Anxiety and menopause

Anxiety can be hidden, and women can carry on as usual, looking as if they are enjoying life, but underneath they may be struggling. Anxiety in menopause is a common symptom, it can lead women to feeling they can’t cope any more and to making decisions which they may later regret, for example giving up work. Women are often juggling many roles with home and work and trying to carry the burden of all these expectations whilst not feeling themselves and this is a source of anxiety for many. Hormonal changes can affect mood, emotions, thoughts, self esteem and can be made worse by stress. At Rowena Health Menopause Specialist Clinic we are here to help support you with this.

What is menopause?

Menopause is said to happen one year after your last natural period, but the time before this is the perimenopause, when women still have periods but can suffer from many symptoms caused by the falling levels of the hormone, oestrogen, in their bodies.

Mood changes and anxiety in menopause

Over 50% of women experience mood changes in perimenopause and menopause, and anxiety is one. It may be the only symptom of the perimenopause and menopause that women experience, and can happen to anyone, including those who have never experienced mental health problems before. There are other psychological symptoms too. Women can have low self-esteem, lack of motivation, panic attacks, poor concentration, anger and low energy. These can be really debilitating despite not being visible. This can result in a lack of pleasure in normal life.

Physical symptoms of anxiety in menopause

Anxiety can lead to physical symptoms such as a fast heart rate, heart palpitations, feeling of nausea, shaking and tremors, sweating, dry mouth, chest pain, headaches, fast breathing and panic attacks, which are severe attacks of fear and panic, that can occur suddenly without warning. Anxiety can also be shown openly, or it can be felt silently, and hidden away from others.

Anxiety can go hand in hand with low mood and symptoms of depression. As levels of oestrogen fall, the levels of neurotransmitters in the brain like serotonin also, reduce and levels of our stress hormone, cortisol, rise. Serotonin is a hormone that stabilises your mood and promotes happiness and wellbeing.

The other female sex hormone, progesterone, has a calming effect. Decreasing progesterone levels can lead to sleep issues, low moods, irritability and anxiety. So many hormonal changes affect women during the perimenopause and menopause.

If you’ve experienced anxiety in the past, it may get worse again as you enter the perimenopause and your hormones change. It can occur at any time, even before you notice that your periods have changed. It is difficult to know if this will settle on its own so it is important to get help.

Taking good care of yourself is so very important.

Hormone replacement therapy, HRT, is recommended as first line treatments for mood changes in menopause and can help improve symptoms in many women by 70-80%.

Lifestyle changes to help anxiety in menopause

There are some simple changes to make to your lifestyle that can help:

  • Ensuring that you prioritise your sleep and rest.
  • Exercise regularly.
  • Eat a healthy balanced diet, limit sugar and ultra processed foods.
  • Take time for relaxation, mindfulness, meditation and yoga can help to reduce stress.
  • Talking therapies like CBT cognitive behavioural therapy can give you coping strategies.
  • Keeping a mood diary can help.
  • Talking to family and friends.
  • Identifying triggers of negative emotions and trying to avoid these can also help.
  • Reading about perimenopause so that you understand why your body is changing, what hormonal changes are happening and and are aware of all the other symptoms that may happen can help, too.
  • Some women find that they need to take medication, like antidepressants, to help with their mood changes.

It can be difficult to find time for yourself when you are juggling a busy life, working and supporting family members, friends or children. If you can simply find time for a cup of tea, time to read a book, or go outside for walk, these can give you a break from the pressures of life and reduce your stress.

Talking therapies like CBT

Cognitive behavioural therapy is an effective approach to help with symptoms of menopause. It has been shown to help manage sleep and vasomotor symptoms. It is based on the principle that behaviour and emotions are the product of cognition/thoughts. Negative thoughts can be identified with cognitive-behavioural techniques. It is then possible through group or individual therapy to make changes in patients thoughts through five steps of relaxation, changing the cognitive thought process, giving coping skills, encouraging self expression, anger management and social support. These techniques increase the ability to cope with stress, adapt to difficult situations and to reduce stress and anxiety. Results of trials show that CBT is effective in reducing stress, anxiety, and depression and in promoting self esteem. This method can be used to improve mental health, alongside lifestyle changes.

If you are interested in CBT to help manage your symptoms then please do speak with me about this.

Every woman’s experience of her menopause is individual, and the majority of women have symptoms that negatively affect their personal, family and work lives. Please take time to talk.

If you are feeling suicidal because of your anxiety, please call your GP, the Samaritans, 111 or 999 immediately.

Updated June 2023 Dr Carys Sonnenberg

To book an appointment at Rowena Health Menopause Specialist Clinic online if you are in the UK or in person at our Guildford Clinic, please click the link. We can help support your mental health, as well as your hormonal, general and sexual health.

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