Heart racing? Thoughts that won’t settle? On edge for no clear reason? Yep, that’s perimenopause anxiety. Many women experience these sudden surges of panic and worry during this stage. In fact, mood changes (such as anxiety, irritability, and low mood) are the most common first sign of perimenopause, according to a recent survey of Midi patients.

Here’s why: Estrogen helps regulate brain chemicals like serotonin and dopamine, which play a big role in mood. As estrogen levels start to shift in midlife, serotonin and dopamine can drop too—leading to emotional ups and downs that can catch you off guard. On top of that, dealing with other menopause symptoms, like hot flashes and night sweats, may affect your mood and increase anxiety.

The good news: perimenopause anxiety is very treatable, and you don’t have to figure it out alone. Your Midi clinician can help you understand what’s happening and find the right approach to help you feel like yourself again, whether with HRT, antidepressants, lifestyle changes, supplements, or another science-backed solution.