Menopause & Anxiety: Understanding the Shift in Mood and Finding Relief

Hormonal fluctuations, coupled with other physical and emotional changes during the menopausal transition, may increase the risk of anxiety. Research shows that between 15% and 50% of women going through menopause report emotional disturbances, with about 25% experiencing anxiety.⁽¹⁾ Despite its prevalence, surprisingly few seek consultation or treatment.

Being aware of anxiety symptoms empowers women to manage them more effectively, reducing unnecessary distress. Studies highlight that early intervention and informed support can greatly improve outcomes. Every woman who experiences anxiety, whether or not they’re going through menopause, should consult a physician to manage it effectively and improve their overall quality of life.

When does menopausal anxiety occur?

Research suggests that early perimenopausal women may be at a higher risk of menopause-related anxiety. However, this isn’t the case for all women. Anxiety can affect women at any stage of menopause, including postmenopause.⁽²⁾

What causes menopause-related anxiety?

Anxiety during menopause is often the result of multiple interrelated factors. Hormonal fluctuations are a primary cause, but lifestyle changes, stress from life transitions, and individual health history all contribute to the development and severity of menopausal anxiety.

Hormonal Fluctuations

During menopause, the fluctuations in estrogen levels can significantly impact mood and emotional well-being. Estrogen influences serotonin, the happiness hormone, by controlling the enzyme needed for its production. This enhances the activity of serotonin receptors and blocks its reuptake, which prevents serotonin breakdown. As estrogen levels decline during the menopausal transition, so do serotonin levels. This decrease often leads to mood changes and anxiety.^(3,4)

Additionally, menopause introduces various physical and emotional challenges, like weight gain, hot flashes, and sleep disturbances. These stressors can trigger the body to release cortisol, the stress hormone. Cortisol prepares the body to respond to an emergency or a threat. However, in the absence of a physical outlet, elevated cortisol levels may further exacerbate feelings of anxiety.^(3,4)

Sleep Disruptions

Vasomotor symptoms like hot flashes and night sweats are commonly experienced during menopause. These disturbances make it difficult to fall or stay asleep, fostering a cycle of poor rest. This pattern can aggravate anxiety.⁽⁵⁾

Life Stressors

Menopause coincides with significant life events that may amplify anxiety for many women. These life events may include adult children leaving or returning home, navigating relationship changes such as divorce or widowhood, caring for aging parents, and undergoing career shifts. Additionally, dealing with the physical and emotional changes associated with aging can be challenging in a society that highly values youth.. Together, these factors can significantly heighten feelings of anxiety during the menopausal transition.⁽⁶⁾

Symptoms of Menopause-Related Anxiety

During menopause, anxiety goes beyond the usual worries — it persists and often worsens over time. It can hinder a woman's ability to function normally, disrupting daily life and affecting work and relationships. Menopausal anxiety may show up with a variety of physical and emotional symptoms:⁽¹⁾

• Persistent feelings of restlessness or being constantly on edge

• Inexplicable fatigue that seems to settle in quickly

• Difficulty focusing, with thoughts often slipping into blankness

• Increased irritability and muscle tension

• Trouble managing persistent worries

• Engaging in self-soothing behaviors, such as nail biting or hand rubbing

Managing Menopause-Related Anxiety During Menopause

Managing anxiety doesn’t take a one-size-fits-all approach. Here are some strategies that prove effective for many, but it often takes some trial and error for individuals to find what works best.

