Why You Feel More Anxious During Menopause

Menopause. For some women, it’s a minor inconvenience. For others, it's a life-altering cycle that impacts their physical and mental health. And for all women, it’s something that happens during their lifetime.

The body undergoes so many changes during menopause like weight gain and low libido. Physical symptoms aside, there are mental challenges too. Up to 50% of menopausal women experience a variety of emotional and psychological symptoms, including memory lapses, difficulty sleeping, and anxiety.

“Anxiety can occur in both perimenopause and menopause due to fluctuating hormone levels, especially estrogen, which affects neurotransmitters in the brain,” explains Wes Knepper, LCMHC, MHA, the director of quality at SonderMind, an online mental health service. “The impact of these hormonal changes vary considerably between individuals, so everyone will experience something slightly different from their friends and family.”

Understanding that anxiety can be the result of hormonal fluctuations is one thing. Knowing what that looks like and taking the steps to navigate the journey successfully is another. Read on to learn why menopause can cause anxiety (and a host of other symptoms), plus the strategies you can use to cope.

Menopause, Physical Health, and Anxiety

The average age for women to start menopause in the United States is 51, though some women enter menopause in their early 40s. A woman becomes menopausal when she has not had her period for 12 consecutive months. Once that happens, your body stops producing estrogen and progesterone, and hormone levels drop.

Perimenopause is the time that leads up to menopause, when the estrogen and progesterone levels start to fluctuate, often resulting in hormonal ups and downs. It’s at this point that some of the physical symptoms can begin.

“Understand that there are over 400 different receptors for estrogen throughout the body, so depending on how each individual is put together, the symptoms will vary,” says Dr. Bruce Dorr, senior medical advisor at Biote. “There are three main categories of symptoms: vasomotor, which includes night sweats and hot flashes; vaginal dryness or painful sex; and difficulty sleeping. It can be disconcerting because you don’t know where or when the symptoms will begin.”

Other physical symptoms include weight gain, dry skin, thinning hair, breasts losing their fullness, and chills.

Of course, some physical symptoms of menopause can be symptomatic of other conditions. But the main thing is that these symptoms often happen without warning. Imagine suddenly being sluggish and headachy, with stomach aches and insomnia. Naturally, these changes will make you anxious, stressed, and worried about what’s going on with your body, hence menopausal anxiety.

Other Ways Menopause Can Cause Anxiety

While fluctuating hormone levels play a part in causing anxiety, menopause doesn’t happen in a vacuum. There are other ways menopause—or the symptoms of it—can make you feel anxious.

Life Events

Remember, life never stops. So, while your body is undergoing major chemical changes, other major life events are still happening.

“This time in a woman's life is also full of other transitions that may impact their anxiety levels,” Knepper notes. “Changes in family dynamics due to children growing up and moving out, career changes, moving to a different house or downsizing, other health concerns outside of menopause. All of these things can also lead to anxiety, which may be further exacerbated by the hormonal changes women experience during this time.”

Unknown Bodily Changes

Then, there's anxiety about the onset and potential course of menopause. Knepper adds that many women don't know how their bodies will change during menopause, which can make them feel more anxious. It doesn't help that anxiety is one of the less talked about symptoms of menopause. There's plenty of information about hot flashes, weight gain, and other physical symptoms but not so much on mental health challenges like anxiety and stress.

The fear of being stigmatized and not taken seriously can keep women from discussing their feelings. Some women want to share their anxiety but struggle to accurately describe what they're feeling (as many don't understand why or what's causing them to be anxious). All of this prevents women from being vulnerable and open about their menopausal anxiety.

This is why it's crucial to have an empathetic doctor who is well-versed in the many symptoms of menopause and is willing to help get to the root cause of the issue.

“Because the symptoms between true anxiety and menopausal symptoms are so similar, the only way for women to understand [their anxiety] is to find a professional that knows what to do and how to screen for these symptoms correctly,” Dr. Dorr explains.

Tips for Dealing With Menopausal Anxiety

There's no set way to deal with menopausal and perimenopausal anxiety, so it's important to consider a multipronged approach to relieving symptoms. Here are practical things you can do to cope with your menopausal anxiety and feel less anxious.

Talk to a Mental Health Professional

Talking to a therapist can help you make sense of your feelings of anxiety, along with any other emotions you’re dealing with. Counseling will help process your thoughts and give you coping mechanisms to curb your anxiety. Mindfulness activities can also help center and calm you.

Make Dietary and Lifestyle Changes

If you love a good cup of coffee, you might want to consider decaf. Research shows that caffeine can exacerbate menopause symptoms. Eating a well-balanced diet can also improve how you feel mentally and physically. Implementing a good exercise routine is another helpful idea. “Light exercise like yoga or a walk can significantly help levels of anxiety,” advises Knepper.

Consider Hormone Replacement Therapy

“Hormone replacement is the process of putting these chemical messengers, the estrogen and progesterone, back inside the body,” Dr. Dorr explains. “Hormone replacement therapy can be delivered via a wide variety of delivery systems. Oral delivery includes pills or salivary tablets. Transdermal—the delivery through the skin—includes patches, gels, sprays, or creams. There are also injections by needle into the fat or muscle.”

According to Dr. Dorr, pellets are also a great delivery system due to their even, consistent dosage into the bloodstream: "However, the delivery system that mimics our glands the closest is a pellet, which is similar to a small grain of rice placed under the skin and provides customized and consistent precision dosing directly into the bloodstream."

Consult your doctor to help determine if this is a good course of action for you.

Look into Anxiety Medication

If meditation and mindfulness aren't working, consider looking into anti-anxiety medication. Your doctor may prescribe antidepressants or SSRIs (selective serotonin reuptake inhibitors) if you are experiencing severe symptoms. Research shows that antidepressant drug treatments are effective in reducing anxiety stemming from menopause.  

Lean on Community

Some days you may feel like you can conquer the world. On other days, getting out of bed may seem like a chore. Learn to lean on your community for help. “Regular contact with friends and family, especially those that might have gone through what a woman is currently experiencing, can make people feel less alone,” says Knepper.

Ultimately, anxiety may be a natural part of your menopause experience. Do your research, be mindful of the symptoms you’re experiencing, and don’t be afraid to ask for help if you need it.

“It is important to remember that all women will go through menopause, once they reach a certain age, so they really aren't alone on this journey,” says Knepper. ”I recommend opening up to older friends and family to talk about what you are going through. Remember, up to half of women will have some sort of behavioral health symptoms as a result of menopause, so you aren't alone.”