One of the things I hear so often from women in perimenopause and menopause is, "I've never been an anxious person, so why am I suddenly anxious about everything?" I think we need to be careful about simply labelling this as anxiety and treating it as though it has appeared from nowhere, because sometimes when we actually stop and look at what is happening, the anxiety makes complete sense.

Think about brain fog for a moment. You forget a word halfway through a sentence, walk into a room and cannot remember why you went there, lose your train of thought in a meeting or forget an appointment you would never normally have forgotten. If you have always been the person who remembers everything, organises everyone else and keeps all the plates spinning, suddenly not being able to rely on your brain in quite the same way can be frightening. You might start checking yourself more, worrying about making mistakes or wondering whether other people have noticed. Of course that can make you anxious.

The same is true of irritability and overwhelm. Perhaps you have always coped with a busy house, a demanding job, family responsibilities and a never ending list of things that need doing, but suddenly it all feels too much. There are too many people talking, the television is on, your phone is pinging and someone asks you another question when you are already trying to hold five other things in your head. You snap, perhaps at someone you love, and then feel terrible afterwards. Now you are not only overwhelmed, you are anxious about your reaction, guilty about what you said and possibly wondering why you no longer feel like yourself.

Add disrupted sleep into that picture and it is not difficult to see how anxiety can begin to build. If you are waking repeatedly during the night, lying awake at 3am thinking about everything you need to do, and then trying to function the following day on very little sleep, your capacity to manage everything else is going to be affected too. For some women anxiety is also very physical, with palpitations, tension, restlessness, a churning stomach or that horrible sense of dread when you cannot actually identify what you are frightened of.

So yes, you may be experiencing anxiety, but I am interested in why.

This is where my EMDR brain gets curious

One of the things I love about EMDR is that we do not just look at what somebody is experiencing in the present. EMDR is underpinned by the Adaptive Information Processing model, or AIP model, which helps us think about how present experiences can connect with earlier experiences, emotions, bodily sensations and beliefs about ourselves.

Imagine, for example, that your brain goes blank during an important meeting. The immediate problem might be menopausal brain fog, but what happens next will be different for every woman. One woman might find it irritating, recover her train of thought and move on. Another might immediately think, "Everyone thinks I'm incompetent." That thought may then connect with something much older, perhaps years of believing "I'm stupid," "I'm not good enough," or "I have to work twice as hard as everyone else."

Now we are looking at something more complicated than brain fog alone. Something happening in the present may be activating an older memory network, and the emotional response can therefore feel much bigger than the situation in front of us might suggest.

That does not mean that menopause suddenly releases all of our unresolved trauma, and it certainly does not mean that every menopausal woman experiencing anxiety needs EMDR. I think it is much more nuanced than that. What it does mean is that we need to understand the whole woman and the context in which her anxiety is occurring, rather than immediately seeing anxiety as a standalone problem that needs to be removed.

What about neurodivergence?

This becomes particularly interesting when we think about neurodivergent women. Many women have spent decades finding ways to compensate for differences in attention, working memory, executive functioning, sensory processing or emotional regulation, sometimes without ever knowing that this is what they were doing. They may have become incredibly organised, made endless lists, checked and double checked everything, prepared far more than everyone else, masked their difficulties or simply pushed through when their brain and body were telling them they had reached capacity.

Those strategies take energy, and when perimenopause arrives some women find that the strategies which have held everything together for years no longer work quite as effectively. Sleep may be poorer, working memory may become less reliable, sensory tolerance may change and emotional regulation can become harder. If you are still expecting yourself to work, parent, care, organise and function at exactly the same level while your available capacity has changed, it is hardly surprising that anxiety and overwhelm can follow.

This is why I think it is important that we do not automatically interpret these changes as a woman suddenly becoming less capable. Perhaps she is having to use considerably more cognitive and emotional energy to achieve what previously required less effort, and perhaps her nervous system is telling us that the way she has always managed things is no longer sustainable.

Looking beyond the anxiety

When a woman tells me that she has suddenly become anxious during menopause, I therefore want to know much more than whether she meets the criteria for an anxiety disorder. I want to know what has changed. How is she sleeping? What is happening with her memory and concentration? Is she overwhelmed by demands that she previously managed? Has her sensory tolerance changed? Is she trying to maintain exactly the same workload despite having less available capacity? Could there be previously unrecognised neurodivergence? What meaning is she making of these changes, and does what is happening now connect with anything she has experienced or believed about herself before?

Sometimes the answer will be predominantly hormonal, sometimes psychological, sometimes relational or environmental, and very often there will be several things interacting at once. For me, that is why understanding menopause requires us to think about hormones, the brain, the nervous system, neurodivergence, our current circumstances and our previous experiences together rather than trying to separate them into neat little boxes.

This is also at the heart of why I wrote When Everything Feels Different: Understanding Perimenopause, Menopause, Neurodivergence and the Nervous System. I wanted to explore what happens when we bring all of these pieces into the same conversation through an EMDR lens, because women do not arrive at menopause as blank slates. We arrive with a nervous system that has lived a life, carrying our experiences, relationships, ways of coping, neurotype and beliefs about ourselves, as well as all the strategies we have developed over many years to keep functioning.

So when a woman says to me, "I don't know what's wrong with me. I've suddenly become so anxious," I don't want to rush to tell her how to get rid of the anxiety. I want us to become curious about it. What has changed? What is happening underneath it? What might be getting activated, and what does her brain and nervous system need now?

Sometimes understanding why everything suddenly feels different is an important part of beginning to feel like yourself again.