Perimenopause panic attacks affect 18–33% of women in their 40s, many with no prior anxiety history. The mechanism is the progesterone–allopregnanolone–GABA chain failing: when progesterone falls, the brain's primary calming system loses power. This article explains the neuroscience behind why panic hits out of nowhere — including at night — and covers what the evidence actually shows about CBT, hormone therapy, and immediate interventions.