Does menopause cause anxiety? One of the TOP 10 questions linked to menopause and one of the leading conversation starters between a patient and their healthcare provider when assessing for menopause, is about "anxiety".
Simple answer - yes it can AND it often does AND you are not alone.
It's Mental Health Awareness Week in New Zealand. While we hear of the common symptoms of menopause being hot flashes/flushes, night sweats and brain fog, anxiety is a symptom that 60% of women in the menopause transition have had or are currently experiencing. It's a complex one to work through because, for women in their mid-40s, there could be an array of scenarios that can heighten anxiety - teenagers, aging parents, work stress, financial stress - oh look! The word "stress" and there we have a relationship to anxiety.
You might not automatically think "I'm in my mid-40's and I'm feeling anxious - must be menopause!" Right? I didn't! The discussion around mental health and asking for help has come leaps and bounds - I'm personally grateful for all the work that many have done to make speaking about our mental health normalised. My teenage daughter can express her challenges with anxiety and stress and not be judged for it.
In my book, My Menopause Memoir, I write about my personal relationship with anxiety. I can't remember a time before menopause where I can say I had anxiety. I've thrown myself at life - put my hand up for new opportunities without doubting myself, moved countries twice, had two children in a foreign country without family support, and started a new business with my dear husband. But anxiety came knocking and had my heart pounding and stomach churning.
I started to doubt my abilities after 30 years of working as an educator. I worried that I would forget the words. I stressed about introducing friends when a name kept evading me. I began to believe I should leave my career because I felt like a fake. When I write this, I am rolling my eyes that I even thought it was time to call it a day. This continued for 2.5 years before I realised this was a symptom of perimenopause - the gnarly stage before menopause/post-menopause.
Here's the tea on anxiety as a menopause symptom. There are oestrogen receptors right throughout your body, including your brain. The fluctuation in oestrogen and progesterone in the body changes the way our brain functions and can cause feelings of anxiety, depression, mood changes, rage, and panic attacks. One study (1) shows the link between oestrogen, progesterone and seratonin, our "happy hormone" and to cortisol, our "stress hormone". When oestrogen levels drop, cortisol levels rise. An interesting fact is that 40-50% of women have sleep disturbances through menopause and this can also cause anxiety....or does being anxious cause sleeplessness?
Some brains have a higher propensity to the effects of changing hormones and if you've had anxiety or depression in the past, there is a higher likelihood of this being a symptom in menopause.
A study by the Indian Journal of Psychiatry states, "the risk of depression appears to be higher during perimenopause, when hormone levels are changing, than during postmenopause, when oestrogen and progesterone levels are low and stable" Wait - what? Does that mean that anxiety can go away??? But how can we manage anxiety now?
My top recommendations for managing anxiety as a symptom of menopause include:
Prioritise sleep and stick to a sleep schedule. This can also help you understand if you are in the midst of perimenopause. Even the most dedicated sleep ritual can have you awake with hormone fluctuations. The chances of having more restful nights than awake nights is better when you are staying to the schedule.
Exercise and Move. Too many studies that tout the benefits of exercise on "feeling good" and elevating endorphins to add in here, so I'll just share THIS ONE from Harvard Medical School. Find a mode of exercise that lights you up and has you grateful that you made time for it. Move in the morning - work with your cortisol levels instead of elevating them further in the evenings.
Write it down. Journal the thoughts that are making you anxious. Are your thoughts valid? NO? Cross it off. YES? Devise actions that will help you manage the situation and seek help.
Breathe. Anxiety can cause an elevation in heart rate so take some time to breathe and consciously lower your heart rate. If you aren't practicing meditation, menopause is the perfect time to get start with a daily 5-10 minute practice.
Talk and share. Speak to a trusted friend, your partner, your healthcare provider. I've found some fantastic Facebook groups where I've been able to share and have recently set up the Sexy Ageing - Menopause Management Facebook group - all welcome!
1. Source: Rubinow, DR, et al. Naturally occurring changes in estradiol concentrations in the menopause transition predict morning cortisol and negative mood in perimenopausal depression. Clin Psychol Sci 2016; 4: 919–935. Tracy Minnoch-Nuku is the host of Sexy Ageing - the Podcast, the author of My Menopause Memoir and the creator of the Sexy Ageing Fitness and Lifestyle APP to support Midlife Women's Health. She is also an experienced educator and speaker with over 30 years as a fitness educator internationally for Les Mills, Fitness First Asia and FireFit. Tracy brings her wealth of knowledge in fitness, nutrition and wellness into tangible tools to support women in the menopausal life stage.
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