You are in your early to mid-forties. Maybe your late thirties. You have always been someone who manages well — stress, demands, the complexity of modern life. And then, gradually, something shifts. The anxiety feels different. More physical, somehow. More unpredictable. Some days, the feeling comes out of nowhere: a spike of dread with no obvious trigger, a racing heart at 3am, a sense of being unmoored in a way that doesn't quite make sense given your circumstances.
You might have attributed it to work pressure, relationship stress, getting older, the general weight of things. What you probably haven't considered is that your hormones may be driving the entire experience.
Welcome to perimenopause — the hormonal transition that precedes menopause, can begin as early as the mid-thirties, and remains, despite affecting millions of women, one of the most under-discussed health experiences of a woman's life.
What Is Perimenopause, and Why Does It Affect Anxiety?
Perimenopause refers to the transitional period from the onset of ovarian dysfunction to menopause itself, which is defined as 12 consecutive months without a menstrual period. This transition typically begins in a woman's mid-to-late forties, though for some women it starts considerably earlier — and it can last anywhere from four to fourteen years.
During perimenopause, oestrogen and progesterone levels don't simply decline in a neat, linear fashion. They fluctuate — sometimes dramatically. These hormonal swings are what produce the full spectrum of perimenopausal symptoms, from irregular periods and hot flushes to joint pain, brain fog, disrupted sleep, and, critically for our purposes here, significantly elevated anxiety.
The reason anxiety is so commonly triggered or worsened by perimenopause comes down to the biology of oestrogen itself. Oestrogen is not only a reproductive hormone. It is deeply involved in the regulation of the central nervous system, including the production and activity of key neurotransmitters that govern mood and anxiety. Specifically:
Oestrogen supports serotonin production and receptor sensitivity. Serotonin is sometimes called the "wellbeing neurotransmitter," and when oestrogen levels drop or fluctuate, serotonin availability and function can be disrupted — contributing to low mood, irritability, and anxiety.
Oestrogen modulates GABA. GABA (gamma-aminobutyric acid) is the brain's primary inhibitory neurotransmitter — it slows neural activity and promotes calm. Oestrogen influences GABA receptor sensitivity; when oestrogen fluctuates, the GABAergic system becomes less effective at calming the nervous system, making it more reactive and harder to settle.
Oestrogen affects cortisol regulation. The relationship between oestrogen and the stress hormone cortisol is complex and bidirectional. Perimenopausal oestrogen fluctuation can impair the body's ability to moderate its cortisol response, keeping the nervous system in a state of heightened alert even when there is no identifiable external stressor.
The result is that for many perimenopausal women, anxiety arrives as a genuinely new experience — or existing anxiety dramatically intensifies — in a way that feels physiologically different from anything they've experienced before.
The Scale of the Problem
This is not a niche issue. Research consistently shows that anxiety is one of the most common — and most impactful — symptoms of perimenopause, yet it is among the least well-recognised.
A major systematic review drawing on data from the Global Burden of Disease 2021 database found that the global burden of anxiety disorders among perimenopausal women has been rising steadily since 1990, and projects a 40% increase in this burden by 2035 — representing one of the fastest-growing mental health challenges in women's health globally (Dong et al., 2025, NCBI). Between 15% and 50% of women experience clinically significant anxiety during perimenopause, and estimates suggest that up to 60% of women experience anxiety during the broader menopause transition.
Research from University College London, published in 2024, found that perimenopausal women are approximately 40% more likely to experience significant depressive symptoms compared to premenopausal women — a risk elevation directly linked to hormonal fluctuation rather than life circumstances alone (ScienceDaily, 2024).
Yet many women do not connect their symptoms to hormonal changes and therefore do not seek or receive appropriate support. Many are instead prescribed antidepressants in isolation, without addressing the underlying hormonal picture — or they dismiss their own experience because it doesn't match what they expected perimenopause to look like.
Why It Goes Unrecognised
Several factors contribute to perimenopause-related anxiety being missed or misattributed:
The timing doesn't match expectations. Many women associate perimenopause with their late forties or early fifties. When anxiety escalates in the late thirties or early forties, hormonal changes are rarely the first explanation considered — by the woman herself or by clinicians.
