Menopause and Anxiety: The Hormonal Link Most Women Don't Know About
You have never been an anxious individual. You have coped with stress and remained calm, not losing your head in difficult circumstances. And then somewhere around the middle to the later 40s, a low whistle of apprehension begins to creep in. There are days when it is silent in the background. On other days it manifests itself in a racing heart, a startling shock of fear, a feeling of doom which comes unexpectedly and does not make the slightest sense.
The majority of women in this case fail to relate it to menopause. They ask themselves whether anything has wrong with their life, whether they are burning or whether they are creating an anxiety disorder out of nothingness. What they have certainly not been made aware of is that anxiety is one of the most widespread and most hormonally motivated symptoms of the menopause transition, and that it has certain biological causes that indicate precisely why it occurs when it does.
This post describes those reasons in simple language and discusses what actually works since anxiety during menopause is not a character weakness, and there are good reasons why it improves.
Whenever individuals consider the issue of menopause and hormones, the first thing that comes to mind is oestrogen. The bone changes, the hot flushes, the dry skin. What receives much less attention is the fact that oestrogen and progesterone have an effect on the brain itself, namely, on mood and anxiety.
This is its essence: oestrogen and progesterone are not only reproductive hormones. They too are brain hormones. They both have receptors throughout the brain, in regions that are directly related to emotion, stress management, memory and how the body reacts to perceived threats. The mood and anxiety control mechanisms of the brain are simply thrown off when these hormones vary unpredictably during perimenopause as they do years before periods cease altogether.
Serotonin is one of the chemical substances that the brain synthesizes and which are at the center of the feeling of calm and emotional stability as well as wellbeing. Imagine that it is the natural stabilizing effect of the brain. Oestrogen is the hormone that stimulates the synthesis of serotonin and also decelerates the breakdown of serotonin. To put it in plain words: oestrogen will maintain the levels of serotonin.
During perimenopause, the serotonin levels follow as oestrogen decreases or rises. The Australian Menopause Society research has reported that serotonin level reduces by half during the menopause transition. Reducing the main mood-stabilising chemical in the brain by half is not a small phenomenon. It is great enough to change the way brain processes stress, manages fear, and responding to daily situations that would have been perceived as manageable.
Progesterone is also referred to as the relaxing hormone, with a reason. It works on the GABA which is the major braking system in the brain, one of its functions. Consider GABA as the inbuilt brakes of the brain. When properly functioning, GABA is capable of decelerating anxious cognition, unease physical muscular tension, and managing the stress reaction.
Progesterone begins to reduce sooner in the transition than oestrogen, usually in the early-to-mid 40s and periods remain regular. With the decrease in progesterone, the relaxing effect of GABA diminishes. The brakes of the brain become ineffective. What is produced is a nervous system that becomes more reactive, is more readily thrown into an anxious condition, and slower to get out of the stress.
This is why one of the most persistent puzzles women report is being anxious without any apparent cause. Their lives are often not really bad. The panic is not to an enemy. It is what occurs when the calming chemistry of the brain has been diminished in itself.
The fact that the swings of hormone levels, high and low in an unpredictable manner, are often the cause of anxiety and not the general decline is one of the most significant lessons related to anxiety in perimenopause. Researchers observe that it is actually the hormonal changes that cause anxiety rather than the low oestrogen.
In some cycles, oestrogen levels in perimenopause may skyrocket and in others, drop to the cellar. The brain that has become used to relatively predictable rhythms of hormones over decades is now receiving dramatically unpredictable signals. This uncertainty is especially disruptive to the anxiety control systems of the brain and this is one of the reasons why anxiety tends to become a little better once the hormones stabilise into a lower range after menopause.
To many women, anxiety during perimenopause does not come as a worry of a low level. It comes in full and in the form of terrifying panic attacks which might involve a racing or pounding heart, chest tightness, sweating, dizziness, a feeling of unreality, and a belief of something being badly wrong.
Approximately ten percent of menopausal transition women report having a panic attack within past six months. It is their first to several of them. There is no background of panic disorder and they do not have a context of what is occurring with their body and they do not know that the hormones might be the cause.
The worst part of this is that the symptoms of a hormonal panic attack are almost similar to the symptoms of heart attack or any serious cardiac event. Increased heart rate, chest pains, dyspnea, sweating. A lot of women find themselves in emergency rooms with tests that are normal and they are informed that they had a panic attack with little or no explanations on why it transpired or what to do with it.
