When Everything Feels Harder: Understanding Stress Tolerance in Perimenopause

If you’ve noticed that your ability to cope with stress just isn’t what it used to be — you’re not imagining it. Many women describe feeling like they get overwhelmed by things that never bothered them before or like the smallest things can tip them over the edge emotionally. While it’s easy to blame busy schedules or the demands of modern life, there’s a very real physiological reason behind this change: perimenopause alters how the body responds to stress.

Hormones, the brain, and the stress connection

The stress response is governed by the HPA axis — a communication pathway between your hypothalamus, pituitary and adrenal glands. Its job is to keep you alive and balanced by releasing stress hormones like cortisol and adrenaline in response to perceived threats.

During perimenopause, levels of oestrogen and progesterone begin to fluctuate, and both of these hormones directly influence the HPA axis.

• Oestrogen generally helps modulate the stress response — keeping cortisol levels stable and supporting mood and resilience.

• Progesterone has naturally calming effects on the brain and nervous system through its interaction with GABA receptors (the same ones that help promote relaxation and sleep).

As these hormones become less predictable, so too does your stress response. The brain becomes more sensitive to stress signals, cortisol regulation can become erratic, and you might feel more easily overwhelmed by things that once felt manageable.

Why perimenopausal stress feels different

The stress response doesn’t operate in isolation. It’s closely linked with:

• Sleep: Night sweats, early waking and disrupted sleep make cortisol regulation harder and increase fatigue and irritability.

• Blood sugar: Cortisol and insulin influence each other — unstable blood sugar can worsen anxiety, cravings and mood swings.

• Inflammation: Chronic stress increases inflammation, which in turn affects hormonal balance and neurotransmitter production.

• Nervous system sensitivity: The brain’s alarm system (the amygdala) becomes more reactive when oestrogen drops, amplifying feelings of anxiety or emotional intensity.

This combination creates what many women describe as a “shorter fuse” — a reduced capacity to adapt to everyday challenges.

Rebuilding resilience through the HPA axis

Supporting your stress tolerance in perimenopause isn’t about avoiding stress altogether, luckily as this just isn't realistic! It’s about improving the body’s ability to recover from it and building in some resilience where you can.

1. Prioritise restorative sleep - Good sleep is the foundation for cortisol balance. Aim for regular sleep–wake times, reduce screen exposure before bed, and create an evening routine that signals it's time to wind down. If night sweats or early waking are issues, herbal or nutritional support maybe able to help.

2. Eat to stabilise blood sugar - Include protein, fibre and healthy fats at each meal to reduce blood sugar swings. Skipping meals or relying on caffeine for energy can elevate cortisol and worsen anxiety.

3. Move in ways that regulate, not deplete - Movement helps modulate the stress response, but too much intensity can backfire. Balance strength training or cardio with yoga, pilates or walking to support both physical and nervous system resilience.

4. Support your nervous system - Gentle practices that activate the vagus nerve like deep breathing, meditation, singing, spending time outdoors all help shift the body out of “fight or flight” mode.

5. Consider nutritional and herbal support - Magnesium, B vitamins and adaptogenic herbs like Withania (Ashwagandha) or Rhodiola can help regulate the HPA axis and support recovery from ongoing stress. Always seek individualised guidance before starting new supplements or herbal medicines.

The bigger picture

Reduced stress tolerance in perimenopause isn’t a character flaw or a lack of resilience, it’s a physiological change. Your brain and body are recalibrating to a new hormonal environment, and that takes energy. By supporting sleep, nutrition, nervous system balance and emotional space, you can rebuild the resilience that feels like it’s gone missing and move through this transition feeling steadier, calmer and more capable.

If you need support

If you’ve been feeling more reactive, anxious or fatigued, and you’re ready to understand what’s really driving it, I can help. Through comprehensive assessment and personalised care, we’ll look at the underlying factors - from hormonal patterns to nervous system regulation and create a plan to restore calm and balance.

You can learn more or book an appointment here.