The symptoms overlap with common life stressors. The age at which perimenopause typically begins also tends to coincide with significant career pressures, caring responsibilities, relationship complexity, and a range of other genuine stressors. It is easy to attribute anxiety to circumstance rather than biology.
It's not always taught. A 2023 survey of UK GP trainees found significant gaps in perimenopause education, meaning that even women who do present to their doctor may not receive a hormonal explanation for their mental health symptoms.
The anxiety often arrives before other, more recognisable symptoms. Hot flushes and night sweats are the symptoms most associated with perimenopause in public awareness. But for many women, anxiety and mood changes are the first symptoms to appear — sometimes years before sleep disruption or vasomotor symptoms begin.
The Sleep Connection — and Why Anxiety Doesn't Stop at Bedtime
One of the most important — and most underappreciated — aspects of perimenopausal anxiety is that it does not stop when the day does.
For many women in perimenopause, the night is when anxiety is at its worst. The classic 3am wake with a racing heart, a surge of dread, or an inability to return to sleep are not coincidental. Falling oestrogen affects the brain's temperature regulation and disrupts sleep architecture, reducing the proportion of deep, restorative slow-wave sleep and increasing nighttime cortisol fluctuations. The result is that many perimenopausal women are, quite literally, not getting the restorative sleep their nervous system desperately needs to regulate during the day.
This creates a self-reinforcing cycle: anxious, under-regulated days lead to disturbed, unrestorative nights, which in turn make the following day harder to manage. Breaking this cycle requires addressing both ends — supporting the nervous system through the day, and actively supporting deep, restorative sleep at night.
This is the principle behind Calmanova's two-patch system: the AM Calming Patch for daytime nervous system support, and the PM Sleep Patch for night-time recovery. Used together as a 24-hour system, they work across the full cycle of perimenopausal anxiety — not just one half of it.
The AM Calming Patch: Daytime Ingredients and the Evidence Behind Them
The AM Calming Patch is formulated with five ingredients selected for their evidence-based roles in reducing anxiety, supporting stress resilience, and calming the nervous system during the day — without sedation or impairment.
Ashwagandha (Withania somnifera)
Ashwagandha is an adaptogenic herb with one of the strongest evidence bases of any botanical for anxiety, and emerging evidence specifically for perimenopausal symptoms.
Adaptogens help the body modulate its response to stressors — reducing the dysregulation of the HPA axis that underlies both chronic anxiety and perimenopausal symptom escalation. A landmark randomised, double-blind, placebo-controlled trial published in the Journal of Obstetrics and Gynaecology Research (Gopal et al., 2021) investigated ashwagandha specifically in perimenopausal women over eight weeks. Participants taking ashwagandha showed significantly reduced anxiety, irritability, and depressive symptoms compared to the placebo group. The study also found measurable increases in circulating oestradiol — offering a potential hormonal mechanism alongside its cortisol-modulating action.
In a separate double-blind trial of adults with chronic stress (Chandrasekhar et al., 2012), ashwagandha produced a 44% average drop in stress scores and significant reductions in cortisol and anxiety compared to placebo. A 2025 Cambridge Media Journals review concluded that ashwagandha "may be a helpful tool in buffering the transitional stressors responsible for symptomatology" during perimenopause.
The mechanism: Ashwagandha's active withanolides help downregulate the HPA axis and reduce cortisol production — directly targeting the hormonal stress cascade that perimenopausal oestrogen fluctuation amplifies.
Passionflower (Passiflora incarnata)
Passionflower has a long history in herbal medicine for nervous tension, anxiety, and restlessness, with a growing clinical evidence base. Several clinical studies have compared it to pharmaceutical anxiolytics; a study published in Phytotherapy Research found passionflower extract equivalent to oxazepam (a benzodiazepine) for generalised anxiety disorder, with fewer side effects and no impairment of work performance.
Further research has pointed to passionflower's ability to increase GABA levels in the brain — the same mechanism by which many prescription anti-anxiety medications work, but through a gentler, dependence-free pathway. For perimenopausal women, whose GABAergic system is already disrupted by oestrogen fluctuation, this is directly relevant. Passionflower appears in both the AM and PM formulas, reflecting its dual role in supporting calm during the day and aiding sleep onset at night.
