Anxiety
Menopause can cause anxiety, as well as a wide range of other mental wellness symptoms such as depression and panic attacks. Some of the symptoms may overlap, as is frequently the case with anxiety and depression. Feelings of anxiousness may start suddenly and might increase and recede without explanation. Some women describe menopausal anxiety as a feeling of PMS (pre-menstrual syndrome) that is constant, not cyclical. They feel they aren’t in full control of their moods and may feel “on edge.” Decision-making difficulty, depression, panic attacks, an inability to face normal daily activities, and a desire to oversleep sleep disturbances are all indicators of menopausal anxiety. To make matters worse, in many cultures these feelings are not discussed openly and a woman may feel disoriented as her emotions and comprehension of situations changes.
up to 58% of women aged 45–55 have reported anxiety
Women who have experienced high levels of anxiety pre-menopause are likely to continue experiencing these disconcerting feelings during peri- and post-menopause. However, women who reported low levels of anxiety prior to the onset of peri-menopause tend to report higher levels as they progress into menopausal transition.
If you are experiencing new feelings of fearfulness, freezing in social situations, non-specific worry, uncontrollable irritability, or panic, you may be experiencing anxiety or an associated disorder (panic disorder, social phobia, generalized anxiety). Although you may take some comfort in knowing that your symptoms are likely temporary and menopause related, it is also good to know that there are treatment options available.
Why is this happening?
A woman’s endocrine system (the system that regulates biological processes through hormone releasing glands) works with her nervous system (hypothalamic-pituitary system) to create physiological wellness. Any imbalance can result in physical and mental effects, and we know that peri-menopause alters the levels of estrogen, progesterone, and serotonin in a woman’s body.
Additional hormones affected by menopause that may cause troubles regarding neurotransmission, resulting in mood-based dysfunction, are progesterone and GABA. During peri-menopause, progesterone levels are declining and can lead to changes in a woman’s sense of emotional stability. When progesterone is metabolized, it produces GABA (a receptor agonist called Gamma-Aminobutyric acid) in order to regulate emotions, moods, and sleep. During times of lowered progesterone and GABA, anxiety, depression, and sleep disorders may increase.
If you are experiencing symptoms you believe may be related to menopausal anxiety or another specific mood-based concern, it is important to talk to a qualified healthcare professional about your observations. Ideally, you will also be able to discuss how you are feeling with those in your immediate support network, as you may need time to adjust to menopausal changes to your hormone levels and to implement effective treatments.
Other impacted areas
Other menopausal symptoms that are often inter-related with anxiety are:
- Mood swings
- Depression
- Irritability
- Fatigue
- Sleep disturbance
- “Brain fog” & difficulty concentrating
- Decreased libido
Diagnosis
Although there is no specific test for anxiety or the existence of peri-menopause, there are self-reporting diagnostic tools for medical professionals to use. Clinical levels of anxiety disorder during menopause will be diagnosed by your healthcare provider using self-reporting based on standard observations. Clinical anxiety requiring treatment can be assessed based on the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) and other methods.
If your level of anxiety is interfering with your daily life, your job, your relationships, or is causing you to self-medicate through use of alcohol and other substances, it is important to reach out for help. Diagnosis and treatment are available and the symptoms you are experiencing are common.
Possible triggers or risk factors
In an interesting interconnection, research has shown that women who experience anxiety are 3 to 5 times as likely to suffer from hot flashes. Anxiety is triggered by elevated levels of fatigue, stress, worry, and uncertainty. There is a likely connection between common symptoms of menopause and higher levels of anxiety, therefore it is important to seek treatment for all menopausal symptoms in order to reduce the likelihood of anxiety being present as well.
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Treatments & remedies
Even though there are effective treatment options available to manage (menopausal) anxiety, a surprising 73% of women do not seek treatment for their menopausal symptoms. Cognitive Behavior Therapy (CBT) and other forms of counseling, intentional reduction of life stressors, and engaging proactively in self-care activities are among the important alternatives to consider. This can of course be done in isolation or in combination with any of the supplement and pharmaceutical alternatives described below.
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Nutrition
- Maintaining a healthy diet and weight is essential for optimal health at every stage of life. Women should reduce their intake of over-processed foods, concentrating on a high-fiber diet with significant vitamin, mineral, Omega-3 fats, and probiotic components. Alcohol, drugs, and smoking should be reduced or eliminated.
- There is a strong positive correlation between a plant-based Mediterranean diet and a lower risk of anxiety and depression. A Mediterranean diet focuses on whole grains, fruits, vegetables, seafood, beans, and nuts. It avoids processed meat, pre-packaged meals with high sodium levels, refined grains, butter and hydrogenated oil.
