Understanding and Managing Anxiety During Menopause

Why Does Anxiety Occur During Menopause? 

As women transition through menopause, their bodies undergo significant hormonal changes, particularly with the hormones oestrogen and progesterone. These hormones play a crucial role in regulating mood and emotions. Oestrogen, for example, affects the production of serotonin, a neurotransmitter often referred to as the "feel-good" chemical in the brain. As oestrogen levels fluctuate and decline during menopause, it can lead to mood swings, irritability, and, for many women, anxiety. 

Progesterone and Its Calming Effects 

Progesterone is often referred to as a "calming hormone" because of its ability to produce a sense of relaxation and well-being. This calming effect is primarily due to its metabolite, allopregnanolone. Allopregnanolone is a neurosteroid that interacts with the GABA (gamma-aminobutyric acid) receptors in the brain, which are the same receptors that sedative medications like benzodiazepines target. GABA is the brain’s main inhibitory neurotransmitter, meaning it helps to calm down neural activity. By enhancing GABA's effects, allopregnanolone—and by extension, progesterone—helps to reduce anxiety and promote a sense of calm. 

Fluctuations in Progesterone and Anxiety 

While progesterone can have calming effects, fluctuations in its levels can contribute to anxiety.  During perimenopause, the years leading up to menopause, progesterone levels can become erratic. This irregularity is often due to anovulatory cycles (when ovulation does not occur), which leads to lower overall progesterone production. As a result, the calming effects of progesterone are reduced, and women may experience heightened anxiety, mood swings, and sleep disturbances. 

Progesterone doesn’t act in isolation; it works in concert with oestrogen. While oestrogen can boost serotonin levels and has mood-stabilising effects, progesterone’s role is to balance these effects by calming the nervous system. If the balance between oestrogen and progesterone is disrupted—such as during perimenopause when oestrogen levels can be high but progesterone is low—women may experience increased anxiety. 

This imbalance is why some women experience anxiety relief with progesterone therapy during menopause. By supplementing with progesterone, the calming effects are restored, helping to reduce anxiety and stabilise mood. This needs to be looked at on an individualised basis. Not every woman will benefit from progesterone alone. 

But it’s not just about hormones. The midlife stage, often coinciding with menopause, can bring additional stressors—like children leaving home, career shifts, or the responsibility of caring for ageing parents. These life changes can amplify feelings of anxiety, making the menopausal transition even more challenging. 

How Long Can Menopausal Anxiety Last? 

The duration of anxiety during menopause varies widely among women. For some, anxiety begins in the perimenopausal stage—the years leading up to menopause—and can last through menopause and into the postmenopausal period. Typically, perimenopause can last 4-8 years, with anxiety possibly peaking during this time as hormone levels are most unstable. 

However, the good news is that for many women, anxiety symptoms tend to diminish after menopause as hormone levels stabilise. But it’s essential to note that without proper management, anxiety can persist, affecting your quality of life. 

Practical Steps to Reduce Menopausal Anxiety 

While menopausal anxiety can be daunting, there are several strategies you can implement to help manage and reduce your symptoms: 

1. Lifestyle Changes 

• Exercise Regularly: Physical activity is a powerful tool for managing anxiety. Engaging in regular exercise, such as walking, swimming, or yoga, helps boost your mood by releasing endorphins. Plus, it can improve your overall sense of well-being. 

• Eat a Balanced Diet: Nutrition plays a crucial role in mental health. A diet rich in whole grains, lean proteins, fruits, and vegetables can help stabilise your mood. Incorporating omega-3 fatty acids, found in oily fish like salmon, sardines and mackerel can also support brain health. 

• Prioritise Sleep: Menopause can disrupt sleep, leading to increased anxiety. To combat this, establish a regular sleep routine. Keep your bedroom cool, avoid caffeine late in the day, and consider relaxation techniques before bed, such as deep breathing or meditation. 

• Practice Mindfulness: Mindfulness practices, including meditation and deep breathing exercises, can be highly effective in reducing anxiety. These techniques help you stay grounded and present, making it easier to manage anxious thoughts. 

• Limit Alcohol and Caffeine: Both substances can worsen anxiety and disrupt sleep. Reducing your intake can make a noticeable difference in how you feel. 

  
  

2. Treatment Options 

• Hormone Replacement Therapy (HRT): HRT is one of the most effective treatments for managing anxiety linked to menopause. By replenishing oestrogen levels, HRT can stabilise mood, reduce anxiety, and improve sleep quality. It’s available in various forms, including patches, gels, and tablets, so you can choose the option that works best for you in consultation with your GP or menopause specialist. 

• Cognitive Behavioural Therapy (CBT): CBT is a type of psychological therapy that can help you identify and change negative thought patterns. It has been proven effective in treating anxiety, including that caused by menopause. 

• Medications: In cases where HRT isn’t suitable, low-dose antidepressants (such as SSRIs or SNRIs) may be prescribed. These medications can help alleviate anxiety and other menopausal symptoms like hot flushes. 

  
  

3. Supplements and Natural Remedies 

If you’re looking for more natural ways to manage anxiety, several supplements and herbal remedies might be worth considering. However, it’s crucial to consult with your healthcare provider before starting any new supplement: 

• Black Cohosh: Often used to alleviate hot flushes, black cohosh may also have a calming effect that can help reduce anxiety. 

• St John’s Wort: Known for its antidepressant properties, St John’s Wort might help with mild anxiety or low mood. However, it can interact with many medications, so it should be used with caution. 

• Magnesium: This mineral plays a role in mood regulation and can help reduce anxiety and improve sleep. 

• Vitamin B6 and B12: Both of these vitamins support brain health and can help stabilise your mood during menopause. 

• Omega-3 Fatty Acids: Found in fish oil supplements, omega-3s have been shown to improve mood and reduce anxiety. 

  
  

How Long Will This Last? 

Anxiety during menopause doesn’t last forever, but its duration can vary. Some women experience it for a few years during perimenopause and find relief once they reach menopause. For others, anxiety might persist longer without treatment. The key is to address symptoms early, using a combination of lifestyle changes, treatments, and natural remedies to manage your anxiety effectively. 

When to Seek Help 

If anxiety is interfering with your daily life, it’s essential to seek help. Persistent anxiety, depression, or panic attacks during menopause should not be ignored. Effective treatments are available, and your GP or a menopause specialist can offer guidance on the best approach for your situation. 

Remember, you don’t have to go through this alone. Reach out to your healthcare provider, explore your treatment options, and make the lifestyle changes that can help you navigate this transition with greater ease. 

Final Thoughts 

Menopause can be a challenging time, but understanding the root causes of anxiety and taking proactive steps to manage it can make all the difference. Whether through lifestyle changes, medical treatments like HRT, or natural supplements, there are many ways to reduce anxiety and improve your quality of life during this transition.