If you read some of the big sites on Google for the question of whether perimenopause can even cause panic attacks, some will say there's no good connection.
Let's first dispense with that nonsense!
Perimenopause can absolutely cause panic attacks and even rolling anxiety.
I had both as a result which is what ultimately led to this site.
We'll get into the mechanics below of what's happening (hello Estradiol!!) but here's where many women are finding themselves.
Around age 47 or slightly after, they start having anxiety or panic attacks.
Of course, they go to see a doctor. It may be the first of many!
I had my first panic attack during a PTO meeting around age 45-46.
A second one happened in a doctor's office. I decided to see my primary.
When I first went in, my blood pressure was all over the place and they immediately put me in on multiple blood pressure and heart meds.
Of course, these made me feel terrible.
Next came the benzos (see CBD versus benzos here).
Those are highly addictive so you can't be on them for long (generally a few weeks is what the FDA recommends).
So then comes the SSRIs (see CBD versus SSRI for anxiety and panic attacks).
Lexapro almost killed me. The full story is here but let's look at the first signal of what was coming...
Panic attacks from perimenopause.
We'll cover these topics:
- Can perimenopause cause panic attacks
- How hormones affect panic attack response
- Can CBD help with perimenopause panic attacks
- Other tools for perimenopause panic attacks
- How much CBD to take for perimenopause
- What's the best CBD to take for perimenopause (the histamine connection)
Let's get started. There's very interesting research we can actually act on now.
Can perimenopause cause panic attacks
Let's first understand what's happening.
From countless women that we hear from, the first step is to know what is going on!
It's very scary to suddenly start unraveling and there's very little guidance from either mothers or our health care system.
Here's the first thing to know.
Roughly 25% of women will have debilitating perimenopause.
We go through the mechanics of why at our perimenopause versus menopause guide.
In a nutshell, there's a disconnect between estradiol and it's upstream signaling partners (LH and FSH) in a lucky subset of women.
This can lead to extreme spikes and drops of estradiol during perimenopause.
We'll decipher but here's the net result:
In other anovulatory cycles, follicular-phase estrogen levels did not lower LH secretion as occurs in cycles of younger women, indicating decreased estrogen-negative feedback on LH secretion.
Let's break that down because it's partially driving why some women get hit so hard.
Anovulatory means a cycle where no egg is produced.
You start to have these as you get closer to the end of perimenopause which is generally 2-3 years.
- FSH causes ovaries to release estrogen
- Once estrogen reaches a certain level, a surge of LH acts as a brake (when working) and triggers the egg to release (no egg during perimenopause)
- Progesterone then gets released (if the egg is released)
Here's the deal...LH isn't getting the signal!
Estrogen can actually spike to levels not seen since pregnancy. And drop as well.
We cover this roller coast with its various symptoms in detail:
- CBD and perimenopause mood changes (review here)
- CBD and perimenopause anger and irritability (review here)
You can find the full list here.
Why does this yo-yo effect of estradiol matter for panic attacks?
Estradiol is a direct controller of serotonin levels.
For those who don't know, serotonin has been dubbed the "feel good" neurotransmitter but it runs deeper than that.
As we discussed in our Tryptophan and CBD for social anxiety, it's our primary stress response buffer and is intimately tied into every "behavior" we exhibit.
Think of perimenopause symptoms.
Now look at just a few of the housekeeping effects of estradiol:
Serotonin regulates appetite, temperature, energy balance, platelet coagulation, bone remodeling, sleep cycles, emesis, inflammatory response, and sexual behavior, just to name a few.
As for estradiol and serotonin…
It controls the conversion of tryptophan to serotonin (creation) and the removal (via MAO enzyme).
Meanwhile, your progesterone has been dropping since your mid 30's. It's at about 50% by age 40.
When you stop releasing an egg (anovulatory) in perimenopause, there's another big drop.
This is important since progesterone drives GABA which is our nervous system brake (key to both anxiety and panic attacks). See CBD and GABA here.
Let's look at estradiol and progesterone more closely for panic attacks.
Again, if you understand why something is happening (as opposed to just thinking you're suddenly losing your #%*#), it can really help.
How hormones affect panic attack response
Let's look at both estradiol and progesterone for panic attacks.
Let's start with estradiol and it's control over serotonin.
Research is showing that too little serotonin or too much can both be associated with panic attacks.
This makes since serotonin has such widespread effects across different regions of the brain.
For example, when a person starts SSRIs, anxiety, and depression can actually INCREASE for the first few weeks.
