Menopause and anxiety

You wake at three in the morning with your heart pounding. Your thoughts spin, and you cannot quite put your finger on what you are afraid of. Perhaps you have never been an anxious person, but suddenly the feeling is there, like an uninvited guest who will not leave. If this sounds familiar, you are far from alone, and there is something important you should know: this is not weakness. It is hormones.

Your body, not your mind

Oestrogen does far more than regulate menstruation. It affects several of the brain's most important neurotransmitters, the substances that govern mood, calm, and the ability to handle stress. Serotonin, often called the happiness hormone, is directly dependent on oestrogen. Oestrogen stimulates serotonin production, prevents it from being removed too quickly from the brain, and increases the number of receptors that receive it.

But it does not stop there. Progesterone, which also falls during menopause, is broken down into a substance that has a calming effect on the nervous system through the GABA receptors. GABA is the brain's main braking system, the mechanism that helps you calm down. When progesterone drops, this natural calming effect is reduced. At the same time, noradrenaline, a neurotransmitter linked to alertness and alarm reactions, is affected.

The result is that the brain loses several of its natural mechanisms for regulating emotions, roughly at the same time. It is no wonder that many women experience anxiety, unease, and a nervous system that feels switched on all the time.

How common is it?

The SWAN study, one of the most comprehensive studies of women in menopause, followed nearly 3,000 women over ten years. Among women who did not have pre-existing anxiety, the risk of developing significant anxiety symptoms was 58 to 61 per cent higher during perimenopause compared with before the hormonal changes began. These figures held even after the researchers adjusted for hot flushes, life events, and other factors that could explain the anxiety.

Overall, research shows that between 23 and 51 per cent of women in menopause experience anxiety symptoms. Many also report that it is the psychological symptoms, not hot flushes, that trouble them the most. In a Norwegian survey, 95 per cent of women in menopause reported having experienced negative mood changes.

Hormonal anxiety or anxiety disorder?

An important distinction to be aware of is the difference between anxiety that arises as part of hormonal changes and a clinical anxiety disorder that needs its own treatment. Hormonal anxiety typically comes in waves that follow the hormonal fluctuations, is often accompanied by other symptoms such as hot flushes and sleep problems, and may respond to hormone therapy.

Clinical anxiety that does not subside, that worsens over time, or that makes it difficult to function in daily life may need other treatment. The challenge is that the symptoms overlap: palpitations from a hot flush can feel identical to palpitations from a panic attack. This similarity can make it difficult for both women and doctors to distinguish cause from effect.

If you are having panic attacks that are becoming more frequent, anxiety that does not improve over time, thoughts of harming yourself, or anxiety that causes you to avoid situations you normally handle well, you should see your doctor for a thorough assessment. That is not overreacting. It is taking yourself seriously.

What helps?

Research points to several approaches with documented effectiveness. Physical activity is perhaps the most accessible and best-documented measure. A large review of 21 studies with over 2,000 participants showed that regular exercise produced a significant reduction in anxiety symptoms among women in menopause. Particularly interesting is that mind-body exercises such as yoga, tai chi, and qigong proved especially effective, probably because they combine movement with relaxation and breathing exercises.

Cognitive behavioural therapy adapted for menopause has also shown good results in several large studies. The therapy helps you recognise and change thought patterns that amplify anxiety, and it provides concrete tools for managing symptoms. British health authorities now recommend such therapy as one of the treatment approaches for menopausal symptoms.

Hormone therapy can have a positive effect on mood and anxiety, especially during perimenopause. Current guidelines emphasise that antidepressants should not be the first choice for mood changes linked to menopause, because hormone therapy is often more targeted.

Everyday measures also play a role. A few minutes of conscious breathing can calm the nervous system surprisingly quickly. Time spent outdoors in nature reduces stress hormones. And maintaining social connections is more important than many people realise, because isolation amplifies anxiety.

Talking about it

One of the hardest things about anxiety during menopause is the shame many women feel. Perhaps you have always been a person who copes, and suddenly everything feels like too much. It is important to understand that this is not about becoming weaker. Your brain is lacking chemical substances it is accustomed to having, and that affects how you experience the world.

Talking to someone you trust, whether a friend, a partner, or your doctor, is a good place to start. Many women say that simply knowing the anxiety has a hormonal explanation makes it easier to bear.

The key takeaway

Anxiety during menopause is common, it has a biological explanation, and effective help is available. You do not have to just endure it. Start with the measures that are easiest to put into practice, whether that is a daily walk, breathing exercises, or a conversation with your doctor. And remember that this is a phase. Your body is changing, and most women find that it gets better.