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This guide will help you understand the factors contributing to perimenopause and anxiety. It will also provide you with strategies to manage perimenopausal anxiety.
What is perimenopause?
Perimenopause is the menopause transition that occurs in the years before and 1 year after menopause.
During this time, the female body undergoes various physical, psychological and emotional changes, which can manifest as many symptoms of perimenopause from fatigue, weight gain to impacts on mood.
Significant hormonal changes occur during perimenopause involving estrogen, progesterone, testosterone, insulin, cortisol and others.
These in tern influence neurotransmitter production and nervous system function.
This perimenopausal phase can last for at least 5-7 years and end a year after menopause.
What is Perimenopause Anxiety?
During perimenopause, fluctuating hormone levels can have a significant impact on a woman's mental health, leading to symptoms such as anxiety.
All hormonal transitions in women are associated with increased vulnerability to mental health challenges such as anxiety including:
puberty,
the perinatal period,
the pre-menstrual period and
perimenopause.
Approximately 13-24 percent of women in perimenopause experience anxiety disorder (Li 2016) and 66 percent experience perimenopausal anxiety symptoms (Seritan 2010).
Perimenopause anxiety is common in women who have no history of previous anxiety. Women with previous anxiety may experience more severe symptoms.
What Are The Symptoms of Perimenopause Anxiety?
Anxiety during the menopausal transition can cause feelings of fear, worry, and tension, leading to a range of physical, emotional, and cognitive symptoms.
Perimenopause can manifest in a variety of ways and can vary between women. Here are some common perimenopause anxiety symptoms:
excessive worrying
feeling on edge/jittery
impatient
in a state of heightened nervousness
irritable
fears
inability to think clearly, make decisions, brain fog
Anxiety symptoms can also be associated with mood changes such as mood swings or depressive symptoms and low mood.
Some women experience anxiety with more bodily symptoms than cognitive symptoms. They may not feel anxious but experience these physical symptoms associated with anxiety include:
Fatigue
Dizziness
Chills
Heart palpitations
Chronic sweating
Nausea and vomiting
Muscle tension
Trembling
Increased blood pressure or rapid heartbeat
Some women may experience a sudden and intense panic attack, characterized by uncontrollable feelings of worry, impending doom, palpitations and restlessness.
Some women describe their internal up-regulated physiological state as
'internal shaking'
'internal bubbling' or
'vibrations in the chest like a cell phone'
Physical symptoms such as heart palpitations, nausea, and shortness of breath often accompany perimenopause panic attacks. Panic attacks can be extremely stressful and debilitating.
The anxiety symptoms and panic attacks of perimenopause and are driven by the dysregulated stress hormones due to fluctuating levels of estrogen and reduction in progesterone.
Risk Factors for Perimenopause Anxiety
Women with the following experiences are at increased risk of perimenopausal anxiety:
Higher life stresses
Severe symptoms or frequent hot flashes and sleep disturbances
Financial problems
Poor health (Bromberger 2013).
What causes Perimenopause Anxiety?
At Ōtepoti Integrative Health we approach perimenopause anxiety from a mind-body-environment perspective.
There are a wide range of psychological, biological, and social factors contributing to the cause and maintenance of perimenopause anxiety.
Perimenopause anxiety has a number of biological contributing factors:
Hormonal fluctuations and declining estrogen and progesterone causes rapid changes in neurotransmitter function and cortisol, your stress hormone. Dysregulated ovarian hormones which result in a dysregulated stress system is the PRIMARY driver of perimenopause anxiety and should be the primary treatment.
Disrupted sleep during perimenopause due to disrupted circadian rhythm, hot flashes and night sweats increases anxiety and reduces resilience to stressors.
Palpitations are associated with increased anxiety. Both these symptoms are mediated by the sympathetic nervous system and experiencing palpitations is a significant health concern for many women resulting in increased emergency department and doctor visits (Zhou 2021) and contributes to ongoing health anxiety.
Past Trauma and Perimenopause Anxiety
Childhood trauma and other life trauma and hurts can intersect with your hormonal transition to trigger worsening of anxiety or PTSD symptoms.
Psychological Factors that influence perimenopause anxiety
Some women have difficulty adjusting to the new phase of life
Others have an increased amount of midlife stressors that converge at perimenopause.
Distress from physical symptoms can contribute to significant anxiety
A lack of resiliency skills, stress management skills, relational skills or communication skills can impact a woman's ability to cope with anxiety symptoms.
Social factors influencing perimenopause anxiety
Family and social pressures: Family and social dynamics can also play a role in triggering anxiety during menopause. Lack of social support can impact on a woman's experience of anxiety.
Balancing the needs of younger children, older children, and aging parents can create additional stress. Social expectations, pressures, and comparisons can also contribute to feelings of anxiety and inadequacy.
Societal stigmatization of women, aging women, and negative portrayals of older women can be fear inducing rather than empowering.
Pressure to remain young and youthful rather than embracing and celebrating a new phase of life.