This is because increased serotonin in a specific part of the brain actually releases a key stress hormone (see CBD and Corticotropin-Releasing Factor).
Doctors will usually prescribe benzos for a few weeks to mask this increase.
Too low is an issue as well:
In contrast, brain serotonin turnover, estimated from the jugular venous overflow of the metabolite, 5-hydroxyindole acetic acid, was increased approximately 4-fold in subcortical brain regions and in the cerebral cortex.
"Turnover" is a measure of serotonin being used up. That chemical is a metabolite of serotonin (an end product after being used essentially).
In that case, an SSRI helped with the panic issue.
Really check out CBD versus anxiety meds to understand better how this all works (get the full story PLEASE).
Half of the women reaching out to us are trying to get off benzos and SSRI's (see CBD to wean off benzos or CBD to wean off SSRIs).
Soo too much or too little serotonin can be a problem.
Great...we have both spikes and drops during perimenopause for roughly 25% of the 1 million women per year entering perimenopause.
Lack of serotonin function has been directly implicated in risk for panic attacks:
Compared to the controls, the patients had a reduction of almost a third in the number of 5HT1A receptors in the anterior cingulate cortex, the posterior cingulate cortex and the raphe nucleus – three structures roughly in the middle of the brain.
5HT1A is part of our serotonin system. We'll look at ways to boost it below.
As for estrogen directly, there's a known genetic variation tied to panic attacks later in life for which hormone replacement therapy helps:
More recently, a study by Ryan et al. noted that these same haplotypes were linked to an increase in panic disorder in elderly women and that this association was mediated by the use of hormone therapy.
Check out our full review on estradiol here. It really is a master regulator!
That's one side of the equation.
What about progesterone?
GABA is the primary target for benzos (Ativan, Xanax, Valium, etc).
Albeit with pesky addiction risks and normalization (your brain goes the other way to compensate for boost).
Progesterone is a general purpose calming agent on our entire nervous system and immune response.
Let's look at one metabolite (breakdown product) of progesterone...allopregnanolone.
It's the basis for the new postpartum depression medication which costs $25,000.
Back to GABA.
If you want to know how progesterone feels via the GABA pathway, look at some of its cohorts:
Positive modulators of the GABA-A receptor include the progesterone metabolites allopregnanolone and pregnanolone, benzodiazepines, barbiturates, and alcohol.
So that's why so many women self-medicate with alcohol during perimenopause!
In fact, with panic attacks, the body tries to offset this runaway train with a surge in progesterone and it's metabolites:
These results suggest that neurosteroids in PD are hypersecretion, possibly as an attempt to counteract the anxiogenic underlying hyperactivity of the hypothalamus-pituitary-adrenal axis and to improve a reduced GABA(A) receptor sensitivity.
Anxigoenic means to increase anxiety.
HPA is the intersection between the nervous system and body for fight or flight. The key chemical there is cortisol which we'll look at below. (See CBD and cortisol).
Okay...so serotonin (our stress buffer) is on a roller coast ride while progesterone (the calm one of the bunch) is fading out.
What can we do about it? Can CBD help there?
Can CBD help with perimenopause panic attacks
We covered CBD and panic attacks here with full detail on what's going on (in addition to the hormone shift during perimenopause).
Let's walk through the pathways that are connected via estradiol and progesterone:
- CBD Serotonin balance and support
- CBD and GABA support
- CBD and cortisol
- CBD and histamine response (very fascinating)
- CBD in the dPAG area of the brain
CBD Serotonin balance and support
This may be CBD's most important effect.
Remember...too high (Serotonin syndrome which I had with Lexapro) or too low is an issue.
What does research show for CBD and the serotonin pathway?
Generally speaking, studies on anxiety are showing that CBD balances and boosts serotonin function:
Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain.
They found the anti-anxiety effect was blocked when serotonin pathways were blocked.
Seven days of treatment with CBD reduced mechanical allodynia, decreased anxiety-like behavior, and normalized 5-HT activity.
Allodynia is pain sensation.
The most important word there is "normalize'. Not boost (like SSRIs) or drop.
If you do this with serotonin, the brain will respond the other way which is why you can have Serotonin Withdrawal Syndrome (not to be confused with addiction or any other Orwellian play on words).
You'll see lots of words like modulating or normalize. Balance!
This is really a function of the endocannabinoid system which CBD plugs into rather than CBD itself and it's CRITICAL with serotonin...a master regulator of mood and stress response.
Let's dig deeper into panic attacks. We'll translate but just to show the level of knowledge they have now.