The mechanism: Passionflower enhances GABAergic activity, supporting the nervous system's natural braking mechanism throughout the day and helping the transition into sleep at night.
Valerian Root (Valeriana officinalis)
Valerian root is among the most extensively researched herbal ingredients for both anxiety and sleep. A major systematic review and meta-analysis published in the Journal of Evidence-Based Integrative Medicine (Shinjyo et al., 2020) reviewed 60 studies involving 6,894 participants and concluded that valerian is a safe and effective herb to promote sleep and reduce anxiety. The review included eight randomised placebo-controlled trials specifically examining anxiolytic effects, and found clinically meaningful reductions in anxiety scores. A 2024 study in Antioxidants confirmed that standardised valerian extract improved overall sleep quality in a double-blind, placebo-controlled clinical trial.
In the AM patch, valerian contributes to daytime anxiety management. Its inclusion in both the AM and PM formulas reflects its evidence for working on both anxiety and sleep — a natural fit for the perimenopausal picture in which the two are so deeply intertwined.
The mechanism: Valerian's active compounds, including valerenic acid, interact with GABA receptors and serotonin receptors, supporting nervous system calm and sleep promotion through multiple complementary pathways.
Vitamin B6 (Pyridoxine)
Vitamin B6 is an essential cofactor in the synthesis of two of the brain's most important calming neurotransmitters: GABA and serotonin. Both of these systems are directly disrupted by the oestrogen fluctuations of perimenopause, making B6 a particularly well-targeted inclusion in the AM formula.
A double-blind, placebo-controlled RCT published in Human Psychopharmacology (Field et al., 2022) assigned over 300 participants to Vitamin B6, Vitamin B12, or placebo for one month. Vitamin B6 produced statistically significant reductions in self-reported anxiety — and crucially, objective visual tests confirmed that GABA levels had measurably increased in those who received it. Vitamin B12 showed no significant effect. The research team noted that "pyridoxine has a significant and selective modulatory impact on central serotonin and GABA production" — a mechanism with direct relevance to the hormonal anxiety of perimenopause.
The mechanism: B6 supports GABA and serotonin synthesis, replenishing two of the key neurotransmitter systems that perimenopausal oestrogen decline disrupts at their source.
Rhodiola Rosea
Rhodiola rosea is an adaptogenic herb formally recognised by the European Medicines Agency, whose 2011 herbal monograph approved its traditional use for "the temporary relief of symptoms associated with stress, such as fatigue, exhaustion and a general sensation of weakness" — a clinical description that maps precisely onto the experience of many perimenopausal women.
Clinical research and review has confirmed that Rhodiola improves mental work capacity, attention, task performance, and overall mood while reducing self-reported mild anxiety and stress (Panossian et al., 2010; published in Phytomedicine). Uniquely among adaptogens, Rhodiola provides energy-supporting properties alongside its calming action — making it well-suited to daytime use for women who are exhausted by chronic anxiety but cannot afford to feel sedated.
The mechanism: Rhodiola modulates the stress response via the HPA axis and supports dopaminergic and serotonergic neurotransmission, helping the nervous system remain resilient under pressure without overstimulation.
The PM Sleep Patch: Night-Time Ingredients and the Evidence Behind Them
The PM Sleep Patch addresses the other half of the perimenopausal anxiety cycle: the night. Its formula is specifically designed for nervous system downregulation, sleep onset, and restorative deep sleep — the physiological recovery that an anxious, hormonally disrupted body urgently needs.
Magnesium Glycinate
Magnesium is involved in over 300 enzymatic processes in the body and plays a central role in nervous system regulation, GABA receptor function, and muscle relaxation. Magnesium glycinate is one of the most bioavailable and well-tolerated forms, with high absorption and minimal digestive side effects.
During perimenopause, the relevance of magnesium is compounded by the fact that chronic cortisol elevation — driven by hormonal disruption — increases urinary magnesium excretion. Research has found magnesium deficiency in up to 60% of chronically stressed women, and subclinical deficiency in up to 45% of stressed subjects studied (Akarachkova et al., Magnesium Research). A 2024 systematic review in Cureus (Rawji et al.) found that five out of seven studies examining magnesium supplementation reported significant improvements in self-reported anxiety and sleep quality, concluding that supplementation is "likely useful in the treatment of mild anxiety and insomnia, particularly in those with low magnesium status at baseline."