The tendency to have panic attack is specifically physiological as to why it is more prevalent during perimenopause. The body raises its temperature, the heart rate rises, and the adrenaline hormone, which causes the fight-or-flight stress response, is released when a hot flush happens. Adrenaline will help to make you feel like you are in a life and death situation, and a little nervous. The sudden rush of it, at any hour of the day, when no outward danger can be attributed to it, may readily cause a panic among the brains whose quietative mechanisms are already depressed.
Not all women experiencing a menopause develop serious anxiety. Others sail comparatively unharmed. Knowing why women are more vulnerable is also helpful, as it helps to explain a personal experience, as well as because it includes what to look at and when.
Menopause anxiety does not necessarily appear like typical anxiety. Among the indicators that the hormonal changes can be a major contributor, there are:
This is not to say that the anxiety is fictitious or not serious. It implies that the hormonal context is potentially a significant aspect of its treatment.
When night sweats are disturbing you every time, your sleep is not continuous and fragmented sleep is one of the surest methods of aggravating anxiety. Sleep is something that the brain requires to balance the stress hormone, cortisol, and to replenish the emotional equilibrium that makes anxiety manageable. The downstream impact of reducing the frequency of night heats, be it through lifestyle intervention, cooling or medical treatment, is usually significant in terms of anxiety.
CBT abbreviated as cognitive behavioural therapy is the most evidence based way of treating anxiety using psychology. It operates through the detection of the thought patterns and behaviours that sustain anxiety and the learning of practical skills to break the patterns. CBT can be more effective than medication in the long term in the case of anxiety that is already established.
CBT has also been particularly examined in the case of menopause and has been found to lessen the anxiety and mood disturbance that accompanies the transition. CBT is best accessed by means of a GP referral to a psychologist. There are also some online CBT programmes available to women living in regions or with less opportunities to make appointments.
One of the most reliable and well-grounded methods of anxiety management is exercise. It lowers cortisol, elevates the brain chemicals that promote mood such as serotonin, endorphins, enhances sleep patterns, and provides the body with an excellent physiological release of the physiological stress produced by anxiety.
Even small, regular exercise, a 30-minute walk daily, produces a significant change in anxiety levels. Exercise is not a luxury lifestyle suggestion to women who are quite anxious in perimenopause. It is a useful treatment instrument.
Some of these habits are highly detrimental to anxiety in the menopause transition, and without women necessarily knowing it:
The mechanism behind mindfulness meditation and controlled breathing is by stimulating the parasympathetic nervous system, the rest and calm system of the body which is the direct opposite of the fight-or-flight stress response. The practices do not take much time to generate benefit. Taking ten minutes of slow deliberate breathing at least once per day has been observed to decrease cortisol and even decrease baseline anxiety in the long run.
In the case of a panic attack, in particular, slowing the breathing down to a rate of about six breaths per minute (breathing in five counts, breathing out five counts) will trigger the relaxation response and may reduce the length and severity of the attack.
Magnesium is also important in GABA action, the braking system that progesterone assists as discussed in the supplements blog in this series. Lots of women lack magnesium during perimenopause. Magnesium glycinate specifically has been shown to alleviate anxiety, enhance sleep quality and aid in the regulation of the nervous system. It is a low risk alternative to be discussed with a GP or pharmacist.
A certain level of anxiety during the menopause transition is normal and can be handled with the above mentioned approaches. However, there are also cases when professional contribution is needed sooner than later:
In women in whom anxiety is evidently linked to menopause transition especially when combined with hot flushed and sleeplessness, hormone therapy can be included in the discussion. Antidepressant and anti-anxiety effects of oestrogen in perimenopausal women have been demonstrated, and psychological and lifestyle treatment cannot always do what direct treatment of the hormonal cause can do.
You are not weak or have a personality defect, and you do not have to live with anxiety in menopause. It has certain biological reasons based on the hormonal changes of the transition and these reasons are exactly why it tends to manifest itself first of all in the middle age, in women who themselves have never thought of being anxious people.
The realisation of the interconnection between the declining progesterone, varying oestrogen, diminished serotonin, and the less efficient braking system within the brain alters the manner in which the experience can be handled. It is not that you are essentially wrong. Your nervous system is adapting to an altered hormonal environment in a predictable manner.
And the relief that is supported by the facts: in the majority of women, with hormones becoming more constant over the course of menopause, anxiety becomes less intense. The fog lifts. The nervous system regains its basis. Meanwhile, there are practical and actual instruments that can make the transition much more acceptable.