It turns out that there's a specific brain area with deep ties to panic attacks (as opposed to just general anxiety).
The dPAG. (see CBD and panic attacks for more info).
When researchers blocked 5HT1A (serotonin receptor from above) activity in the DPAG, the anti-panic effects of CBD go away:
CBD effects were prevented by DPAG injection of the 5-HT1A receptor antagonist.
In fact, there's a direct tie with people who have panic attacks and serotonin function via the 5HT1A pathway:
In patients with a PD diagnosis, studies have shown that both presynaptic and postsynaptic 5-HT1A receptor binding is reduced in the anterior cingulate, posterior cingulate, raphe, orbitofrontal cortex, temporal cortex, and amygdala.
And what does CBD do (selectively if we may add):
CBD has been suggested to activate 5-HT1A receptors in several brain regions, such as the basal ganglia , the bed nucleus of stria terminals , the prelimbic prefrontal cortex  and the dorsal raphe nucleus.
Okay...before your eyes glaze over...let us explain why we're going so deep into the weeds here (no THC mind you!).
Here's the most critical piece of this whole article.
CBD has the ability to selectively support serotonin function depending on the brain area for balance.
Look, serotonin function is incredibly complicated.
- You increase it in areas up above and you reduce panic.
- You increase it in the PVN (where corticotropin-releasing stress hormones), and you get more anxiety and panic attacks.
CBD will support serotonin levels were low and reduce where high!
SSRIs will boost levels everywhere!!
Hence the varied and fascinating list of side effects (don't get us started on the gut!).
Again, this speaks to the role of the endocannabinoid system in balancing other key systems (such as the neurotransmitters).
THAT'S why we research 2-3 hours day….we saw this effect with CBD and couldn't believe what the research was showing.
In fact, when researchers block CB1 activity (endocannabinoid receptor), the effects of SSRI's go away!
Cut out the middle man.
What about GABA for perimenopause panic attacks?
CBD and GABA support for perimenopause panic attacks
Look...benzos will slam a panic attack into oblivion (along with your ability to think or stay awake).
Benzos are a one-trick pony. Jack up GABA levels fast and furious (don't drive on them).
The problem is that they're incredibly addictive and the brain will "panic" with the sudden influx of GABA and reduce natural GABA production (called normalization).
That's why withdrawal from benzos can be so rough.
What about CBD and GABA for panic attacks?
Finally, the anxiolytic effects of systemic CBD partially depended on GABAA receptor activation in the EPM model but not in the VCT model.
That study is interesting because it showed a biphasic effect.
- In unstressed participants, it was actually stimulating
- In stressed participants, it boosted GABA activity
A study on autism looked at CBD's effect on GABA (brake pedal) and glutamate (gas pedal).
Across regions, CBD increased GABA+ in controls, but decreased GABA+ in ASD; the group difference in change in GABA + in the DMPFC was significant.
Interestingly, in autism, there is too little glutamate in the DMPFC (prefrontal cortex). You don't want more GABA there.
Consequently, CBD did not increase GABA in that area...in people with autism.
In fact...it decreased it! Less GABA activity means more glutamate activity (which is lacking in autism).
Very fascinating. Action-based on need. See why we geek out on this??
There's a known body tie-in with perimenopause panic attacks.
The increased heart rate, a spike in blood pressure, etc.
Let's look at this fight or flight mechanism and CBD.
CBD and cortisol for perimenopause panic attacks
There may be a priming of the stress response system before a panic attack actually occurs:
During spontaneous panic attacks there was a subtle but significant elevation of cortisol levels, compared with levels obtained 24 hours later.
Cortisol is a primary messenger of the HPA axis mentioned above.
What does CBD do there?
Turns out that the endocannabinoid system is intimately tied in this stress response system.
Interestingly, cannabidiol at low (5 mg/kg) and intermediate doses (15 mg/kg) successfully blocked the effects induced by acute stress on corticotropin-releasing factor, pro-opiomelanocortin, and glucocorticoid receptor gene expression.
Interesting indeed if you're about to have a panic attack.
So much of a panic attack (speaking from experience) is self-referential.
You feel a twinge of anxiety and your heart rate goes up. This makes you more anxious and the spiral continues.
The fear of having a panic attack can be self-serving in this respect.
Stopping that initial stress response impulse is critical.
We actually have a good proxy for this.
To make it interesting, let's throw in a documented social anxiety diagnosis.
The full review can be found at our CBD and public speaking phobia article.
Yes, the dosage of CBD obliterated the Negative self-score results (insecurity essentially) but the part we're interested in for panic attack is what it did to the autonomic body functions.
