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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, a desire to oversleep and 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.

The Lowdown on Anxiety

Why it happens and the science behind it, how it may impact your life, how you and your doctor can diagnose it and common triggers or risk factors.

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 symptoms that are often inter-related with anxiety are:

  • Mood swings
  • Depression
  • Irritability
  • Fatigue
  • Sleep disturbance
  • “Brain fog” & difficulty concentrating
  • Decreased libido

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.

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.

Mental health

Anxiety

In many cultures feelings of anxiety (and mental health in general) are not discussed openly and a woman may feel disoriented as her emotions and comprehension of situations changes. It however is far more common than most of us realise and you are certainly not the only one experiencing this. According to studies conducted in Brazil (2016) and China (2020), between 13% - 58% of women aged 44 - 55 years old report anxiety symptoms.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of Axniety. This is not an exhaustive list of the treatment options available, but a good start.

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.

  • 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.

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.
  • 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.
  • 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 that have proven to be effective 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.

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.

FAQs

Is anxiety common in midlife?

According to studies conducted in 2016 and 2020 in Brazil and China, between 13% - 58% of women aged 44 - 55 years old report anxiety symptoms.

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