Yes — new-onset anxiety and panic attacks are a well-recognised symptom of perimenopause, even in women who have never experienced anxiety before. You are not imagining it, and it is not a sign that something has “gone wrong” with your mind.

Oestrogen has direct effects on the amygdala — the brain’s threat-detection centre — and on GABA receptors that regulate anxiety. When oestrogen fluctuates erratically, as it does in perimenopause, the anxiety threshold drops. The nervous system becomes more reactive to triggers that it would previously have handled without difficulty.

There is also a physical component: hot flashes themselves can trigger panic. The sudden rush of heat, a racing heart, and shortness of breath during a flash can set off a panic response in a brain that interprets these sensations as danger. Some women have panic attacks that are essentially their nervous system misreading hot flash sensations as a medical emergency.

The most important first step is getting properly assessed. Rule out thyroid disorders (hyperthyroidism causes anxiety and palpitations), anaemia, and cardiac causes — a doctor can do this with a blood test and ECG. Once other causes are excluded, perimenopause-related anxiety has effective treatments.

Options include: HRT (particularly if hot flashes are triggering the panic), antidepressants prescribed by a doctor, and CBT — Cognitive Behavioural Therapy — which has excellent evidence specifically for perimenopause-related anxiety. iCall (9152987821) offers accessible mental health support in India. Please don’t try to manage this alone.