Exercise
- Exercise is essential for proper physical and mental wellbeing. Studies show the clear correlation between an active lifestyle and the ability to regulate moods and emotions. Anxiety is our body’s response to stress, danger, over-tiredness, or worry. These factors are reduced by mild to moderate aerobic activity.
- A 10-minute walk has been shown to be as effective as a 45-minute workout for reduction of anxiety for several hours. Active people have been found to be less anxious than sedentary individuals, and researchers found that women who get regular, aerobic exercise are 25% less likely to develop anxiety-related symptoms.
Mindset
As anxiety is directly related to mental wellness, there are many therapy alternatives available, including:
- Counseling and psychological support - discussing your symptoms with trusted professionals and your support base
- Focusing on stress reduction
- Employing self-awareness techniques such as daily journaling
- Maintaining positive and frequent social contact
- Cognitive behavioral therapy (a type of psychotherapy) may be helpful in treating some types of anxiety disorders.
Supplements
- Preliminary studies suggest that chamomile extract might be helpful in managing generalized anxiety disorder, but as the clinical evidence is limited a conclusive answer to its efficacy cannot be given.
- A recent study (2020) looking at the effectiveness of Melatonin as a possible alternative to conventional anxiety-reducing drugs had promising short-term results, but the long-term effects are unclear.
- Passionflower and valerian have been used to treat anxiety but clinical research to support the claims.
- Even though some women have reported positive benefits from taking additional supplements of Vitamin B in order to reduce stress levels, there is no clinical proof tying increased levels of Vitamin B to reductions in anxiety.
OTC Products
There are no over-the-counter pharmaceutical products available for the treatment of anxiety.
Prescription
Antidepressants (SSRIs and SNRIs) are the most effective prescription medicine for (menopausal) anxiety. SSRIs (selective serotonin reuptake inhibitors) work by increasing the level of the brain’s serotonin. SNRIs (serotonin and norepinephrine reuptake inhibitors) are an antidepressant medication that increases both serotonin and norepinephrine levels. These medications work with neurotransmitters in the brain as nerve signals travel over cell synapses between neurons.
In some cultures there is a lingering stigma concerning antidepressant prescriptions. The effectiveness of antidepressant medication is well known over many years and your healthcare professional will understand whether an SSRI or SNRI prescription could help with symptoms of menopausal anxiety. Mental health is a critical topic which deserves care and attention whether symptoms are new and problematic, or chronic and significant. It is important to seek professional guidance and full understanding of your pre-, peri-, and post-menopausal mental wellness alternatives.
Hormone Treatment
The medical community is ambivalent regarding the effectiveness of HRT for menopausal anxiety. Research indicates mixed and conflicting results. Generally, there are less invasive forms of stress management that should be considered in order to reduce anxious feelings.
As many women suffering from a clinical diagnosis of troubling peri- or post-menopausal symptoms receive a prescription for Hormonal Replacement Therapy (HRT), it is worth noting that there is some research indicating that menopausal women who received HRT with 17beta-estradiol and Tibolone show a marked improvement in symptoms of anxiety and depression.
Holistic Treatment
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
References
Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001 Oct;26(5):363-7. doi: 10.1046/j.1365-2710.2001.00367.x. PMID: 11679026.
Beck, T. (2012, August 9). Estrogen and female anxiety. Harvard Gazette.
Bromberger JT, Kravitz HM, Chang Y, et al. Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation. Menopause. 2013;20(5):488-495. doi:10.1097/GME.0b013e3182730599
Jaeger MB, Miná CS, Alves S, Schuh GJ, Wender MC, Manfro GG. Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause. Braz J Psychiatry. 2021 May-Jun;43(3):277-284. doi: 10.1590/1516-4446-2020-0871. PMID: 33053044; PMCID: PMC8136388.
Li RX, Ma M, Xiao XR, Xu Y, Chen XY, Li B. Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine (Baltimore). 2016 Aug;95(32):e4466. doi: 10.1097/MD.0000000000004466. PMID: 27512863; PMCID: PMC4985318.
Madsen BK, Zetner D, Møller AM, Rosenberg J. Melatonin for preoperative and postoperative anxiety in adults. Cochrane Database Syst Rev. 2020;12(12):CD009861. Published 2020 Dec 8. doi:10.1002/14651858.CD009861.pub3
Modabbernia A, Akhondzadeh S. Saffron, passionflower, valerian and sage for mental health. Psychiatr Clin North Am. 2013 Mar;36(1):85-91. doi: 10.1016/j.psc.2012.12.007. PMID: 23538079.
Siefken, K., Junge, A., & Laemmle, L. (2019). How does sport affect mental health? An investigation into the relationship of leisure-time physical activity with depression and anxiety. Human Movement, 20(1), 62–74.
