Social Anxiety During Perimenopause: Practical Tips That Help
Social anxiety often increases during perimenopause. These practical strategies help you stay connected and manage anxious feelings in social situations.
Preparation reduces the unpredictability
A significant part of social anxiety is fear of the unpredictable: what will happen, how will I feel, what if I have a hot flash, what if my mind goes blank. Reducing uncertainty before a social event can lower the baseline anxiety going in. Knowing the venue, what the event involves, who will be there, and roughly how long it will last all help. Choosing clothes you are comfortable in that can be layered for temperature management also reduces one variable. Having a plan for stepping outside briefly if you need to cool down or collect yourself gives you a sense of control that lowers the overall threat level of the event.
Breathing as a quick regulation tool
Controlled breathing is one of the most accessible tools for managing an anxiety response in a social setting. A slow exhale, longer than the inhale, activates the parasympathetic nervous system and reduces the physical sensation of anxiety relatively quickly. Breathing in for four counts, holding for one or two, and exhaling for six or seven counts is a pattern many people find effective. It is subtle enough to practise without drawing attention. If you feel an anxious surge starting, even in the middle of a conversation, a few deliberate breaths can take the edge off the physical intensity without requiring you to leave the situation.
Limiting alcohol and caffeine
Both alcohol and caffeine can worsen social anxiety during perimenopause. Alcohol is a common social prop for anxiety, but it disrupts sleep, increases hot flash frequency, and creates a rebound effect that heightens anxiety the following day. Caffeine stimulates the nervous system in ways that can mimic or amplify anxious sensations. Reducing both, particularly on days leading up to and including social events, can make a noticeable difference to your baseline reactivity. Sparkling water with fruit or a non-caffeinated herbal drink tends to manage the social drinking question without drawing attention.
Tracking your anxiety patterns alongside your symptoms
Social anxiety that appears to fluctuate without obvious cause often tracks closely with the hormonal cycle in perimenopause. Some women notice their anxiety is significantly worse in the week before a period, or in the days following a run of poor sleep. When you track symptoms including mood and anxiety levels over time, patterns start to emerge that make the fluctuations feel less random and more manageable. Apps like PeriPlan allow you to log symptoms regularly and see how they shift, which can help you anticipate harder periods and plan accordingly rather than being caught off guard.
When to seek additional support
If social anxiety is significantly limiting your life, causing you to withdraw from relationships, avoid work situations, or feel persistently distressed in social contexts, that is a signal to seek professional support. A GP can discuss whether the anxiety has a hormonal component that might respond to treatment, including HRT in some cases. A therapist who works with anxiety can provide tools that go beyond the practical strategies in this article. Cognitive behavioural therapy in particular has a strong evidence base for social anxiety and is worth exploring. You do not have to wait until the anxiety is severe to ask for help. Earlier intervention tends to produce faster results.
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