Supporting your mental health during perimenopause
Treatment options for managing perimenopause anxiety should take a holistic approach by using a bio-psych-social approach or mind-body-narrative-environment perspective.
Lifestyle Changes
Adopting a healthy lifestyle can reduce symptoms of anxiety during perimenopause. Regular exercise, adequate sleep, stress reduction techniques (such as mindfulness or meditation), and a balanced diet can help promote overall well-being and reduce anxiety symptoms.
Exercise for perimenopause anxiety
Exercise is one of the most important factors in managing anxiety during perimenopause.
Regular physical activity can help improve both mental and physical health, reduce stress hormones, and increase serotonin levels (which have a calming effect). Exercise can also help with sleep quality.
Both aerobic and strength training exercise are great for supporting health and wellbeing in perimenopause. So go for a walk, a run, swim, or do some air-squats or lift some weights.
Adequate sleep
Getting enough sleep during perimenopause is essential to minimize anxiety. Perimenopause insomnia can be treated with:
supplements such as magnesium, tart cherry or melatonin.
Menopause hormone therapy, estradiol patches and particularly utrogestan/prometrium (natural progesterone) can support better sleep.
Ensure you sleep in a dark, cool, quiet bedroom.
Calm your nervous system before bed by using strategies like meditation, mindfulness or deep breathing.
Caffeine and perimenopause anxiety
Caffeine can exacerbate perimenopause anxiety so you may want to reduce your caffeine intake to 2 cups of coffee per day.
Some women find they are unable to tolerate any coffee/caffeine during perimenopause. Try slowly reducing your caffeine intake and see if your anxiety symptoms improve.
Perimenopause Anxiety Treatment
Hormone Replacement Therapy (HRT) and anxiety
Balancing hormones is a good option for perimenopause anxiety for some women.
By reducing the fluctuating estrogen and progesterone levels, HRT can help reduce the severity of anxiety or panic symptoms. Ask your healthcare professional if HRT is a good choice for you. Some types of HRT are funded in New Zealand, including body identical estrogen and progesterone.
Related: Estrogen Patches
Talk Therapy for anxiety
Talk therapy can help with perimenopausal anxiety by identifying and changing negative thought patterns that contribute to panic and anxiety.
Cognitive behavioral therapy (CBT) can help individuals develop coping strategies, challenge unrealistic thoughts, and learn relaxation techniques to manage panic symptoms effectively.
Acceptance and commitment therapy (ACT) is another form of talk therapy that can help individuals accept their feelings and focus on what they can control in their life.
3. Relaxation Techniques
Incorporating relaxation techniques into your daily routine can be a beneficial treatment for managing anxiety during this phase of life.
Relaxation techniques calm the mind and nervous system, reduce stress levels, and promote a sense of inner peace and well-being. '
Simple relaxation techniques that can be used to alleviate anxiety symptoms during menopause include:
Deep Breathing Exercises
Progressive Muscle Relaxation
Meditation
Yoga
Aromatherapy
Prescription Medications for perimenopause Anxiety
If anxiety or panic attacks significantly impact your daily life, you may be prescribed medication to reduce your symptoms.
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), or a beta-blocker such as propranolol may be prescribed to help manage anxiety and panic symptoms.
Your doctor should discuss the potential benefits and risks of any medication they recommend.
Social Support
Social support is essential in the treatment of anxiety during menopause. We are social creatures.
Having a strong social support system can provide comfort, understanding, and empathy, which can help alleviate anxiety symptoms.
Loved ones who listen and show empathy without judgment can be particularly helpful.
Joining a support group online or in person can help you make friendships or receive advice from women experiencing similar symptoms.
Developing hobbies and hanging out with friends or associates with similar interests can help with your general wellbeing.
Seek Professional Help
If feelings of panic and anxiety during menopause become overwhelming or are impacting your daily life, or you are having about suicidal thoughts, it is essential to seek professional help.
Experiencing anxiety is common but you should not have to suffer alone with perimenopausal anxiety. There are many treatment options available.
The Takeaway
Perimenopause anxiety is common. Understanding the symptoms, causes and treatment options for managing feelings of anxiety during this period is crucial.
Get support and don't think your symptoms are normal or that you have to suffer alone.
Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you through the perimenopause and menopause, supporting all aspects of your health and wellbeing.
Dr Deb Brunt is a specialist GP and menopause doctor in Dunedin, New Zealand and also provides menopause health coaching internationally to support optimal health habits for aging well so you can live your best life.
References
Li RX, et al. Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine (Baltimore). 2016 Aug;95(32):e4466.
Seritan AL, et al. Self-reported anxiety, depressive, and vasomotor symptoms: a study of perimenopausal women presenting to a specialized midlife assessment center. Menopause. 2010 Mar;17(2):410-5.
Zhou Q, et al. Investigation of the relationship between hot flashes, sweating and sleep quality in perimenopausal and postmenopausal women: the mediating effect of anxiety and depression. BMC Women's Health 21, 293 (2021).
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