What is 'morning dread' during perimenopause?

Perimenopause is the stage when a woman’s reproductive hormone levels begin to decline. This often brings a range of symptoms that can have a significant impact on your daily life. This transition typically begins in your late thirties or forties, and signals that your reproductive years are gradually coming to an end. Eventually, it leads to menopause - the point at which your periods stop completely - which most commonly occurs in your early fifties.

The symptoms of perimenopause can vary widely and affect each person differently. One particularly debilitating symptom is a persistent feeling of dread or anxiety, which can arise at any time but is often most intense in the morning.

Dr Jody-Ann McLean, a specialist in women’s hormonal and metabolic health, explains that morning anxiety during perimenopause can feel like a sudden wave of panic or foreboding that appears for no clear reason - an intense sense that something is wrong, even when there’s no obvious trigger.

“Many people experience anxiety during menopause, and it can sometimes be more noticeable in the morning just as you’re waking up,” she says.

"The term ‘morning dread’ has emerged as a way to describe this pattern. Some describe it as more of a sinking feeling, or a racing heart. You might feel overwhelmed as you start to wake up, and it can feel especially confusing on those days when there’s nothing obviously stressful going on.”

McLean notes that anxiety can sometimes be the only symptom of perimenopause. Because of this, many women may not immediately connect their experiences to hormonal changes. Instead, they assume they’re simply struggling to cope with everyday stress in a way they never did before.

“Anxiety in perimenopause is more common in people with a previous personal or family history of mental health conditions," she adds. "But it can happen to anyone."

Because anxiety can feel more emotional than physical, it’s easy to think it’s ‘all in your head’. And while stress, burnout, and everyday pressures can definitely make it worse, anxiety during perimenopause is also strongly linked to physical changes happening in your body - things such as fluctuating hormones that you can’t really control.

“Cortisol levels usually fluctuate during the day, peaking in the morning to help you wake up, which is a very normal process,” says McLean. “But when your oestrogen and progesterone levels shift during perimenopause, your body can become more sensitive to the stress hormone cortisol.

“Oestrogen and progesterone usually have a calming effect on the HPA axis, which controls the release of cortisol in response to stress. As these hormone levels change, the system may become less efficient at regulating cortisol, meaning levels can stay higher for longer instead of settling back down after a stressful moment.

“That’s why the same stress you might have handled easily at 35 can feel much more overwhelming at 48 during perimenopause.”

If you’re going through perimenopause and dealing with this intensified anxiety, you might also be wondering how long it will last - if it eases as the day goes on or when it might end entirely.

McLean says that, while morning dread affects everyone differently, the intensity often eases as the morning goes on and you continue with your day.

“Your cortisol levels naturally drop as the day progresses, and your blood sugar stabilises once you’ve had a balanced breakfast,” she explains.

“Simply engaging with your normal daily activities and having some form of distraction might help you feel less overwhelmed. Even though it does tend to ease as the day goes on, having to repeat this every morning can be exhausting, so it’s definitely worth addressing.”

Morning anxiety and mood fluctuations after reaching full post-menopause can ease for some people, while for others they may persist - it really depends on the person.

McLean says that once your oestrogen and progesterone levels even out, anxiety and mood-related symptoms often calm down - at least if hormones were the main cause. But that’s not always the case. Some people may still experience these symptoms after menopause, especially if there are other factors at play, such as untreated anxiety or depression, or ongoing sleep issues.

She recommends not just ‘waiting it out’ if your symptoms cause distress or interfere with your daily life.

If you’re experiencing heightened anxiety, it’s important to speak with your doctor. They can assess your symptoms, provide guidance, and, if they determine your anxiety is related to perimenopause, may recommend treatments such as terapia de reposição hormonal (HRT).

Talking to a healthcare professional is the best way to manage these symptoms. While treatment may not completely eliminate them, regular check-ins can help monitor your progress - especially if your symptoms flare up again.

“Your body’s survival mode - or what you perhaps know as your fight, flight, or freeze response - is meant to be a short-term measure to deal with temporary stressful situations,” McLean explains. “But when it carries on for longer periods, it might have some less desirable effects.”

She cautions that if your HPA axis stays activated more than usual, it can push cortisol and adrenaline levels higher.

Long-term elevated cortisol may lead to:

• Sleep issues.

• Weakened immune function.

• Metabolic issues - such as insulin resistance.

• Fat shifting towards your abdomen.

• Increased chance of doença cardiovascular.

“Long-term anxiety can also contribute to mental health challenges, such as depression or general anxiety,” McLean adds. “Over time, it might even affect your cognitive function or memory.”

“Your doctor can help figure out what’s contributing to your anxiety and which treatment options might work best for you - whether that’s mental health support, lifestyle changes, HRT, or other medical approaches,” McLean explains.

“Even if it just seems different from what you expected in perimenopause, it’s always okay to reach out for help before things start to feel unmanageable.”