Does evening primrose oil help with anxiety during perimenopause?

Evening primrose oil (EPO) is sometimes used for perimenopause-related anxiety, but the direct evidence for this specific use is limited. The theoretical rationale is plausible and worth understanding, but you should go into any EPO trial with realistic expectations about what current research supports.

EPO's active compound is GLA, gamma-linolenic acid, an omega-6 fatty acid. In the body, GLA converts to DGLA (dihomo-gamma-linolenic acid), which then feeds into the production of prostaglandin E1 (PGE1). PGE1 has anti-inflammatory effects and is thought to have calming properties on the nervous system. Separately, GLA metabolism helps moderate the production of PGE2, a more inflammatory prostaglandin. This shift in prostaglandin balance toward a less inflammatory state may reduce neuroinflammation, which some researchers believe contributes to mood and anxiety symptoms.

Anxiety during perimenopause has multiple drivers. Erratic estrogen fluctuations directly affect the amygdala, the brain region that processes threat and fear, and can amplify its sensitivity. Estrogen also modulates serotonin and GABA receptor activity. When estrogen swings unpredictably, those neurotransmitter systems become less stable, which can present as heightened anxiety, restlessness, irritability, or a sense of dread without an obvious external cause. Poor sleep, which is nearly universal in perimenopause, also amplifies anxiety significantly.

The honest assessment of the evidence is that no large randomized controlled trial has tested EPO specifically for anxiety in perimenopausal women as a primary outcome. The anti-inflammatory and prostaglandin-modulating mechanisms provide theoretical support, but theoretical support is not the same as clinical proof. Most of the positive evidence for EPO in women's health comes from hot flash and breast pain research. For anxiety specifically, the evidence is indirect and relies heavily on the neuroinflammation hypothesis rather than direct clinical data. Some smaller studies and case reports describe improvements in emotional symptoms with EPO, but these are far from definitive and should be weighed accordingly.

EPO is available in softgel capsules. Studies on menopausal symptoms have used doses ranging from 500 mg to 3000 mg daily, often split into two doses. Talk to your healthcare provider about the right dose for your situation.

If you have or have had a hormone-sensitive condition such as breast cancer, endometriosis, or uterine fibroids, discuss this supplement with your healthcare provider before using it. EPO contains GLA, which has mild estrogenic-pathway interactions, and caution is appropriate in hormone-sensitive conditions.

EPO may interact with blood thinners and anticoagulants, including warfarin and aspirin, by adding to their blood-thinning effect. Tell your prescriber if you take any of these medications. EPO also appears to lower the seizure threshold and may reduce the effectiveness of anticonvulsant medications. If you have epilepsy or take seizure medications, do not use EPO without direct guidance from your neurologist or prescribing physician.

For most women, if EPO is going to have any effect on anxiety, changes tend to be gradual rather than immediate. Give it at least six to eight weeks of consistent use before evaluating. Because anxiety naturally fluctuates with stress, sleep, and cycle phase, tracking anxiety severity daily alongside those variables helps you distinguish a real trend from normal ups and downs. Rate your anxiety on a simple 1-to-10 scale each day and note how well you slept and where you are in your cycle, because that combination of data makes it much easier to see whether EPO is contributing to any improvement or whether other factors explain the change.

If EPO does not address the underlying hormonal instability driving anxiety in perimenopause, it may provide only modest benefit at best. Evidence-supported alternatives worth discussing with your provider include hormone therapy (which addresses the hormonal root cause), certain antidepressants effective for anxiety and approved for perimenopausal use, cognitive behavioral therapy, and regular aerobic exercise, which has strong evidence for anxiety reduction. Magnesium glycinate is another supplement with a reasonable evidence base for anxiety that works through GABA pathways and carries fewer interaction concerns than EPO.

See a doctor if anxiety is interfering with sleep, work, or relationships; if you are experiencing panic attacks; or if anxiety feels chronic and unmanageable. Perimenopause-related anxiety can be treated effectively, and no supplement should be a substitute for a clinical conversation about it.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.