Smoller JW, Pollack MH, Wassertheil-Smoller S, et al. Prevalence and Correlates of Panic Attacks in Postmenopausal Women: Results From an Ancillary Study to the Women's Health Initiative. Arch Intern Med. 2003;163(17):2041–2050. doi:10.1001/archinte.163.17.2041
Ventriglio, A., Sancassiani, F., Contu, M. P., Latorre, M., Di Slavatore, M., Fornaro, M., & Bhugra, D. (2020). Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clinical Practice & Epidemiology in Mental Health, 16(1), 156–164.
Yasgur, B. S. (2018, December 17). Mood Changes in Menopausal Women: A Focus on Anxiety. Psychiatry Advisor.
Yazici K, Pata O, Yazici A, Aktaş A, Tot S, Kanik A. Menopozda hormon yerine koyma sağaltiminin anksiyete ve depresyon belirtilerine etkisi [The effects of hormone replacement therapy in menopause on symptoms of anxiety and depression]. Turk Psikiyatri Derg. 2003 Summer;14(2):101-5. Turkish. PMID: 12844276.
Young, L. M., Pipingas, A., White, D. J., Gauci, S., & Scholey, A. (2019). A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals. Nutrients, 11(9), 2232.Harvard Health Publishing. (2014, February). 8 principles of low-glycemic eating.
Exercise for Stress and Anxiety | Anxiety and Depression Association of America, ADAA. (n.d.). Anxiety And Depression Association Of America.
Perimenopause: rocky road to menopause. Symptoms we call "menopausal" often precede menopause by years. Harv Womens Health Watch. 2005 Aug;12(12):1-4. PMID: 16206381.
https://chopra.com/articles/an-ayurvedic-approach-to-anxiety
https://www.mountsinai.org/health-library/report/menopause
Anxiety
Menopause can cause anxiety, as well as a wide range of other mental wellness symptoms such as depression and panic attacks. Some of the symptoms may overlap, as is frequently the case with anxiety and depression. Feelings of anxiousness may start suddenly and might increase and recede without explanation. Some women describe menopausal anxiety as a feeling of PMS (pre-menstrual syndrome) that is constant, not cyclical. They feel they aren’t in full control of their moods and may feel “on edge.” Decision-making difficulty, depression, panic attacks, an inability to face normal daily activities, and a desire to oversleep sleep disturbances are all indicators of menopausal anxiety. To make matters worse, in many cultures these feelings are not discussed openly and a woman may feel disoriented as her emotions and comprehension of situations changes.
up to 58% of women aged 45–55 have reported anxiety
Women who have experienced high levels of anxiety pre-menopause are likely to continue experiencing these disconcerting feelings during peri- and post-menopause. However, women who reported low levels of anxiety prior to the onset of peri-menopause tend to report higher levels as they progress into menopausal transition.
If you are experiencing new feelings of fearfulness, freezing in social situations, non-specific worry, uncontrollable irritability, or panic, you may be experiencing anxiety or an associated disorder (panic disorder, social phobia, generalized anxiety). Although you may take some comfort in knowing that your symptoms are likely temporary and menopause related, it is also good to know that there are treatment options available.
Dr. June Tan Sheren
Why this is happening
A woman’s endocrine system (the system that regulates biological processes through hormone releasing glands) works with her nervous system (hypothalamic-pituitary system) to create physiological wellness. Any imbalance can result in physical and mental effects, and we know that peri-menopause alters the levels of estrogen, progesterone, and serotonin in a woman’s body.
Additional hormones affected by menopause that may cause troubles regarding neurotransmission, resulting in mood-based dysfunction, are progesterone and GABA. During peri-menopause, progesterone levels are declining and can lead to changes in a woman’s sense of emotional stability. When progesterone is metabolized, it produces GABA (a receptor agonist called Gamma-Aminobutyric acid) in order to regulate emotions, moods, and sleep. During times of lowered progesterone and GABA, anxiety, depression, and sleep disorders may increase.
If you are experiencing symptoms you believe may be related to menopausal anxiety or another specific mood-based concern, it is important to talk to a qualified healthcare professional about your observations. Ideally, you will also be able to discuss how you are feeling with those in your immediate support network, as you may need time to adjust to menopausal changes to your hormone levels and to implement effective treatments.
Other impacted areas
Other menopausal symptoms that are often inter-related with anxiety are:
- Mood swings
- Depression
- Irritability
- Fatigue
- Sleep disturbance
- “Brain fog” & difficulty concentrating
- Decreased libido
Diagnosis
Although there is no specific test for anxiety or the existence of peri-menopause, there are self-reporting diagnostic tools for medical professionals to use. Clinical levels of anxiety disorder during menopause will be diagnosed by your healthcare provider using self-reporting based on standard observations. Clinical anxiety requiring treatment can be assessed based on the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) and other methods.
