Menopause is an inevitable phase in life, marking the natural end of a person's reproductive years. Although most people associate menopause with the end of their periods and other physical changes (like hot flushes, night sweats and brain fog), it also brings lots of emotional and psychological challenges. And these are changes we don't speak about enough.

Somewhere between 15-50% of people experience menopause related-anxiety, with symptoms ranging from mild to severe. It's unfortunately quite common, and you're not alone. One of the most common concerns people have during the menopausal transition is whether or not the anxiety that accompanies the menopause will ever go away. We know it can sometimes feel like it never will, but hopefully, this article will shed some light on how you can best manage it.

We will look into anxiety during the menopause transition and beyond, exploring its causes, symptoms, and the various factors that determine how long it lasts. 

Why does menopause cause anxiety?

Understanding why menopause can cause anxiety requires looking at a combination of hormone levels, menopausal symptoms, and the broader context of your daily life.

Hormone fluctuations

The menopausal transition is characterised by big changes in hormone levels, particularly a drop in oestrogen levels (or estrogen levels). These shifts can bring about some physical symptoms like night sweats and sleep issues, which might indirectly play a part in those moments of anxiety. When your body is going through such significant hormone shifts, it can affect your brain chemistry, which might result in feelings of anxiety.

Disruption in daily life

Dealing with the physical changes that come with menopause, like hot flushes and joint pain, can throw your daily routines off balance. Managing these symptoms can be a real challenge, and it's perfectly normal to feel more stressed as a result, which can, unfortunately, lead to feelings of anxiety.

Psychological symptoms

Alongside the physical changes, menopause also brings about a host of psychological symptoms, including mood swings, mood disorders, and depressive symptoms. The unpredictability of mood fluctuations can be unsettling, leading to feelings of unease and anxiety.

Common symptoms of anxiety

Some menopausal symptoms bear a striking resemblance to common symptoms of anxiety. Heart palpitations, shortness of breath, and chest pain, are all manifestations of menopause that mirror what you would experience during a panic attack.

The end of your menstrual period

It's a pretty big deal when something that's been a regular part of your life for years comes to an end. The complete cessation of a regular menstrual cycle, a phase sometimes referred to as the menopausal transition, can have a real impact on your emotions and contribute to feelings of anxiety.

How long will this last?

The duration of menopausal anxiety can vary widely from one person to another. There's no one way to experience menopause and there's no fixed timeline for how long it will last. It depends on several factors, including:

Personal variation

The most important thing to keep in mind when looking at menopause symptoms is that each person's experience of the menopausal transition is unique. Some may have more pronounced anxiety symptoms, while others may have milder or no symptoms at all. That being said, there are some factors that can contribute to why some people's menopausal transition is more anxiety-ridden than others.

Hormonal changes

Fluctuations in hormone levels, particularly levels of oestrogen (or estrogen), play a significant role in menopausal anxiety. Hormone replacement therapy (HRT) or other treatments can help alleviate these symptoms. We'll get more into treatments later on.

The menopause stage you're at

Menopause occurs in stages, including perimenopause (the transitional phase leading up to menopause), menopause itself, and postmenopause. Anxiety may be more prevalent in perimenopausal people, but can continue into menopause and even postmenopause for some people.

Health and lifestyle factors

Overall physical health, lifestyle, and stress levels can influence the duration of menopausal anxiety and other mental symptoms. A healthy lifestyle, regular exercise and physical activity, stress management, and a balanced diet can help ease symptoms.

Psychological factors

Individual psychological factors, such as someone's ability to cope with change and stress, can influence the duration and severity of anxiety during menopause. This goes hand-in-hand with any family history of anxiety disorders or other mental health conditions. Having this family history is a risk factor for menopausal anxiety symptoms.

Previous mental health struggles

If you've experienced mental health issues in the past, such as a panic disorder or postnatal depression, you may be more susceptible to low mood and anxiety. If you have been on antidepressant medication before and think it may help boost levels of serotonin and reduce anxiety, consult your doctor or health professional to discuss if they are the right option for you.

Social support

Having a strong support network, whether through friends, family, or support groups, can contribute to better emotional wellbeing and potentially shorten and reduce anxiety in menopausal and perimenopausal people.

It's important to note that menopausal anxiety is a common but manageable symptom of the menopause transition. If you're experiencing prolonged or severe anxiety, we would advise speaking to your GP or Fertifa Patient Advisor if you're a Fertifa patient. They can give you some guidance and suggestions for treatment that can hopefully help manage the symptoms and improve your overall wellbeing. Remember, you shouldn't struggle in silence.

So what can I do?

Hormone therapy 

To address menopause-induced anxiety, many people explore hormone therapy options, like hormone replacement therapy (HRT). Studies have shown that HRT can help protect against heart disease and alleviate some of the physical symptoms of menopause, including anxiety. HRT helps with menopausal anxiety by stabilising hormone levels, particularly oestrogen. This stabilisation reduces mood swings and emotional symptoms linked to menopausal anxiety.

Hormone therapy can also alleviate physical symptoms like hot flushes (or hot flashes), night sweats, and sleep disturbances, indirectly reducing anxiety. It is an effective treatment of anxiety, enhancing overall wellbeing and quality of life and reducing stress, all in a way that tailors to the individual's needs. However, HRT is not suitable for everyone and should be discussed with your doctor to assess risks and benefits. 

Vaginal estrogen therapy

Vaginal estrogen therapy helps menopausal anxiety by relieving physical discomfort like vaginal dryness and painful intercourse. This alleviation enhances sexual function, self-esteem, and overall wellbeing, reducing anxiety indirectly. It's a localised, generally safe treatment for vaginal symptoms, but it may not directly address generalised anxiety, especially if you have a generalised anxiety disorder.

Any medical treatment should be paired with developing healthy coping strategies, seeking social support, and adopting some lifestyle changes. These can all help manage the psychological and emotional aspects of this transition.

Behavioural therapy

This includes Cognitive-Behavioural Therapy (CBT) and it can be really useful when it comes to managing menopausal anxiety and associated depressive symptoms. It's like having a handy toolkit of practical strategies to help you deal with your anxiety.

CBT offers a range of helpful techniques, from calming your emotions to managing stress, teaching you to relax, stay present in the moment, get better quality sleep, and even encourage you to make positive lifestyle changes. Breathing exercises in particular are a great way to calm yourself and bring your heart rate down. It's all about boosting your emotional wellbeing, and it encourages you to reach out to friends, family, or support groups for that extra dose of social support. 

Mild anxiety vs. chronic or severe anxiety

These treatments are all suitable for mild anxiety. If you have chronic anxiety, remember that managing it may require more time and patience. The above solutions are still great options, but it may also be worth asking your doctor or medical professional about anti-anxiety, or other prescription medications as well.

Menopause and anxiety are closely intertwined due to the physical and psychological challenges that accompany this phase of life. We know just how stressful the effects of anxiety can be on day-to-day life. However, understanding the reasons behind menopause-induced anxiety is important to help navigate through the difficulties that accompany the menopausal transition. By acknowledging the contributing factors and seeking support and solutions, you can ease the journey through menopause and minimise the impact of anxiety on your wellbeing.

If you have any questions about anxiety, or any other menopause symptoms, don't hesitate to contact your Fertifa Nurse Practitioner. We're always here to support. 💜