Is it a 'Panic Attack' or a 'Vasomotor Symptom'?"

Why Do Panic Attacks and Menopause Symptoms Feel So Similar?

The main reason panic attacks and menopause symptoms feel similar or happen simultaneously is because of how your hormones interact with your nervous system.

As estrogen levels fluctuate during perimenopause and menopause, they affect neurotransmitters in the brain that help regulate mood, temperature, and stress. And when estrogen dips, you might notice changes in heart rate or body temperature. That heightened sensitivity can make otherwise normal bodily sensations feel sudden, intense, or even alarming.

More specifically, estrogen plays a role in our body’s temperature regulation system, which is why menopause often brings hot flashes and night sweats. Basically, they happen when the brain has a more narrow zone that regulates body temperature, triggering a sudden release of heat. Since the fight-or-flight response can also cause flushing, sweating, and a racing heart, these sensations can feel pretty much identical.

Then add emotional stress and poor sleep — both common during menopause, partly thanks to changes in estrogen — to the pile, which just amplifies symptoms further. When you’re overtired or already feeling on edge, both anxiety and vasomotor symptoms can get more frequent or intense.

Cortisol can also be a big reason why hot flashes and feelings of panic can look alike or overlap. It’s the body’s main stress hormone and a key driver of the fight-or-flight response. During periods of hormonal transition, your stress response might be triggered more easily. That means the body might react as if it’s under threat, leading to symptoms like palpitations, sweating, and shakiness. 

Long story short: These experiences aren’t a sign that something is “wrong” with you. They’re the result of overlapping systems in the body all adjusting to change at the same time.

Spot the Difference: Panic Attacks vs. Hot Flashes and Night Sweats

Because panic attacks and menopause-related vasomotor symptoms share so many physical sensations, it can be hard to tell which one you’re experiencing in the moment. Paying attention to how symptoms start, how long they last, and what’s happening emotionally can offer some helpful clues. 

Here are three ways to tell the difference: 

1. Panic attacks tend to center on fear and urgency. Along with physical symptoms, panic attacks come with an overwhelming sense of dread or impending doom. You might feel suddenly out of control or scared that something serious is happening to your body. Panic attacks are usually triggered by emotional stress, anxious thoughts, or situations that feel threatening, even if the danger isn’t obvious.

2. Night sweats are more about sleep disruption than panic. Night sweats, which are a sign of menopause, can involve waking up drenched in sweat or feeling hot and clammy. While they can be distressing, they aren’t always accompanied by serious anxiety or feelings of fear. The emotional impact often comes after waking, when sleep disruption leads to frustration, fatigue, or worry.

3. Timing can help you piece things together. Panic attacks tend to peak within minutes and then gradually go away. Hot flashes and night sweats, on the other hand, tend to last longer and often follow a familiar pattern. 

If you’re not sure which symptoms you’re experiencing, tracking them can be surprisingly helpful  and make it easier to discuss what’s going on with a healthcare provider if you decide to go that route. 

Why Does Menopause Trigger Anxiety and Panic Symptoms?

Often, menopause isn’t just a physical transition. Shifts in reproductive hormones can change how the brain processes stress, emotion, and bodily sensations, making anxiety and panic symptoms more likely to crop up or intensify during this time.  

Let’s break this down further and explore what could be at play: 

Fluctuations in Estrogen and Progesterone Impact Mood

Estrogen and progesterone help support neurotransmitters like serotonin and GABA, which play big roles in regulating mood. As hormone levels fluctuate during perimenopause and decline in menopause, this balance can be disrupted. 

Progesterone, in particular, has natural calming effects. So as it declines, another buffer against anxiety is removed. This change can leave you feeling more reactive and prone to stress than you were before midlife. 

Sleep Disruptions Lower Emotional Resilience 

Sleep issues are super common during menopause. And, not sleeping well can lower emotional resilience. 

Though things like sleep apnea can become more common, the biggest culprits during this time are hot flashes and night sweats. When these issues result in chronic sleep loss, anxiety can get harder to manage, too. In other words, our brains need adequate rest to regulate emotional responses, like managing anxiety and stress.

