Perimenopause panic attacks: why they happen, and what can help
By Softer Mind · Updated 15 October 2026 · 8 min read · Based on NHS guidance and published research
It comes from nowhere. Your heart pounds, your chest goes tight and you can't seem to get enough air. You feel hot, shaky and sick, and a wave of dread tells you something is badly wrong. Then, after a few minutes, it fades and leaves you drained.
If this has started in your forties or fifties, you may wonder whether it's linked to your hormones. Perimenopause panic attacks are something many women describe, and anxiety is a recognised symptom of the menopause. But a first attack with chest pain needs checking straight away, because the same feelings can come from the heart.
Call 999 if:
- it's your first ever panic attack and you have chest pain. Don't assume it's panic: let a doctor rule out your heart
- you have chest pain that comes on suddenly and doesn't go away, spreads to your arm, neck, jaw, stomach or back, or comes with feeling sweaty, sick, light-headed or short of breath
- your breathing doesn't settle: you're gasping, can't get your words out, your chest feels tight or heavy, or your lips or skin look pale, blue or grey
- you have thoughts of suicide and don't feel you can keep yourself safe. You can also call Samaritans free on 116 123
See a GP if: you keep having panic attacks, or you're worrying about when the next one will come.
These signs come from the NHS pages on chest pain, shortness of breath and urgent help for mental health. The chest pain page lists a panic attack as one cause of chest pain, but it also warns against diagnosing yourself.
What does a panic attack feel like?
The NHS describes a panic attack as a sudden rush of intense mental and physical symptoms. It can come on very quickly. Symptoms can include:
- a pounding or racing heartbeat
- feeling faint or dizzy
- sweating, hot flushes or chills
- feeling sick, or a churning stomach
- chest pain
- feeling short of breath, or as if you're choking
- trembling or shaky arms and legs
- pins and needles or tingling fingers
- a dry mouth
- a sense of dread, or a fear that you're dying
- feeling cut off from your body
The NHS says most panic attacks last between 5 and 20 minutes, and some have been reported to last up to an hour. They are frightening, but the NHS says they are not dangerous and won't physically harm you.
Can perimenopause cause panic attacks?
It can play a part. The NHS lists anxiety, mood swings and palpitations among the symptoms of menopause and perimenopause. It also says hot flushes can come with palpitations, anxiety or dizziness. Those are the very feelings that make up a panic attack.
The research on panic attacks in particular is fairly thin, but two studies are worth knowing about.
- A large US study followed nearly 3,000 women through midlife for ten years. Women who hadn't been anxious before were more likely to report high anxiety in perimenopause and after menopause than they had been before. Frequent hot flushes or night sweats were also linked with high anxiety (Bromberger and others, 2013).
- Another US study asked 3,369 women aged 50 to 79, all past menopause, about the last six months. Just under 1 in 10 had had a full panic attack in that time. These attacks were most common in women in their fifties. They were also linked with stressful life events, low mood and some health problems. Use of HRT made no clear difference (Smoller and others, 2003).
Neither study can prove the menopause causes panic attacks. But together they suggest you're far from alone, and that midlife is a time when anxiety can rise.
Why might menopause bring on panic attacks?
Several things can stack up.
Hot flushes and a racing heart. A flush can bring a pounding heart and a rush of heat out of nowhere. Women's Health Concern, the patient arm of the British Menopause Society, says palpitations can happen quite normally with hot flushes.
The fear loop. Women's Health Concern explains that in panic, people tend to read a fast heart and quick breathing as signs of a heart attack or of fainting. That thought makes the body even more alarmed, which brings on more panic. Once you've had one attack, it's easy to start watching your body for the next.
Broken sleep. The NHS says sleep problems in menopause can leave you irritable, stressed and anxious.
Midlife pressures. Women's Health Concern points out that menopause often lands at a busy time: ageing parents, teenagers, children leaving home, and work. In the 2003 study above, panic attacks were more likely the more stressful events a woman had been through in the past year.
Is it a hot flush or a panic attack?