The mechanism: Magnesium glycinate modulates NMDA receptors and supports GABA receptor function — calming nervous system reactivity and promoting muscle relaxation for deeper, more restorative sleep.
Passionflower (Passiflora incarnata)
As noted in the AM section, passionflower works across both daytime anxiety and night-time sleep. In the PM context, its GABAergic action is particularly valuable for easing the transition into sleep and reducing nighttime nervous tension — including the anxious wakefulness and early morning arousal that many perimenopausal women experience.
The mechanism: Supports GABA activity for nervous system calming, helping to reduce the physiological activation that prevents restful sleep onset and maintenance.
Valerian Root (Valeriana officinalis)
Valerian's evidence base spans both anxiety and sleep, and in the PM formula it serves its most extensively studied function: supporting sleep onset and sleep quality. The 2020 Shinjyo et al. meta-analysis found consistent improvements in subjective sleep quality across studies, particularly for people reporting stress-related sleep disruption — which describes perimenopausal sleep disturbance precisely. A 2024 randomised, double-blind, placebo-controlled clinical study confirmed that standardised valerian extract improved overall sleep quality in adults with sleep complaints.
The combination of valerian and hops is notably well-supported in the clinical literature, with several studies finding synergistic effects between the two botanicals for sleep and sedation.
The mechanism: Valerenic acid modulates GABA receptors and serotonin pathways, reducing sleep onset latency and supporting deeper sleep architecture.
Hops (Humulus lupulus)
Hops have been used traditionally as a sedative botanical for anxiety, tension, and insomnia for centuries. In Germany, hops baths have historically been used specifically to reduce hot flushes in menopausal women, suggesting a particular relevance to this life stage.
The science confirms the traditional use. Research published in Frontiers in Neuroscience (2020) identified humulone — the primary alpha-acid in hops — as a positive allosteric modulator of GABA-A receptors, confirming the mechanism by which hops promotes sedation and reduces sleep onset time. In animal models, humulone shortened sleep latency and increased total sleep duration. A clinical study involving female nurses consuming non-alcoholic beer (retaining hop content) over 14 days found significant improvements in sleep quality and reductions in anxiety levels, measured by actigraphy. The pairing of hops with valerian is particularly well-studied, with multiple clinical trials demonstrating that the combination is synergistically effective for sleep.
The mechanism: Hops' bitter resins, particularly humulone, are positive modulators of GABA-A receptors — the same receptor system targeted by pharmaceutical sleep medications, but through a gentler, non-habit-forming pathway.
Reishi Mushroom (Ganoderma lucidum)
Reishi mushroom — known in traditional East Asian medicine as the "mushroom of immortality" and long valued for promoting calm and supporting sleep — has attracted a growing body of modern clinical and preclinical research.
A clinical analysis cited in the Journal of Medicinal Food found that participants with neurasthenia (a condition characterised by chronic fatigue and emotional distress, with significant overlap with perimenopausal presentations) experienced significant reductions in fatigue and improvements in well-being after consuming reishi. Animal studies have found that reishi shortens sleep latency and increases total sleep time, including non-REM sleep — the deepest and most restorative stage. A 2022 clinical study (Wang & Wang) demonstrated significant improvements in 60 chronic insomnia patients, with reduced sleep onset time and increased total sleep duration. A 2024 review noted reductions in fatigue and anxiety specifically in people using reishi products.
As an adaptogen, reishi also supports cortisol regulation, helping to bring the overnight cortisol fluctuations — which drive early-morning waking in perimenopausal women — back into a more normal pattern.
The mechanism: Reishi's triterpenes and polysaccharides support cortisol regulation, modulate neurotransmitter systems including serotonin, and are associated with reduced sleep onset latency and improved non-REM sleep architecture.
A Note on Transdermal Delivery
Calmanova's patches deliver their active ingredients transdermally — through the skin, directly into the bloodstream — bypassing the digestive system. This method of delivery offers a steadier, more consistent release of active ingredients compared to oral supplementation, which is subject to variable absorption and the peaks and troughs associated with single-dose delivery. Transdermal delivery is the same principle used in HRT patches, nicotine patches, and a range of well-established medical applications, and it is particularly well-suited to botanical ingredients that benefit from sustained, steady-state presence in the body.
