Does omega-3 help with anxiety during perimenopause?

The evidence that omega-3 fatty acids, particularly EPA (eicosapentaenoic acid), may reduce anxiety is more robust than most people expect, and the mechanisms are relevant to what happens in perimenopause specifically. This is one area where supplement research has produced reasonably consistent results across multiple studies.

Omega-3 fatty acids work on anxiety through at least two documented pathways. First, EPA competes with arachidonic acid for COX-2 enzymes, reducing the production of pro-inflammatory prostaglandins (PGE2) and leukotrienes (LTB4). This matters because elevated inflammatory markers, including IL-6 and TNF-alpha, are consistently found in people with anxiety disorders and are elevated during perimenopause as estrogen's anti-inflammatory effects decline. Reducing this inflammatory burden appears to dampen one input that amplifies anxiety signaling in the brain. Second, EPA and DHA (docosahexaenoic acid) influence the hypothalamic-pituitary-adrenal (HPA) axis, which governs the cortisol stress response. Research suggests omega-3s help moderate HPA axis reactivity, reducing the cortisol spike that anxiety generates.

A 2011 meta-analysis by Sublette and colleagues found that EPA specifically was associated with significant antidepressant effects, which frequently overlap with anti-anxiety effects given the shared neurochemical pathways. A study by Fontani and colleagues in 2005 found that 4 grams per day of omega-3 supplementation improved mood and reduced anxiety symptoms alongside better cognitive function in healthy adults. Studies have examined doses ranging from 1 to 4 grams of combined EPA and DHA daily for mood-related outcomes, with EPA-dominant formulations generally showing more consistent effects in the mood literature. Talk to your healthcare provider about the right dose for your situation.

The perimenopause context adds a layer of relevance. Estrogen modulates serotonin and GABA systems that calm anxiety. As estrogen fluctuates and declines, these natural buffers become less reliable, leaving the nervous system more reactive. Omega-3s support neuronal cell membrane fluidity, which affects receptor sensitivity for neurotransmitters including serotonin. This structural role in brain function is why DHA is so concentrated in neural tissue.

There is an important distinction between EPA and DHA for anxiety. EPA appears more relevant for mood and anxiety through its anti-inflammatory role, while DHA is more important for structural brain health and cognition. For anxiety specifically, fish oil products with higher EPA relative to DHA may be worth discussing with your provider. Plant-based omega-3 sources like flaxseed and chia provide ALA (alpha-linolenic acid), but the body converts only about 5 to 15% of ALA into EPA and DHA, making them a less efficient option if targeting mood symptoms.

For supplementation, choosing a molecularly distilled fish oil ensures mercury and other heavy metals are removed during processing. Taking omega-3s with meals reduces the likelihood of fishy aftertaste. Enteric-coated capsules are another option for the same reason.

It takes consistent use over 4 to 8 weeks before most people can fairly assess whether omega-3s are influencing anxiety symptoms. Tracking anxiety severity daily gives you objective data to evaluate rather than relying on memory.

The PeriPlan app lets you log mood and anxiety patterns over time, which can help you see whether supplementation alongside other lifestyle changes is moving the needle.

When to see a doctor: If anxiety is severe, persistent, interfering with daily life, or accompanied by panic attacks, it deserves a direct evaluation by a healthcare provider rather than a supplement-first approach. A provider can assess whether anxiety has a perimenopausal hormonal driver, a primary anxiety disorder component, or both, and discuss evidence-based options including hormone therapy, cognitive behavioral therapy, or medications. Also discuss omega-3 supplementation with your provider if you take blood thinners or have a clotting disorder, as high doses above 3 grams per day of EPA and DHA may mildly increase bleeding risk.

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