Sometimes it's hard to tell, and it can be both. A hot flush and a panic attack can share a pounding heart, sweating, heat and a sense of alarm.
Women's Health Concern suggests keeping a diary. Note when your racing heart happens, and what was going on just before. Over a few weeks, you may see whether it tends to come with flushes, with stress, or out of the blue. Take the diary to your GP.
What else can cause panic attacks?
The NHS says the exact cause of panic disorder isn't fully understood. Things that may play a part include:
- a very stressful or upsetting event, such as a bereavement
- a close family member with panic disorder
- caffeine, alcohol, sugary food and drinks, and smoking, which the NHS says can make attacks worse
Many symptoms of a panic attack can also come from other health problems. That's why your GP may examine you, and why chest pain should never be put down to panic without a check. Our page on perimenopause heart palpitations covers some of the other things a GP may look for.
What to do during a panic attack
The NHS suggests:
- Stay where you are, if you can.
- Breathe slowly and deeply.
- Remind yourself it will pass.
- Picture something calm, a place or an image you find soothing.
- Remember it isn't life-threatening.
Women's Health Concern describes slow breathing from your stomach. Put one hand on your chest and one on your stomach. As you breathe in, the hand on your stomach should rise while the one on your chest stays fairly still. Relax your shoulders and focus on your breathing. Practise it when you're calm, so it's easier to reach for in a panic.
What can help with menopause panic attacks?
The NHS suggests these steps for panic day to day:
- Try a self-help book for anxiety based on CBT. Your GP can suggest one.
- Do something calming, such as yoga or pilates, and learn some breathing exercises for stress.
- Move regularly. Exercise helps burn off stress and tension.
- Cut down on caffeine, alcohol and sugary food and drinks.
- Stop smoking, if you smoke.
- Look for support. The NHS mentions support groups and charities such as Anxiety UK, Mind and No Panic.
Women's Health Concern also suggests reminding yourself that anxious thoughts are not facts. Ask: Is there really a threat here? What would I say to a friend who felt like this? Have I coped with something like this before?
Our guide to menopause anxiety has more on the worry that can sit underneath panic.
What your GP can do
Your GP will ask about your symptoms, how often they happen and how long you've had them. They may examine you to rule out other causes. The NHS says panic disorder may be diagnosed if you have regular, unexpected panic attacks, followed by at least a month of worrying about having another.
Things your GP may talk to you about:
- CBT (cognitive behavioural therapy). The NHS says talking therapy is one of the main options for panic disorder. A therapist can help you understand how you react during an attack and learn ways to stay calm. In England, you can refer yourself to NHS Talking Therapies without seeing a GP.
- Medicines. The NHS says some antidepressants and other medicines may be offered if your doctor thinks they could help. Antidepressants can take a few weeks to start working.
- HRT. If your panic comes alongside hot flushes, poor sleep or other menopause symptoms, it's worth asking your GP whether HRT could suit you.
- A referral to a specialist, if things don't improve.
If you already take any medicine, please don't stop or change it without talking to your GP or pharmacist first.
When to see a GP about panic attacks
Book an appointment if:
- you keep having panic attacks
- worry about the next attack is taking over
- anxiety or panic is getting in the way of work, sleep or family life
- you feel low most days, or you feel you can't cope
If you ever have thoughts of harming yourself, please get help straight away. Call 111 and choose the mental health option, call Samaritans on 116 123, or call 999 if you feel you can't keep yourself safe.
Where relaxation fits in
After a panic attack, many women feel on edge for a while, waiting for the next one. Once your GP has checked you over, you might like a quiet routine to come back to each day. Our hypnosis for menopause anxiety, Calm the Anxious Mind, is a recording to help you relax and feel calmer. It includes slow breathing with a longer out-breath, and a cue you can practise: feet flat on the floor, a hand on your stomach, a long breath out, and the word "settle". It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.
You may also find these pages useful: perimenopause heart palpitations, menopause dizziness and perimenopause depression.
This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