If your level of anxiety is interfering with your daily life, your job, your relationships, or is causing you to self-medicate through use of alcohol and other substances, it is important to reach out for help. Diagnosis and treatment are available and the symptoms you are experiencing are common.
Possible triggers or risk factors
In an interesting interconnection, research has shown that women who experience anxiety are 3 to 5 times as likely to suffer from hot flashes. Anxiety is triggered by elevated levels of fatigue, stress, worry, and uncertainty. There is a likely connection between common symptoms of menopause and higher levels of anxiety, therefore it is important to seek treatment for all menopausal symptoms in order to reduce the likelihood of anxiety being present as well.
Treatments & Remedies
Even though there are effective treatment options available to manage (menopausal) anxiety, a surprising 73% of women do not seek treatment for their menopausal symptoms. Cognitive Behavior Therapy (CBT) and other forms of counseling, intentional reduction of life stressors, and engaging proactively in self-care activities are among the important alternatives to consider. This can of course be done in isolation or in combination with any of the supplement and pharmaceutical alternatives described below.
Products
- Preliminary studies suggest that chamomile extract might be helpful in managing generalized anxiety disorder, but as the clinical evidence is limited a conclusive answer to its efficacy cannot be given.
- A recent study (2020) looking at the effectiveness of Melatonin as a possible alternative to conventional anxiety-reducing drugs had promising short-term results, but the long-term effects are unclear.
- Passionflower and valerian have been used to treat anxiety but clinical research to support the claims.
- Even though some women have reported positive benefits from taking additional supplements of Vitamin B in order to reduce stress levels, there is no clinical proof tying increased levels of Vitamin B to reductions in anxiety.
There are no over-the-counter pharmaceutical products available for the treatment of anxiety.
Antidepressants (SSRIs and SNRIs) are the most effective prescription medicine for (menopausal) anxiety. SSRIs (selective serotonin reuptake inhibitors) work by increasing the level of the brain’s serotonin. SNRIs (serotonin and norepinephrine reuptake inhibitors) are an antidepressant medication that increases both serotonin and norepinephrine levels. These medications work with neurotransmitters in the brain as nerve signals travel over cell synapses between neurons.
In some cultures there is a lingering stigma concerning antidepressant prescriptions. The effectiveness of antidepressant medication is well known over many years and your healthcare professional will understand whether an SSRI or SNRI prescription could help with symptoms of menopausal anxiety. Mental health is a critical topic which deserves care and attention whether symptoms are new and problematic, or chronic and significant. It is important to seek professional guidance and full understanding of your pre-, peri-, and post-menopausal mental wellness alternatives.
Lifestyle
- Maintaining a healthy diet and weight is essential for optimal health at every stage of life. Women should reduce their intake of over-processed foods, concentrating on a high-fiber diet with significant vitamin, mineral, Omega-3 fats, and probiotic components. Alcohol, drugs, and smoking should be reduced or eliminated.
- There is a strong positive correlation between a plant-based Mediterranean diet and a lower risk of anxiety and depression. A Mediterranean diet focuses on whole grains, fruits, vegetables, seafood, beans, and nuts. It avoids processed meat, pre-packaged meals with high sodium levels, refined grains, butter and hydrogenated oil.
- Exercise is essential for proper physical and mental wellbeing. Studies show the clear correlation between an active lifestyle and the ability to regulate moods and emotions. Anxiety is our body’s response to stress, danger, over-tiredness, or worry. These factors are reduced by mild to moderate aerobic activity.
- A 10-minute walk has been shown to be as effective as a 45-minute workout for reduction of anxiety for several hours. Active people have been found to be less anxious than sedentary individuals, and researchers found that women who get regular, aerobic exercise are 25% less likely to develop anxiety-related symptoms.
As anxiety is directly related to mental wellness, there are many therapy alternatives available, including:
- Counseling and psychological support - discussing your symptoms with trusted professionals and your support base
- Focusing on stress reduction
- Employing self-awareness techniques such as daily journaling
- Maintaining positive and frequent social contact
- Cognitive behavioral therapy (a type of psychotherapy) may be helpful in treating some types of anxiety disorders.
Holistic
TCM
Banxia houpu decoction with pinellia tuber, magnolia bark, hoelen, perilla herb, and ginger rhizome is recommended.
Ayurveda
From an imbalance in the vata dosha, with too much energy in the mind and not enough in the feet. Stabilize your energy through warm foods (steamed vegetables, soups, baked squash) and follow a daily routine with regular meals, work times, and sleeping patterns.
Acupuncture
There are a few clinical studies that suggest Acupuncture can help reduce anxiety, however the research is too limited to allow definite conclusions to be reached. In general it can be beneficial in reducing stress levels, balancing hormones, and regulating your brain’s emotional center.
Mindfulness
Meditation, yoga, mindful breathing, and body scanning are all helpful.
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