Things we can't control...heart rate, blood pressure, sweaty palms.
The study found that these were elevated for all groups in the public speaking test but a curious thing occurred in terms of how the participants interpreted them:
Although physiological measures have not shown significant differences among the groups, the self-report of somatic symptoms (BSS) increased significantly only for the SAD patients who received a placebo during the test.
Meaning, those on placebo were much more aware of their internal reactions to the stress of public speaking.
Also, the following are interesting areas of research for panic attacks:
- Silexan - A lavender extract that is showing effects similar to benzos but without the addiction/sedation (serotonin pathway) Buy here
- Siberian Rhubarb - acts on the Estrogen B receptors which are critical for mood issues. Full review is here Buy here
- Tryptophan - supports serotonin pathway and function (see CBD and tryptophan for stress response) Buy here
- Low histamine diet - an interesting study on allergies actually showed that panic attacks went away
- Magnesium Glycinate - powerful stress response supporter Buy here
- B vitamin complex - (methylated) - All these pathways above require B vitamins Buy here
I've tried many of the herbs and plant-based options but histamine responses (see perimenopause and histamines here) usually caused side effects for me.
One note and this is important.
Until your hormones are addressed (bioidentical - estradiol and progesterone), these are all just bandaids.
Every system in your body depends on estrogen and progesterone to operate correctly and they're all over stress response. Check out the estradiol review to look at the real story on safety.
There's no getting around it.
On to some practical questions on CBD and perimenopause panic attacks.
How much CBD to take for perimenopause
We actually have some research we can look at here.
First, always start with 25-30 mg doses to test how it feels on your body.
The study on public speaking for social anxiety was a one-time 600 mg dose but that's a pretty high dose.
Other studies on anxiety, in general, were closer to 300 mg.
I personally take 150 mg in the morning and 150 mg at night since 300 is the level that research shows for maximum neurogenesis (see CBD and neurogenesis).
This is the process by which the nervous system repairs and replenishes itself with important effects on both anxiety and panic attacks.
Remember that estradiol is a growth promoter and we're losing it!
That's why we see deterioration in many systems (skin and hair show it more readily).
People generally report back with levels at about 50-150 mg for anxiety in general.
Panic attacks might require a higher level but everyone's body is different so test the ideal level for you.
Peak CBD is about 4-6 hours after ingesting.
You can get a faster effect by holding it under your tongue up to 60 seconds.
If I really need help NOW, I'll just keep it there as long as I can.
The effects can be very fast via this delivery with the sublingual gland (avoids the stomach and liver).
You can also use CBD prior to a situation that might cause a panic response (see CBD and fear of flying or phobias).
Let's now look at the type of CBD for perimenopause panic attacks.
What's the best CBD to take for perimenopause (the histamine connection)
First, we have our basic requirements:
- Organically grown in the US at an FDA certified farm
- 3rd party tested (we test both biomass and finished product separately)
- THC free (Roughly a 1/3rd of people are allergic to THC and panic response can be a result)
- No pesticides
- No mold
- No heavy metals
- No bacteria
These are minimum requirements but it's amazing how many brands don't show their 3rd party testing online and make it accessible.
Then there's the big question...CBD Isolate versus full spectrum.
Probably 90% of the market is full-spectrum based on….
We're not sure.
We've read maybe 200-300 NIH studies on CBD and they're all on CBD isolate.
More importantly, 40-60% of people have histamine issues (the root of allergies).
All that plant material is likely to go the wrong direction.
This number goes higher for women and as we get older!
Sound like perimenopause? (see CBD and perimenopause allergies).
Remember that progesterone has a calming effect on this pathway and it's been dropping since our mid 30's (just took a major downturn when we stopped producing an egg in perimenopause).
Here's the important piece for panic attacks.
Have you ever had a really bad allergy attack? Does it feel familiar to any other "attack"?
Check out the research on histamine and anxiety here.
This very effect is what led us to IndigoNaturals.
We tried 3-4 of the biggest CBD brands when we were in the throes of perimenopause panic attacks.
Typical histamine responses (clicking in the back of the throat, rash, etc) all followed.
Those all went away with CBD isolate.
Hopefully, you can tell that all our decisions are based on research.
This glimpse into perimenopause is just the beginning. 'Dre's Story' offers our complete, research-rich journey into hormones, tools to feel better, and safety. The full Perimenopause Toolkit with new additions can be found Here. Please review so other can learn. Feeling better starts with understanding what is happening.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.