Biological Predispositions May Be Involved

Women with a personal or family history of anxiety or depression may be more susceptible to panic symptoms during menopause. Hormonal changes don’t create anxiety out of nowhere, but they can amplify existing tendencies or bring previously well-managed symptoms back to the surface. Similarly, they may be more likely to experience vasomotor symptoms, too.

Stress Can Compound Hormonal Changes

Menopause can happen at the same time as other major life transitions. So all these other stressors, layered on top of hormonal and sleep-related changes, can further strain your nervous system and contribute to anxiety or panic symptoms.

When to Seek Medical Advice: Red Flags and Next Steps

If your symptoms are persistent, worsening, or interfering with daily life, you don’t have to just push through them. Panic symptoms, hot flashes, and night sweats aren’t things you’re expected to “deal with” on your own. And the good news is that there are medical treatment options. Plus, seeking help early can lead to better outcomes. 

In  addition to noticing worsening or persistent symptoms, here are some signs it may be time to seek professional support:

• You’re unsure what’s driving your symptoms. Tracking symptoms to see when they happen, how long they last, and what else is going on at the time can help clarify whether panic, menopause-related changes, or both are unfolding. Providers can use screening tools to better identify the cause of your symptoms.

• Other medical causes should be ruled out. If you’re not sure what the underlying cause is, a medical evaluation can help rule out conditions that can mimic anxiety or panic symptoms, such as thyroid disorders or certain heart-related issues. This can be reassuring and ensures you’re treating the real underlying cause of your symptoms.

• You want a more tailored treatment plan. Working with a provider who understands menopause and anxiety can make a real difference. Menopause-trained clinicians are better equipped to look at the full picture, from hormones, mental health, sleep, and stress. And they can collaborate with you on a treatment approach that fits your needs and goals.

Evidence-Based Strategies for Managing Both Panic and Menopause Symptoms

When panic symptoms and menopause-related changes overlap, the most effective approach is often a layered one. Addressing stress, sleep, hormones, and mental health together can lead to more lasting relief. 

Your holistic treatment approaches may include some combination of:

• Lifestyle strategies. Things like regular exercise, stress-reduction habits, and improved sleep hygiene can help relieve both anxiety and vasomotor symptoms. 

• Cognitive behavioral therapy (CBT). CBT is a form of talk therapy that helps people recognize and change patterns of thinking and behavior that contribute to anxiety and feelings of panic. Research also shows that CBT can reduce the distress associated with hot flashes and night sweats, even when the physical symptoms don’t disappear entirely.

• Non-hormonal medications. Certain non-hormonal treatments, such as selective serotonin reuptake inhibitors (SSRIs), may help ease anxiety while also reducing the frequency or intensity of hot flashes. These options can be especially helpful for women who can’t or prefer not to use hormone therapy.

• Menopausal hormone therapy (MHT). MHT is considered the most effective treatment for vasomotor symptoms like hot flashes and night sweats. For some women, stabilizing hormone levels may also support mood and reduce anxiety symptoms. 

At the end of the day, personalized care is often the best route. Many women find the greatest relief through a combination of approaches tailored to their symptoms, preferences, and overall health. No matter what approach you choose, it can be especially helpful to work with a healthcare provider who can help you build a treatment plan that feels manageable and aligned with your goals.

Ahead, we’ll go over some of these treatment options and lifestyle strategies in great detail. 

How Hormone Therapy Can Help: What to Know About MHT

Menopausal hormone therapy (MHT) works by replenishing hormones to address symptoms of menopause. This includes stabilizing the temperature regulation system and reducing the frequency and intensity of hot flashes and night sweats. 

For some women, hormone therapy may also support mood and ease anxiety symptoms. While MHT isn’t a primary treatment for anxiety or panic disorders, stabilizing hormone fluctuations can make the nervous system feel less reactive, which may indirectly improve emotional well-being.

