Perimenopause and the Nervous System: Why Everything Feels Like Too Much

When the Volume Gets Turned Up on Everything

You used to handle noise without thinking. Now the sounds of your household feel like an assault. Bright light bothers you in ways it never did. Crowded spaces are suddenly overwhelming when they were once fine. Your threshold for frustration has dropped so low that a minor inconvenience can send you into a spiral that takes hours to recover from.

This is not anxiety in the traditional sense. It is not a personality change. It is nervous system dysregulation, and it is one of the least-discussed but most pervasive aspects of perimenopause. Understanding what is happening physiologically can make it feel less like you are going crazy and more like what it actually is: a tractable biological process that responds to specific interventions.

Estrogen and the Nervous System: What You Lose as It Drops

Estrogen is not just a reproductive hormone. It is a neuroactive steroid with significant effects throughout the central and peripheral nervous system. Estrogen receptors are present in the brain's limbic system, including the amygdala, which processes threat and emotional reactivity, and the hippocampus, which is involved in memory and emotional context.

Estrogen promotes serotonin production and reduces serotonin reuptake, essentially acting as a natural antidepressant. It supports GABA signaling, the primary inhibitory neurotransmitter that reduces neural excitability and promotes calm. It also modulates norepinephrine, the neurotransmitter associated with the fight-or-flight response.

As estrogen fluctuates and declines in perimenopause, all of these regulatory functions become less stable. Your brain becomes more reactive. Your stress response activates more easily and takes longer to resolve. Your baseline level of neural excitability rises. The result is that your nervous system is operating with less buffering, less inhibition, and more sensitivity across the board. This is the biological basis for the feeling that everything is too much.

Progesterone, GABA, and the Calm You've Lost

Progesterone deserves specific attention here. Progesterone is metabolized in the body into a compound called allopregnanolone. Allopregnanolone is a potent positive modulator of GABA-A receptors, the same receptors targeted by benzodiazepines and alcohol. In other words, progesterone effectively produces a natural calming, anti-anxiety effect through this metabolite.

In perimenopause, progesterone often drops before estrogen does. The luteal phase, the second half of the cycle where progesterone is typically produced, becomes shorter and more erratic as ovulation becomes irregular. This means the natural calming effect of progesterone is reduced and unreliable earlier in the transition than most people expect.

The premenstrual anxiety that many perimenopausal women describe, the week before a period that is suddenly much harder than it ever was, is often a progesterone drop signal. When progesterone is low, allopregnanolone is low, GABA activity is reduced, and the nervous system becomes more excitable. For women with prior premenstrual dysphoric disorder, perimenopause can intensify this pattern significantly.

The Hypervigilance State

Many women in perimenopause describe a persistent state that is not quite anxiety but feels like being always slightly on alert. Ready for something to go wrong. Scanning for problems. Startling easily. Responding to ordinary events with a level of internal intensity that seems disproportionate.

This is hypervigilance, and it corresponds to a nervous system stuck in sympathetic activation. The sympathetic nervous system is the one responsible for fight-or-flight responses. It is meant to activate acutely in response to threat and then resolve when the threat passes. When it stays elevated chronically, which is exactly what reduced estrogen and progesterone can cause, the result is persistent low-grade hyperarousal.

Living in this state is exhausting. It depletes the same neurotransmitter and hormonal resources that are already being depleted by perimenopause itself. It increases cortisol, which further destabilizes sleep and mood. And it creates a physiological state in which genuine rest and recovery are very difficult to achieve, because the system cannot downregulate efficiently on its own.

Sensory Sensitivity in Perimenopause

The sensory sensitivity that many perimenopausal women experience, to noise, light, smell, touch, and social demand, follows directly from nervous system dysregulation. When the inhibitory systems that regulate sensory processing are running low, ordinary sensory input can feel overwhelming.

This is clinically distinct from sensory processing disorder, though it shares characteristics. It is driven by a change in the gain settings of the nervous system rather than a developmental difference in how the brain processes sensation. The good news is that this means it is more responsive to interventions that directly address nervous system state.

Many women also notice changes in their tolerance for emotional and social stimulation. Being around people, managing others' emotional needs, large gatherings, or even busy environments that never used to bother them can feel depleting in ways that were not true before. This is not introversion. It is resource depletion. The nervous system is spending more energy on basic regulation, leaving less available for processing complex social environments.

Polyvagal Theory and Why It Matters

Polyvagal theory, developed by neuroscientist Stephen Porges, provides a useful framework for understanding nervous system states and why certain interventions work. The theory describes three main nervous system states: the ventral vagal state (safe and social, calm and connected), the sympathetic state (mobilized for fight or flight), and the dorsal vagal state (shutdown, freeze, disconnected).

In perimenopause, reduced estrogen and progesterone make it harder to access and maintain the ventral vagal state. The threshold for dropping into sympathetic activation is lower, and recovery back to ventral vagal takes longer. Some women describe also entering dorsal vagal states more easily, particularly the emotional numbness, fatigue, and disconnection that can accompany perimenopause.

What polyvagal theory adds to this picture is the concept of neuroception, your nervous system's ongoing unconscious assessment of safety. Practices that signal safety to your nervous system, through social connection, rhythm, voice, movement, and breath, directly address the regulatory problem at its root. This is why certain specific practices, rather than general relaxation, are more effective.

Regulation Practices: Beyond Just Breathing

Breathing is genuinely useful, and the next article in this series covers specific techniques in detail. But there are nervous system regulation practices that target different pathways and can be used alongside breathwork.

Vagus nerve stimulation through the throat and voice is direct and underused. Humming, singing, gargling, or even just sighing audibly activates the vagus nerve at a physiological level. These are not metaphors. The vagal fibers in the larynx and pharynx are directly activated by these actions. Two to three minutes of humming can measurably shift autonomic state for some people.

Rhythmic movement is another pathway. Slow, rhythmic, bilateral movement, such as walking at a comfortable pace, gentle rocking, or swimming, uses the same neural circuits involved in self-regulation. This is one reason walking is so consistently effective for anxiety and mood, beyond its cardiovascular benefits.

Cold water to the face activates the dive reflex, which is a parasympathetic response that slows heart rate and reduces sympathetic activation almost immediately. Splashing cold water on your face during a moment of overwhelm is not just refreshing. It is physiologically active.

Eye movements and panoramic vision also shift nervous system state. High stress tends to create tunnel vision and focused gaze. Deliberately softening your gaze and taking in the periphery of your visual field, looking at a horizon or a wide open space, activates a calming neural response associated with safety and orientation.

Rest as Medicine, Not Indulgence

A nervous system in chronic dysregulation cannot repair itself during ordinary activity. It requires genuine downtime, the kind that is qualitatively different from just sitting on the couch watching television. True rest means low sensory input, low demand, and low performance pressure.

For women in perimenopause, this kind of rest is often the thing they are least willing to give themselves. The internal narrative that they should be able to handle their normal life, that resting is giving in, or that there is too much to do to stop, is a significant obstacle to recovery.

The reframe that is clinically useful is this: rest is a therapeutic intervention for a measurable physiological condition, not a lifestyle preference. When your nervous system has lost its regulatory buffer because of hormonal changes you did not choose, the biological need for restoration is greater than it was before. Meeting that need is not weakness. It is treatment.

PeriPlan can help you track your nervous system patterns alongside your cycle, so you can see when your most dysregulated periods occur and plan your schedule accordingly. Matching lower demand to lower capacity windows is a legitimate management strategy, not avoidance.

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