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Understanding the connection between menopause and anxiety

Get a better understanding of how to manage menopause so symptoms like anxiety don't rule your life.

Understanding the connection between menopause and anxiety
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Menopause is responsible for a number of changes in a woman's life. While you may have heard of hot flushes, weight gain, headaches or night sweats, you may be less familiar with side effects like mood disorders, including anxiety.

Despite affecting a significant number of menopausal women, fewer are equipped to identify and deal with these lesser-known menopausal symptoms.

This is why we've created this handy guide on the link between menopause and anxiety, so you can get a better understanding of how to manage menopause and ways to treat it so the symptoms don't rule your life.

What is menopause?

Menopause is the stage of life beginning 12 months after a person's last period, marking the end of their ovulating years [1].

It is brought on by a natural decrease in female sex hormones, like oestrogen. During this time, the ovaries stop releasing eggs and periods will cease. It can also result in a number of physical changes.

While menopause formally refers to the post-ovulation years, it is often used to describe perimenopause, or the period during which these hormonal changes start to occur and oestrogen starts to drop. Perimenopause can also be called 'climacteric' in some medical literature.

Typically, menopause begins between the ages of 45 and 55, however, one can also experience early menopause as a result of illness, injury or other disruption to one's hormones [2][3].

Can menopause cause anxiety?

Anxiety is a potential symptom of menopause and studies suggest more than half of women experience menopause-related anxiety [4][5]. That is a staggering number considering that every woman will go through menopause in their lifetime.

It is thought that anxiety is caused by hormonal fluctuations, as well as other physical and lifestyle changes that occur at this time of life. But, there are no conclusive findings that suggest when in the menopause journey women are likely to experience anxiety.

Some studies found no difference in anxiety rates during different stages of menopause, while others found it more prevalent in perimenopause, as opposed to early or late menopause [5].

What causes anxiety during menopause?

There is a range of potential causes, ranging from hormonal changes to one's personal response to this period of change.

But, it is believed that the steep or erratic change of hormones can lead to anxiety in menopausal women as the drop in oestrogen can cause low moods and depression [6].

We also can't discount the change that occurs at this stage of life and this can trigger anxiety for some women as they adjust to their new normal.

Some women experience anxiety around the following:

  • Ageing
  • Physical changes
  • Other menopause symptoms (for example, hot flushes and insomnia)
  • Changes to libido
  • Changes in the family (menopause can also line up with children leaving home, parents also ageing or passing away)
  • Career changes [2].

One study links anxiety to vasomotor symptoms (including hot flashes, night sweats, and high blood pressure, which are all symptoms related to alterations to blood cells) — this suggests that anxiety has less to do with the menopausal transition itself and more to do with the severity of vasomotor symptoms [5][6].

Furthermore, it has been suggested that hormone levels themselves are not the determining factor, but other biological functions, including how these hormones interact with the central nervous system [6].

How many women experience anxiety after menopause?

Research indicates more than 50 per cent of women in menopause will experience symptoms of anxiety. One study found that around 51 per cent of women between the ages of 40 and 55 will experience anxiety, while another study of women aged 40 to 65 recorded 53.7 per cent [5][4].

However, while all women experience hormonal fluctuations in life, not all women experience anxiety disorder as a response to this. Those who have experienced premenstrual anxiety may be more likely to experience anxiety during perimenopause [6].

Why can anxiety be worse during menopause?

It has been found that general symptoms of anxiety can worsen during menopause. One longitudinal study found that even women with low levels of anxiety prior to menopause were likely to experience an increase in anxiety symptoms during menopause [6].

This is potentially due to the hormonal drama taking place during perimenopause. However, exacerbation of symptoms can occur for a whole cocktail of reasons.

The physical symptoms of menopause, such as hot flushes and insomnia, and the potential life events occurring simultaneously, can exacerbate anxiety symptoms [6].

Studies have also found a relationship between hot flushes and panic attacks. Women with high levels of somatic anxiety — anxiety that manifests more in physical symptoms — had three times the risk of hot flashes. It was even suggested that anxiety could predict hot flashes [6].

Having said that, if you have experienced anxiety prior to menopause you may not notice a difference in your anxiety symptoms. If you haven't experienced anxiety or you have only experienced it mildly, it may be more severe [5][6].

Unfortunately, there's no way to tell whether you'll experience menopause-related anxiety but it's good to be aware of it just in case.

What does menopause anxiety feel like?

It's important to know that anxiety symptoms can differ for everyone but menopause-related anxiety can manifest in panic attacks, shortness of breath, nervousness, fearfulness, heart palpitations, low energy and low mood.

Interestingly, the symptoms of hot flushes and anxiety can be similar, with each of them potentially resulting in sweating, heart palpitations, shortness of breath and nausea [6].

It should be noted that anxiety is a general term used to describe a range of symptoms, from panic attacks to mood swings to not getting enough sleep. There are also different types and severities of anxiety.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), General Anxiety Disorder (GAD) can be diagnosed if a person has three or more of the following symptoms:

  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) [7].

A key study on menopause-related anxiety measured anxiety via four major symptoms: irritability, nervousness or tension, feeling fearful for no reason, and heart-pounding or racing, so these may be symptoms you experience during menopause [5].

Can menopause cause depression?

One study found that 36.8 per cent of women experienced depression during menopause. Depression was also more frequent in women with anxiety and insomnia, but less prevalent in those who had a job [4].

For the same reasons one might experience anxiety, one could also experience depression. The physical, hormonal and lifestyle changes of this age can all contribute to depression in menopausal women, so know that you're not alone if you're experiencing mood changes during menopause.

How long does menopause anxiety last?

This will depend on the individual and whether or not you've experienced anxiety prior to menopause. But, in saying that, the chances of experiencing anxiety peaks in late perimenopause and symptoms may subside over time along with other major menopausal symptoms (like hot flashes).

The risk of anxiety decreases after menopause, which formally starts a year after your last period [5].

How can anxiety be treated?

There is a range of treatment options for anxiety disorders, including cognitive behaviour therapy (CBT), medications, complementary therapies or lifestyle changes, like more exercise, social activity and a healthy diet [8][6].

Given that anxiety in menopause can be triggered by a range of factors, some people may benefit from a holistic and rounded treatment of anxiety. Plus, interventions such as exercise and CBT could work to combat multiple symptoms at once [9].

Menopausal Hormone Therapy, or MHT — previously referred to as Hormone Replacement Therapy (HRT) — can be effective at treating a range of menopausal symptoms and in turn, could be used in conjunction with other treatment options to help with anxiety.

Juniper's team of specialised GPs have extensive experience in recognising and treating the symptoms of menopause and can work with you to get these under control.

Simply complete the text-based consult and one of our local doctors will be able to prescribe you the most effective menopause treatments without needing to leave your home.

And, your doctor will provide you with ongoing care with follow-up appointments throughout treatment.

Regardless of your chosen path, always seek medical advice before pursuing any new treatments.

If you or anyone you know is struggling and needs support, call Lifeline on 13 11 14. If you are in immediate danger, please call 000.

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