Reviewed by: Cynthia Krause, MD
Occasional anxiety is normal at any stage of life. It’s common among women in midlife and can accompany perimenopause and menopause in some women. Prolonged anxiety during menopause, however, could be a sign of an anxiety disorder.
What is Anxiety?
Anxiety is the feeling of fear, nervousness, or apprehension that arises when facing a stressful situation, like a looming deadline or a job interview. Most people experience anxiety at least once in their lives. It can arise during perimenopause and menopause for a number of reasons, including fluctuations in the levels of the hormones estrogen and progesterone and major life changes that tend to happen around midlife. Anxiety symptoms are reported more often during perimenopause compared to before its onset.
Experiencing anxiety during menopause is common. But prolonged anxiety—the kind that interferes with work, socializing, and everyday tasks—may be a sign of an anxiety disorder, such as generalized anxiety disorder, panic disorder, and social anxiety disorder. This too is not uncommon: Nearly 30 percent of adults are affected with an anxiety disorder at least once in their lives.
At any stage of life, anxiety can lead to a wide range of symptoms. In addition to nervousness and tension, it may also cause feelings of panic, terror, and dread. Physical symptoms may include a racing heart, rapid breathing, sweating, trembling, muscle weakness, and stomach issues. People with anxiety disorders often also have depression. Fortunately, anxiety disorders can be treated in a number of effective medical and non-medical interventions, including medication and psychotherapy. For people going through menopause, hormone therapy can be helpful.
What Causes It?
During menopause, levels of the sex hormones estrogen and progesterone start to decrease. These fluctuations, though normal, are sometimes associated with the onset of anxiety. The mechanisms aren’t clearly understood yet, but some researchers think that mood disorders like anxiety and depression happen during menopause because shifts in hormone levels affect the brain’s neurotransmitters, including serotonin and norepinephrine. Others have suggested that the brains of people with serious anxiety during menopause may be more sensitive to hormonal changes during this stage of life.
Menopause also tends to coincide with big life changes, such as children reaching adulthood and leaving home, elderly parents becoming sick or passing away, career upheavals, and the realization that one can no longer have children. All of these events can be stressful, which may also contribute to feelings of anxiety. In addition, uncomfortable physical symptoms of menopause such as hot flashes can disturb sleep, which can also lead to anxiety.
What’s Happening Inside Your Body?
Anxiety is the way the body prepares to respond to a stressful situation or threat. For a short while, the heart races, blood rushes to the brain, blood pressure spikes, and breathing becomes faster. These events are mediated by a flood of stress hormones like adrenaline (also known as epinephrine) and cortisol, which is triggered by the brain. As a result, you’re mentally and physically primed to handle the source of stress.
For people experiencing menopause, these hormonal shifts occur against the backdrop of steadily decreasing estrogen and progesterone. The role of estrogen in regulating mood is complex and not fully understood. Research has linked estrogen in the brain to increased serotonin, the production of endorphins, and the protection and growth of neurons. These effects may change as estrogen levels drop.
What Does the Research Say?
- A 2018 review in the journal Obstetrics and Gynecology Clinics of North America reported that anxiety tends to peak early in menopause, together with irritability and mood swings.
- A study published in the journal Menopause in 2012 found that women with low anxiety before menopause were more likely to report high anxiety during early and late perimenopause and postmenopause, while women who had high anxiety before menopause continued to experience high anxiety throughout these periods.
- A 2005 study in the same journal of women in midlife found that women with high anxiety are five times more likely to experience hot flashes than women with normal levels of anxiety.
How is anxiety diagnosed?
A psychiatrist, psychologist, licensed clinical social worker, or other mental health professional will speak to you about your experience of menopause, symptoms, family history, and medical history before coming to a diagnosis. Sometimes a physical exam or blood test is recommended to rule out any health-related causes. Your mental health professional will tell you whether what you’re experiencing is normal anxiety or an anxiety disorder.
What are effective treatments?
Anxiety disorders are often treated with medication, psychotherapy (also known as “talk therapy”), or a combination of both. Some common medications include:
- Antidepressants: The most commonly used class of antidepressants used to treat anxiety are known as selective serotonin reuptake inhibitors (SSRIs), which increase the amount of serotonin in the brain and thereby improve mood and reduce anxiety. Some common antidepressants include fluoxetine (Prozac), sertraline (Zoloft), paroxetine HRI (Paxil), escitalopram oxalate (Lexapro), and citalopram (Celexa)
- Benzodiazepines: Drugs from this class are used as anti-anxiety medications because they provide short-term relief of anxiety disorder by calming the nervous system. They work more quickly than antidepressants, but they are habit-forming and some people build up a tolerance to them. Some common benzodiazepines are clonazepam (Rivotril), alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium).
- Buspirone: This is another type of anti-anxiety medication specifically for treating chronic anxiety.
- Beta Blockers: A type of blood pressure medication, beta blockers can be used on occasion for the physical symptoms of anxiety. They prevent adrenaline from acting on beta receptors in the heart, which in turn prevents the heart from racing. These drugs help address some of the physical consequences of anxiety, like fast heart rate, sweating, and trembling. Some common beta blockers include acebutolol (Sectral), bisoprolol (Zebeta), and carvedilol (Coreg).
- Hormone Replacement Therapy: There’s increasing evidence that hormone replacement therapy can help treat emotional changes, including anxiety, that occur during menopause by helping restore estrogen levels. Your doctor may recommend it together with other treatments. While HRT is not usually the first-line treatment for emotional disturbances during menopause, some physicians have argued that this should change. When mild anxiety occurs along with other menopausal issues like hot flashes and sleep disturbance, hormone therapy often helps. (However, if anxiety is the primary symptom and especially if it is severe, you should see a psychiatrist to consider other medications.)
What are some non-medical treatments?
Psychotherapy is a common and effective treatment for anxiety disorders that’s often used along with medication.
- Cognitive-behavioral therapy (CBT): CBT is a form of talk therapy that focuses on changing thought and behavior patterns. This helps patients see anxiety-inducing situations more clearly and respond to them in a more healthy way.
- Exposure therapy: This is a type of CBT that involves exposing a person to the thing or situation that triggers anxiety in order to change the way they respond to it.
Non-psychotherapy interventions can also be helpful in managing anxiety.
- Deep breathing: Taking slow, deep breaths and focusing on the breath help you disengage from troubling thoughts, reducing anxiety.
- Mindfulness meditation: This type of meditation involves focusing the mind on the present moment, rather than letting it drift into worrying thoughts about the past or future. Some research has shown that it helps reduce anxiety.
- Exercise: Physical activity helps divert your attention away from thoughts that cause anxiety as well as trigger changes in brain chemistry that help keep anxiety at bay.
- Yoga: In addition to being a form of exercise, yoga is also a relaxation technique. It’s been shown to promote general wellness, mood, and mental and emotional health as well as help people manage symptoms of anxiety.
What to do next:
- Connect with a mental health professional: A doctor, psychologist, psychiatrist, or licensed clinical social worker can talk to you about your anxiety symptoms and family and medical history, and provide a diagnosis, if needed.
- Discuss your treatment options: Your mental health specialist may recommend lifestyle changes, medication, psychotherapy, hormone therapy, or a combination. Since anxiety may subside once menopause ends, your specialist may also help you manage a timeline for your treatment.
- Find treatments that work for you: Listen to your body, paying attention to the treatments it responds to well. With the help of your medical provider or therapist, create a treatment plan that works best for you.
Are you experiencing other symptoms that you want to better understand and learn how to treat and manage them? Check out our following guides:
Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.