individuals clarify their interpersonal values during this next stage of life, to better connect with their wants and help move in directions that align with their goals. The most important thing is to be goal directed, not anxiety dependent! Sit down and think about what really matters to you, how you want to fill your time, and who you want to spend this time with. Even when anxiety is high, move in the direction of these goals.
Behavioral experiments. This refers to making a hypothesis of what we suspect may happen and then testing it out. Did others really make negative statements or comments about my hot flashes? Did others appreciate my presence or were they focused on how I looked? Did they ignore me or engage me in the interactions? Setting out our hypotheses before an event can help us challenge our negative thoughts in the future with actual evidence instead of emotions.
Managing physical symptoms. Finally, it is important to manage the physical symptoms that are present. Cope ahead for physical discomfort, bring ice packs or other cooling sources, engage in exercise that offsets body discomfort, and use deep breathing and other relaxation exercises to calm our body and decrease some of the associated distress. CBT can also help with what is called sleep hygiene, tools that can be used to help offset the sleep disturbances that occur during the menopause transition. With a calm, rested body we are more likely to push through social discomfort to engage with our values.
While these strategies can provide a framework for managing social anxiety during menopause, it is important to also know that there is help out there, and providers that are trained in supporting women through the menopause transition. The Menopause Society maintains a database of trained medical and mental health providers that understand and can provide compassionate care during menopause.
References:
Interested in learning more about the science behind this post? Check out the following articles:
Bromberger JT, Kravitz HM, Chang Y, Randolph JF, Avis NE, Gold EB and Matthews KA (2013). Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause, 20 (5), 488–495.
Buran G, & Çankaya S (2023). Effect of women’s menopausal complaints and social appearance anxiety on their level of depression, stress, and anxiety: A cross-sectional study. Psychiatric Annals, 53 (7), 325–332.
Faubion SS, Kuhle CL, Shuster LT and Rocca WA (2015). Long-term health consequences of premature or early menopause and considerations for management. Climacteric, 18 (4), 483–491.
Freeman EW and Sammel MD (2016). Anxiety as a risk factor for menopausal hot flashes: Evidence from the Penn Ovarian Aging cohort. Menopause, 23 (9), 942–949.
Hantsoo L and Epperson CN (2017). Anxiety disorders among women: A female lifespan approach. Focus, 15 (2), 162–172.
Hu LY, Shen CC, Hung JH, Chen PM, Wen CH, Chiang YY and Lu T (2016). Risk of psychiatric disorders following symptomatic menopausal transition. Medicine, 95 (6).
Lebin LG, Blissett G, Patel K and Metcalf CA (2025). The role of menopause hormone therapy in psychiatric symptoms and disorders: A review of evidence. Current Treatment Options in Psychiatry, 12 (1).
Mulhall S, Andel R and Anstey KJ (2018). Variation in symptoms of depression and anxiety in midlife women by menopausal status. Maturitas, 108, 7–12.
This article was originally posted to the National Social Anxiety Center blog on 12.19.2025.