There are several FDA-approved estrogen (or estradiol) options available, including pills, patches, gels, sprays, and creams. The right form and dose depend on many factors, including symptoms, medical history, and your personal preferences.

Lifestyle and Self-Care Tips for Symptom Relief

Alongside medical interventions, everyday habits can help manage both anxiety and menopause-related symptoms. Small, consistent changes often matter more than dramatic overhauls:

• Move your body. Regular physical activity can help regulate stress hormones and support temperature control. Practices like walking, yoga, stretching, and deep breathing are especially helpful for calming the nervous system.

• Be mindful of common triggers. Caffeine, alcohol, spicy foods, and warm environments can trigger or worsen symptoms for some women. Paying attention to how your body responds can minimize symptom flare-ups without requiring strict rules.

• Prioritize sleep and stress management. Consistent sleep routines, a cool bedroom environment, and stress-reduction practices can improve both emotional resilience and physical symptoms. Even small steps, like winding down before bed, can make a difference.

• Lean on support and reliable information. Connecting with others going through similar experiences — and learning more about menopause — can help you feel less alone and more confident advocating for your health.

Special Considerations: When Symptoms Overlap with Other Conditions

While menopause-related changes and anxiety can explain many overlapping symptoms, it’s still important to rule out other medical conditions that may present in similar ways. Doing so helps ensure you’re getting the right treatment — and can bring you peace of mind.

For example, an overactive or underactive thyroid can cause symptoms like heart palpitations, heat intolerance, sweating, anxiety, and mood changes. These can look pretty similar to both panic symptoms and menopause-related vasomotor changes. So, a healthcare provider may run blood tests to check thyroid function to make sure you get the right treatment. 

Other symptoms, like chest pain, fainting, or shortness of breath, could also point to more serious cardiac issues. A provider can help you rule out or get treatment for other medical issues.

The bottom line? Getting an accurate diagnosis matters. When symptoms are clearly identified, treatment can be more targeted and effective. The goal is to help you move forward with confidence.

Frequently Asked Questions

Why do panic attacks and menopause symptoms like hot flashes often feel identical?

The similarity is due to how declining estrogen affects the nervous system. Estrogen helps regulate the brain's "temperature zone"; when it dips, the brain may trigger a sudden release of heat (a hot flash).Because the body's "fight-or-flight" response also causes flushing, sweating, and a racing heart, a hot flash can physically mimic the sensations of a panic attack.Additionally, lower estrogen affects neurotransmitters like serotonin and GABA, which help regulate mood and stress.

How can I tell the difference between a panic attack and a menopausal hot flash?

While they share physical sensations, there are three key differences:

• Emotional state: Panic attacks are usually accompanied by an overwhelming sense of dread, impending doom, or a feeling of being out of control.

• Timing: Panic attacks typically peak within minutes and then gradually fade, while hot flashes often follow a more familiar, lingering pattern.

• Context: Night sweats (a sign of menopause) often involve waking up drenched in sweat without the immediate feelings of intense fear or anxiety that characterize a panic attack.

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Why does menopause make me feel more prone to anxiety and stress than before?

Several biological shifts lower your emotional resilience during this transition. Progesterone has natural calming effects, so as it declines, you lose a natural buffer against anxiety. Furthermore, chronic sleep disruption caused by night sweats makes it harder for the brain to regulate emotional responses. If you have a personal or family history of anxiety, these hormonal fluctuations can amplify existing tendencies or bring previously managed symptoms back to the surface.

What are the non-hormonal treatment options for managing these overlapping symptoms?

If you prefer not to use hormone therapy, there are several evidence-based strategies:

• Cognitive Behavioral Therapy (CBT): This helps change thought patterns contributing to panic and has been shown to reduce the distress associated with hot flashes.

• Non-hormonal medications: Certain SSRIs can ease anxiety while simultaneously reducing the frequency of hot flashes.

Lifestyle adjustments: Regular exercise, stress-reduction habits (like deep breathing or yoga), and avoiding triggers like caffeine and alcohol can help calm the nervous system.