Medically reviewed by Dr. Tamara Neuhaus MD

Anxiety & Menopause - Can Peri/Menopause Make You Anxious?

It happens every night, shortly after midnight. I wake up, and no matter how hard I try to still my mind, I lie there for an hour or two, worrying about Every. Little. Thing. The work I need to do tomorrow, the things I forgot to do yesterday, my kid with high school angst, my Mom’s health. I know worrying about it won’t solve anything, but I just can’t stop myself. - Margo, 47

What is it?

Anxiety is a normal and often healthy response to stressful situations. Especially stress associated with what will happen as a result of a situation you’re facing now. But sometimes it can start to get in the way of important things like sleeping, eating or socializing, even if the stressful situations that are causing it aren’t really putting you in danger. 

Anxiety often comes with increased heart rate, perspiration, and heightened sensitivity to your surroundings, which also happen to be symptoms of perimenopause. So it can be hard to tell if what you’re feeling is anxiety, or just a hot flash and palpitations. And other perimenopause symptoms, like brain fog or forgetfulness, can be anxiety-provoking, causing you to fear that you may be experiencing early-stage dementia. Loss of libido can make you feel anxious about the stability of your marriage or relationship. Urinary incontinence can cause anxiety about getting out and enjoying life with friends. So it can be a bit hard to tease apart anxiety and menopause.

Why does it happen?

Fluctuating estrogen levels in perimenopause can alter two neurotransmitters in the brain that are strongly linked to anxiety: serotonin and norepinephrine. So if you’re prone to anxiety or panic attacks, you’re more likely to experience them during perimenopause. And if you’re prone to worry, that tendency may tip into anxiety in perimenopause. But let’s be honest: there’s also a lot to stress out or be anxious about at this point in your life: caring for growing children and aging parents, managing increased responsibilities at work, nurturing more complex relationships, dealing with your own physical and cognitive changes that come with perimenopause. It seems life throws the most at women when our coping mechanisms are most vulnerable. 

What can you do about it?

There are a few ways you can address your anxiety, and they can be used on their own or in combination with each other.

Exercise

Regular exercise can help ease anxiety directly by taking your mind off the things that are causing your anxious feelings, decreasing muscle tension, increasing the feel-good neurochemicals in your brain, and keeping your amygdala (the part of your brain that reacts to real or perceived threats) in check. Indirectly, exercise can improve your sleep and mood.

Mindfulness Meditation

In some small studies, mindfulness meditation has shown moderate evidence of improving anxiety. Espoused by a Zen Buddhist monk named Thich Nhat Hanh, the practice involves sitting comfortably and turning your attention to what is happening in the present: your breathing; the smells, sights, and sounds around you; the feeling of your body in space. Mindfulness meditation can work in tandem with medication and/or psychotherapy to ease anxiety.

Psychotherapy

Cognitive Behavioral Therapy (CBT) has shown to be very successful in treating anxiety in women in peri/menopause. CBT teaches you new ways to behave or react to stressful situations by changing your thought patterns around them.

Supplements

If the lifestyle changes above aren’t giving you the relief you need, there are some supplements that have been proven effective at easing anxiety.

  • Lavender - Evidence from several high-quality, randomized trials suggests essential oil extract of Lavandula Angustifolia, taken orally, can play a role in treating anxiety. It calms quickly without sedating and is not addictive. 

  • L-theanine - Published data suggests that daily doses (200-400 mg) of L-theanine, an amino acid naturally found in green tea, can safely reduce stress levels. 

  • Inositol - A.K.A. Vitamin B8, inositol has shown to be as effective as a common prescription med for anxiety called Fluvoxamine, and it has fewer adverse side effects.

Prescription Meds

Often lifestyle changes, supplements and/or hormone therapy (HRT) can be enough to reign in the anxiety associated with peri/menopause. But if you suspect you’re suffering from an anxiety disorder, your doctor can prescribe one of several medications that help manage anxiety. SSRIs (like Prozac, Paxil, Zoloft, Lexipro, and Celexa) increase the serotonin levels in your brain. SNRIs (like Cymbalta, Pristiq, Fetzima and Effexor XR) increase the levels of both serotonin and norepinephrine. You can talk with your doctor about which might be right for you, depending on any other medications you might already be taking.



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