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The Menopause Exchange Blog


The word ‘anxiety’ derives from the Latin word that means ‘to vex’ or ‘trouble’.  Anxiety is often experienced as a tense unsettling anticipation of a threatening but formless event. Unlike fear, anxiety can be low level and ongoing, unpredictable and uncontrollable. Recent media coverage has increased awareness, and more women are realising that anxiety is a common symptom of the menopause.

This article was included in issue 76 (spring 2018) of The Menopause Exchange newsletter.

Anxiety triggers
Whether or not anxiety is hormonally based at the menopause can be hard to establish. Few studies have looked at the relationship between menopausal hormones and neurotransmitter chemicals, which cause anxiety and difficulties with mood. Declining oestrogen levels at the menopause can play a part, especially if a woman is already prone to feeling anxious. Body changes, and symptoms such as hot flushes and night sweats leading to a lack of sleep and fatigue, may increase a sense of pressure and unease. Lack of sleep is known to reduce rational thinking.

Women often find their confidence undermined and their daily functioning disrupted. There are also significant life events in our late-40s and early-50s: children leaving home (or sometimes coming back); parents’ (and sometimes our own) health deteriorating; and careers not quite achieving what we had hoped. These factors may generate worry and anxiety.

Generalised Anxiety Disorder (GAD) is a distinct entity and it’s important to recognise the difference. Anne had crippling anxiety and was intensely cancerphobic. Every symptom she had she believed was caused by some life-threatening serious disorder that her doctors were failing to detect. She had heard about menopausal anxiety and brain fog and recognised her anxiety did get worse premenstrually. However, she had none of the other typical menopause symptoms like flushes and sweats (she was 42), no changes in her periods and her normal follicle stimulating hormone (FSH) test indicated her anxiety wasn’t linked to the menopause.

Managing anxiety
Anxiety can feel inescapable, and you may worry about everything and anything, big and small. Is my thinning hair going to make me bald? Will the babysitter turn up on time? Could I get cancer if I buy too many ready made meals? Will next door’s cat get run over? Everyday concerns during the normal course of the day hang around in your head. You can’t get rid of them, although you know there’s no point worrying. Everything is a challenge, yet you know you have coped perfectly well in the past.

The role of HRT
HRT may help anxiety caused by the menopause in the same way as it may help other typical menopausal symptoms, such as hot flushes and sweats, sleep problems and vaginal dryness. Standard oestrogen and progestogen HRT in patch and pill formulations will be effective in reducing the severity and prevalence of all menopausal anxiety.

Panic and palpitations, which can be generated by anxiety, will recede with HRT. Many women cite anxiety as the second most troublesome symptom of the menopause, and medical practitioners may prescribe HRT specifically and solely for this symptom.

Antidepressants (usually SSRIs) are often prescribed for anxiety in the general population. They can reduce symptoms and improve mood, and some have a small beneficial impact on hot flushes. Generally, these aren’t as effective as HRT for the menopause and may have side effects, but they may benefit women who can’t take HRT.

Self-help measures
Self-help strategies, such as dietary and lifestyle changes, may help, depending on the severity of your anxiety.
Food choices: Caffeine in tea or coffee can trigger anxiety. Alcohol (a depressant) can worsen underlying causes of anxiety. Foods high in sugar are not only bad for teeth, but also encourage weight gain and lead to quick highs and even quicker lows.
Physical activity: Pick something you really enjoy and do it on a regular basis. This could be walking, running, swimming, yoga, dance. It helps burn off nervous energy, produces endorphins (‘feel good’ hormones) and makes you feel stronger and more capable.
Paced breathing and relaxation: When you’re feeling overwhelmed, breathe in for a count of seven, then out for a count of 11 and repeat. After a few deep relaxing out-breaths, your body and mind slows down and your thoughts become clearer. Mindfulness, meditation or prayer lower your blood pressure and heart rate, reducing anxiety and stress. Focus on peaceful or positive images and develop calming sleep strategies, such as writing down anxious thoughts.
Take time out: Get plenty of ‘me-time’ – doing something for yourself that you take pleasure in, including talking to friends, sharing your feelings and emotions and having a good laugh! Getting the support of others, also from support groups, can provide a positive sense of empowerment.

Sometimes counselling or cognitive behavioural therapy (CBT) can be useful for anxiety. Each offers new ways of understanding yourself and your situation, providing helpful coping mechanisms, a renewed recognition of your own inner strengths and resources in a confidential non-judgmental setting. This process can release the stress and anxiety of holding so many emotions. Remember, your commitment is key to your success. Anxiety isn’t all bad. It often stimulates creative activity as well as an opportunity to learn greater self acceptance and compassion, and much of what you’re experiencing is temporary.

About the authors
Dani Singer is a specialist counsellor in three NHS clinics, a long-standing patron of the Daisy Network and a trustee of NAPS (National Association for Premenstrual Syndrome).  Dr Jane Woyka is an accredited menopause specialist.  She works at the Menopause and Clinical Research Unit at Northwick Park Hospital and at her private practice at the Harrow Health Care Centre, based at the Clementine Churchill Hospital.

Created Spring 2018

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