Catastrophising in Perimenopause: Why Your Brain Expects the Worst
Catastrophising spikes in perimenopause due to hormone changes. Learn why your brain goes to worst-case scenarios and how to interrupt the pattern.
When your brain leaps to the worst possible outcome
You notice a new symptom and immediately assume something is seriously wrong. A difficult conversation at work replays in your head until it becomes a catastrophe. A headache becomes a brain tumour. A missed call becomes a crisis. If your thinking has started to spiral more easily than it used to, you may be experiencing catastrophising. It is one of the most common but least acknowledged mental health shifts during perimenopause.
The hormone connection
Estrogen has a stabilising effect on the amygdala, the part of your brain responsible for threat detection and fear responses. As estrogen levels fluctuate during perimenopause, the amygdala can become more reactive. Your brain's threat radar gets turned up, and it starts interpreting ambiguous situations as dangerous. At the same time, the prefrontal cortex, which helps you apply rational perspective to those fear signals, becomes less effective at doing its job. The result is a brain that is primed to expect the worst.
How to recognise catastrophising in yourself
Catastrophising often feels like realistic thinking in the moment. The thoughts come with a sense of certainty and urgency that makes it hard to dismiss them as exaggerated. Common signs include frequently imagining the worst possible outcome before you have enough information, struggling to accept reassurance even when it is offered, mentally rehearsing disasters that haven't happened, and feeling that if you stop worrying you are somehow leaving yourself unprotected. Another marker is the speed of the spiral: a neutral event becomes a disaster within seconds, without any real evidence to support the leap. The brain in perimenopause can move from observation to catastrophe almost instantaneously, and recognising that speed as a sign of hormonal dysregulation rather than accurate prediction is genuinely useful.
The cost of catastrophising
Catastrophising is exhausting. It keeps your nervous system in a low-level state of alarm that drains your energy and disrupts your sleep. It also tends to be self-reinforcing. The more you rehearse worst-case scenarios, the more familiar and plausible they feel. Over time it can erode your confidence in your own judgement and make you more avoidant of situations that feel unpredictable. You might start declining invitations, postponing decisions, or over-preparing for conversations because the anxiety of not controlling the outcome feels unbearable. Recognising catastrophising as a symptom of perimenopause rather than an accurate assessment of reality is an important first step toward interrupting it.
Practical ways to interrupt the spiral
When you notice a thought spiralling, try asking yourself three questions. What is the actual evidence for this outcome? What is a more likely explanation? What would I say to a friend who was thinking this? Writing the answers down rather than just running them through your head tends to be more effective, because it slows the thinking process down. Another useful technique is to set a specific time limit for worry. Give yourself ten minutes to think through the concern, then deliberately redirect your attention.
Using symptom tracking as a reality check
One reason catastrophising is so persistent is that perimenopause does produce real symptoms, which can make it harder to distinguish between genuine concern and anxious amplification. Logging your symptoms daily in PeriPlan gives you an accurate record of what is actually happening over time. When you can look back and see a pattern, it becomes easier to say with confidence that the headache you had last Tuesday was not something serious, it was a symptom that has come and gone before. Data is a useful antidote to catastrophic thinking.
Getting support that works
Cognitive behavioural therapy is particularly effective for catastrophising because it directly targets the thinking patterns involved. A therapist can help you identify the specific thought traps you fall into and build more accurate, balanced responses to them. If your catastrophising is severe or significantly affecting your quality of life, speak to your GP about all your options including HRT, which many women find reduces the anxiety and reactivity driving catastrophic thinking. You are not stuck with this pattern. Many women are genuinely surprised by how quickly catastrophic thinking reduces once their hormone levels are more stable, because the physiological basis for the brain's threat overreaction is directly addressed. Treat the cause, not just the symptom.
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