Best Supplements for Perimenopause Anxiety
A guide to the best supplements for perimenopause anxiety, including magnesium, ashwagandha, L-theanine, and B vitamins, with practical dosage notes.
Why Anxiety Increases During Perimenopause
Anxiety is one of the most frequently reported but least expected symptoms of perimenopause. Many women who have never previously experienced significant anxiety find it emerging during their 40s, sometimes before other more recognisable symptoms like hot flashes or irregular periods. The reason is hormonal. Oestrogen modulates the production and sensitivity of serotonin, GABA, and dopamine, the neurotransmitters that regulate mood and fear responses. As oestrogen levels fluctuate unpredictably during perimenopause, these neurotransmitter systems become less stable, and the threshold for anxiety is lowered. Progesterone, which has a naturally calming effect via GABA pathways, also declines during this period, removing another layer of protection against anxious states. Supplements cannot replace the effects of lost hormones, but several have meaningful evidence for reducing the severity and frequency of anxiety symptoms.
Magnesium Glycinate: The Foundational Option
Magnesium is the supplement most consistently recommended for anxiety during perimenopause, and for good reason. A large proportion of women are deficient in magnesium due to dietary gaps, and deficiency directly lowers the threshold for anxiety and nervous system reactivity. Magnesium glycinate is the most bioavailable and well-tolerated form. It supports GABA activity in the brain, which has a calming effect on the nervous system, and it also reduces the physical symptoms of anxiety such as muscle tension, racing heart, and the inability to relax. Doses of 200 to 400mg taken in the evening tend to work best because the calming effect also supports sleep. Most women notice improvement within two to four weeks of consistent daily use.
Ashwagandha: Targeting Cortisol and Stress Reactivity
Ashwagandha is the most studied adaptogen for anxiety and stress resilience. Multiple randomised controlled trials have shown it reduces self-reported anxiety scores, lowers morning cortisol levels, and improves stress tolerance over four to eight weeks. During perimenopause, cortisol dysregulation is a specific driver of anxiety, particularly the type that feels like persistent background tension or an inability to switch off. KSM-66, a standardised ashwagandha extract with a 5 percent withanolide content, is the most researched form and is widely available in the UK and internationally. A typical effective dose is 300 to 600mg per day. Some women take it in the morning to support daytime stress resilience; others take it in the evening to support the cortisol drop needed for relaxed sleep.
L-Theanine: Fast-Acting Calm
L-theanine is an amino acid that promotes alpha brain wave activity, associated with a relaxed and alert mental state. Unlike sedating supplements, L-theanine does not cause drowsiness, which makes it useful for anxiety experienced during the day, including the anxious anticipation, social anxiety, or generalised worry that some women experience during perimenopause. It can be taken as needed rather than daily, making it a flexible option. A dose of 100 to 200mg works within 30 to 60 minutes for most people. Some women take it before situations they expect to find stressful, such as important meetings or social events. It combines well with magnesium for a non-pharmaceutical approach to evening anxiety and sleep difficulty.
B Vitamins and Their Role in Nervous System Health
The B vitamin group is essential for neurotransmitter synthesis, including serotonin and GABA. B6 in particular is a cofactor in the production of serotonin and dopamine, and deficiency is associated with increased anxiety, irritability, and low mood. B12 deficiency can also present with anxiety and fatigue, and absorption of B12 declines with age. A good quality B-complex supplement that provides methylated forms of B12 (methylcobalamin) and folate (methylfolate) is preferable to cheaper versions using synthetic cyanocobalamin and folic acid, particularly for women who carry MTHFR gene variants affecting folate metabolism. Taking B vitamins with food in the morning avoids any potential stimulating effect that might interfere with sleep.
Saffron: An Emerging Option for Mood and Anxiety
Saffron extract has a growing body of evidence as a natural support for mood and anxiety, with several clinical trials showing results comparable to low-dose antidepressants for mild to moderate symptoms. It appears to work primarily by modulating serotonin reuptake, similar in mechanism to SSRIs but with a much gentler effect profile. For women experiencing the low-grade but persistent anxiety and low mood that accompanies perimenopause, saffron is worth considering. A standardised extract dose of 30mg per day is typically used in studies. It is more expensive than most supplements on this list and less widely available, but can be found from specialist UK supplement retailers. It should not be combined with SSRIs or SNRIs without discussing with a GP.
What Supplements Cannot Replace
Supplements are most useful as part of a broader approach to managing perimenopause anxiety. Regular exercise, particularly aerobic activity and strength training, has a well-established anxiolytic effect. Consistent sleep significantly reduces anxiety reactivity. Limiting caffeine and alcohol, both of which destabilise mood and hormone balance, often provides more relief than any supplement. If anxiety is severe, persistent, or significantly affecting daily function, a conversation with a GP is important. HRT addresses the hormonal root cause for many women, and the relief from anxiety is often described as one of its most notable effects. Tracking symptoms daily allows you to see whether your anxiety has a hormonal pattern, with peaks at certain points in an irregular cycle, which is useful information to share with a clinician. PeriPlan lets you log symptoms over time so that patterns become visible.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.