The 24-Hour Approach: Why Both Patches Work Better Together
Perimenopausal anxiety does not observe office hours. It builds through the day and disrupts the night, and the sleep deprivation it causes feeds directly back into the next day's anxiety. A support system that only addresses one half of this cycle is always working at a disadvantage.
The AM and PM patches are designed as a complete 24-hour system: the AM Calming Patch supports nervous system regulation and stress resilience through the day, while the PM Sleep Patch works to downregulate the nervous system at night, support deeper sleep, and allow the body the restorative recovery it needs to face the following day with greater calm.
Each patch works independently — and many women begin with one and find genuine benefit from it. But the full cycle of support — addressing both the waking and sleeping nervous system — reflects the most complete response to what perimenopause actually does to the body across a full 24 hours.
Getting the Support You Deserve
If you recognise perimenopausal anxiety in your own experience, the first and most important step is to name it — to yourself, and to your GP. Hormonal support in the form of HRT (Hormone Replacement Therapy) is one of the most effective interventions for perimenopausal anxiety and mood symptoms when prescribed appropriately. NICE updated its menopause guidelines in 2023 to reflect the evidence supporting HRT for mental health symptoms of perimenopause, and women should feel empowered to request it and have an informed discussion with their doctor.
Alongside medical support, lifestyle factors — sleep, movement, dietary quality, stress reduction — remain foundational. Botanical and nutritional support, including the ingredients in Calmanova's patches, can play a meaningful complementary role in supporting nervous system regulation during this transition.
Perimenopause is not a condition to be endured. It is a transition to be supported — with information, with community, and with the right tools, day and night.
Important note: Calmanova patches are wellness supplements and are not intended to diagnose, treat, cure, or prevent any medical condition. The information in this article is for educational purposes only and does not constitute medical advice. If you are experiencing significant anxiety or perimenopausal symptoms, please consult your GP or a qualified healthcare professional. For menopause-specific support, the British Menopause Society (bms.org.uk) and Menopause UK (menopause.org.uk) are excellent resources.
Sources:
- Dong, Y. et al. (2025). Global burden of anxiety disorders during the perimenopause (1990–2021) and projections to 2035. NCBI/PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706191/
- University College London / ScienceDaily (2024). Women are 40% more likely to experience depression during the perimenopause. https://www.sciencedaily.com/releases/2024/05/240501091701.htm
- Gopal, S. et al. (2021). Effect of an Ashwagandha root extract on climacteric symptoms in women during perimenopause. Journal of Obstetrics and Gynaecology Research, 47(12).
- Chandrasekhar, K. et al. (2012). Safety and efficacy of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med, 34(3).
- Cambridge Media Journals (2025). Is Withania somnifera a safe and effective treatment for reducing perimenopausal symptoms? https://journals.cambridgemedia.com.au/ajhnm/volume-37-issue-3/
- Akhondzadeh, S. et al. (2001). Passionflower in the treatment of generalised anxiety. Phytotherapy Research.
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- Field, D.T. et al. (2022). High-dose Vitamin B6 supplementation reduces anxiety. Human Psychopharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9787829/
- European Medicines Agency (2011). Herbal monograph on Rhodiola rosea L. EMA/HMPC/232091/2011.
- Rawji, A. et al. (2024). Examining the Effects of Supplemental Magnesium on Self-Reported Anxiety and Sleep Quality: A Systematic Review. Cureus. https://pmc.ncbi.nlm.nih.gov/articles/PMC11136869/
- Zanoli, P. & Zavatti, M. (2008). Pharmacognostic and pharmacological profile of Humulus lupulus L. Journal of Ethnopharmacology.
- Frontiers in Neuroscience (2020). Humulone Modulation of GABAA Receptors and Its Role in Hops Sleep-Promoting Activity. https://www.frontiersin.org/articles/10.3389/fnins.2020.594708/full
- Tang, W. et al. (2021). Ganoderma lucidum promotes sleep through a gut microbiota-dependent and serotonin-involved pathway. Scientific Reports.
- NICE Menopause Guidelines (2023 update): nice.org.uk/guidance/ng23