Healthy Lifestyle Habits

Experts recommend the following lifestyle changes to manage anxiety during menopause:

• Having a balanced diet: Nutrient-rich foods can help manage the physical changes of menopause. Adding leafy greens to the diet can be beneficial, as they are high in folate, which helps regulate serotonin levels and improve mood. Foods rich in Omega-3 fatty acids, like fatty fish, flaxseeds, and walnuts, can also boost mood and may reduce anxiety. Additionally, fiber-rich foods such as whole grains, fruits, and legumes support digestive health and can help maintain a healthy weight.^(7,8)

• Staying active: Regular physical activity releases endorphins that promote feelings of happiness. Individuals can aim for 150 minutes of moderate activity or 75 minutes of intense activity weekly, complemented by strength training a few days a week.⁽⁹⁾

• Improving sleep hygiene: Menopause often brings sleep challenges, exacerbated by night sweats and anxiety. To improve sleep, it’s important to maintain a regular sleep schedule, create a restful environment that is dark, quiet, and cool, and limit exposure to screens before bedtime. Relaxation techniques, such as deep breathing, progressive muscle relaxation, and visualization may also help achieve better sleep.⁽¹⁰⁾

• Limiting stimulants: Excessive consumption of alcohol can worsen hot flashes and negatively impact sleep quality, thereby increasing anxiety. So, it’s best to limit alcohol intake during menopause.⁽¹¹⁾

Stress Management and Relaxation Techniques

Maintaining a symptom diary can help identify and understand anxiety triggers. Recording when anxiety peaks and noting the surrounding circumstances allows individuals to pinpoint specific triggers and work on strategies to avoid or mitigate them.

Alongside this reflective practice, women can also experiment with relaxation techniques. Experts recommend deep breathing, yoga, or meditation to soothe the mind and body during menopause. Research has shown that mindfulness-based stress reduction methods help reduce anxiety and ease other hormone-related symptoms typical of perimenopause.⁽¹⁾

Yoga can be particularly beneficial for relieving anxiety. It combines physical activity with mental focus, fostering a mind-body connection that promotes overall well-being, encourages self-awareness, and relieves anxiety.

Simple breathing exercises can also help calm the nervous system and decrease anxiety. The 4-7-8 breathing technique is a popular method. It involves inhaling deeply for 4 seconds, holding the breath for 7 seconds, and exhaling slowly for 8 seconds.⁽¹³⁾ 

Social Connection

Social connections are also important in managing anxiety because they help release oxytocin, the "bonding hormone." This hormone promotes feelings of calm and happiness. Originally known for its role in mother-child bonding, like helping with breastfeeding, oxytocin's benefits extend much further. It works alongside other hormones like serotonin and dopamine to foster emotional resilience and support mental health. Simple actions like holding hands, hugging, or petting animals can increase oxytocin levels and soothe anxiety.⁽¹⁴⁾

Cognitive Behavioral Therapy (CBT)

CBT aids in managing anxiety by identifying and altering negative thought patterns. It operates on the principle that thoughts, feelings, and behaviors are interconnected, and changing one can positively affect others. This therapy helps individuals recognize their faulty or unhelpful ways of thinking and replace them with more beneficial thought patterns. 

CBT encourages people to challenge distorted perceptions and develop healthier responses to anxiety-provoking situations through various techniques. By focusing on these new, constructive habits, CBT can help alleviate the mental and physical symptoms of menopause.⁽¹⁵⁾

Medications

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are antidepressants that also help soothe anxiety, especially if it’s associated with hot flashes. It's recommended to consult a psychiatrist who can help decide if these medicines would improve symptoms. In addition, symptoms that don’t improve or increase in severity need immediate attention from a physician.⁽¹⁶⁾

Can hormone replacement therapy (HRT) help with menopause anxiety?

Studies have shown that HRT might help manage mood and emotional responses during menopause by influencing certain brain functions. Moreover, HRT proves to be effective in alleviating physical symptoms associated with menopause like hot flashes, night sweats, and sleep disturbances. By addressing these symptoms, HRT indirectly reduces anxiety. ⁽¹⁷⁾

Additionally, localized treatments like vaginal estrogen therapy can address menopausal symptoms that might trigger anxiety, like vaginal dryness and painful intercourse.

Experiencing anxiety during menopause? Discover if HRT is right for you.

If you’ve entered the menopause transition and are struggling with anxiety, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.