When Annie* started pacing around her house at 3am and struggling to find words during work meetings, she put it down to stress and perimenopause. She wasn’t entirely wrong. But it wasn’t the whole story.
At 43, she was juggling a full-time job as a hospitality HR manager, three teenage children and the endless demands of family life. Like many women in midlife, she felt stretched in every direction. “I was doing long hours at work, running around with kids’ activities and household chores. I wasn’t sleeping well. Then I’d get up feeling exhausted and spend the day dealing with headaches, mood swings, hot flushes and brain fog. I went around in circles for six months feeling like my world was imploding.”
After speaking with friends and reading about the symptoms online, Annie became convinced she was in the depths of perimenopause. One friend’s advice seemed particularly appealing. “She said, ‘When the kids are in bed, run yourself a bath, pour yourself a glass of wine and then get into bed.’ At the time, it sounded like the perfect way to end the day.”
At first, Annie felt it was helping. She would often have a glass of wine with dinner to unwind after a stressful day. But the glass before bed soon became two. Then three. What had started as a way to relax gradually became a nightly ritual. “It seemed to quiet the racing thoughts I was having at that time of night and make it easier to fall asleep.”
While alcohol can initially make people feel sleepy, it often disrupts sleep later in the night, leading to poorer sleep quality and early waking with increased fatigue the following day. For women already experiencing sleep disruption because of perimenopause, alcohol can make an already challenging situation significantly worse.
Annie confessed that over a few short weeks her consumption increased. “I didn’t really think it was a problem – I told myself I was simply helping myself fall asleep. My husband had no idea as he was in bed before I was and up at 5am for work.”
It wasn’t until Annie slept through her alarm and was too sleepy to drive to work that she began to question herself. “I’d always been reliable. I remember sitting in my car later that day thinking, ‘This isn’t me.’”
Annie’s experience reflects what many of us therapists and clinicians see during perimenopause. Fluctuating hormone levels can affect the brain, contributing to memory lapses, poor concentration, anxiety and “brain fog”. These symptoms coincide with the stage of life when career pressures, family responsibilities and relationship stress are at their peak.
Mood changes, sleep disruption and emotional overwhelm can place enormous strain on women during midlife. For some women, like Annie, perimenopause also marks the first time they experience significant anxiety symptoms.
While women can experience all the usual signs of anxiety disorders such as excessive worry and physical signs (sweating, heart racing and shaking), there can be specific anxiety-related signs that can be more common in women. These include difficulty making decisions, increased crying, irritability, mood swings and feelings of guilt or shame.
By the time Annie sought help from her local doctor for her symptoms, she was drinking most nights and feeling paralysed with anxiety. “I still thought perimenopause was the real culprit,” she said. “I didn’t really question the wine because many of my friends seemed to be doing the same thing.”
What Annie didn’t realise was that the very thing she was using to manage her symptoms had become an even bigger problem. The challenge is that many symptoms of perimenopause overlap with the effects of alcohol itself.
Annie’s doctor recommended a residential treatment program after completing an online alcohol addiction self-assessment that can help identify key indicators of alcoholic behaviour. The program gave her something she hadn’t had for months: the time and space to understand what was really happening. Through individual therapy, group counselling and a comprehensive mental health assessment, Annie began to see the pattern clearly. What had started as a way to cope with anxiety, insomnia and stress had evolved into a cycle that was worsening her sleep, anxiety, cognitive functioning and emotional wellbeing.
Treatment focused on both her alcohol use and the anxiety that had been driving it. Annie learned practical strategies to manage racing thoughts, regulate stress and improve her sleep without relying on wine. Over several weeks, Annie learned to meditate, took up yoga and pilates, and began beach walks to relax and reconnect with something she enjoyed. And while she still enjoys the occasional bath at the end of a busy day, she no longer reaches for wine.
Anxiety treatment for women should be personalised and consider specific symptoms and life circumstances. Annie’s treatment plan also included medical support, ongoing psychological therapy and lifestyle changes tailored to her individual needs.
Today, Annie’s sleep is improving. She still experiences hot flushes from time to time, and there are days when the brain fog returns. But the symptoms are no longer as relentless as they once were. She is sleeping more consistently, her anxiety has eased and she feels clearer, more energetic and better equipped to manage the changes that come with perimenopause.
Perimenopause was part of Annie’s story. But it wasn’t the whole story. Many women like Annie can actually find themselves treating symptoms that alcohol is quietly making worse. While sometimes hormones are the explanation, other times they’re only one piece of a much bigger puzzle. It is essential for women to seek professional help to explore the best treatment options for their needs.
*All clients discussed are fictional amalgams
Diane Young is a trauma specialist and psychotherapist with South Pacific Private, a trauma, addiction and mental health treatment centre
