Can Menopause Cause Anxiety?

Transitioning into menopause or perimenopause can be a turbulent time. Your hormone levels drop quickly, which causes your period to fluctuate and then slow to a stop, while some other not-so-fun symptoms (hello, hot flashes) set in.

These changes may also affect the chemicals in your brain and in turn, your mood.And those hormonal-induced mood changes can include feeling anxious or depressed.

Psychiatrist Adele Viguera, MD, answers some questions about the mental and emotional aspects of menopause and how you can overcome these challenges.

What causes menopause anxiety?

It's not "all in your head." Hormonal changes play a significant role in your mental health. Feelings of anxiety or depression can happen during menopause due to the fluctuation of estrogenand another key hormone, progesterone in your body.

Not only that, but other symptoms of menopause like lack of sleep, daytime hot flashes, and night sweats can all lead to symptoms of anxiety and depression.

About 15% to 50% of perimenopausal and postmenopausal individuals may experience symptoms like anxiety, depression, forgetfulness and insomnia, noted a 2023 study. The same study also found that the more severe your menopausal symptoms, the greater the degree of mental health symptoms like anxiety and depression you may experience. 

Menopause anxiety symptoms

You may be wondering how to identify anxiety caused by menopause. Feelings of anxiety can manifest in many ways including:

• Feelings of worry or panic
• Shortness of breath
• Restlessness
• Irritability (cranky) 
• Muscle tension
• Difficulty concentrating
• Rapid heartbeat 
• Sleep disturbances
• Problems with memory

Keep in mind, everyone experiences anxiety in life and everyone experiences it differently. Anxiety becomes a clinical problem when it interferes with your everyday functioning and quality of life. Some people may have primarily psychological symptoms, while others may have more physical symptoms. The severity of symptoms can also vary

Menopause and depression

With menopause, changes in hormone levels may influence neurotransmitters in your brain. The drop in estrogen levels can also lead to hot flashes that disturb sleep, which can then lead to a host of different problems including depression. Studies like this one from 2018 consistently show that women are more vulnerable to experiencing depressive symptoms during the perimenopausal transition.

Keep in mind that you may also experience anxiety and depression together. “If you experience symptoms of depression or a loss of pleasure in things that usually made you enjoyed for nearly every day for at least a two-week period or more, you might be depressed,” Dr. Viguera says. She adds that it’s important to talk with your healthcare provider about finding the best treatment for you.

“Your healthcare provider will also want to rule out any medical causes for your depression, such as thyroid problems,” she adds.

Menopause and panic disorders 

If you’ve experienced anxiety in the past, you may have described your mood as “panicky.” Does this mean that having anxiety means you have a panic disorder? Not necessarily.

“Those with panic disorder have frequent panic attacks,” explains Dr. Viguera. “And, in between, they worry about when the next one will strike and try to avoid triggers or situations that can bring an attack on. Most commonly, panic attacks come out of the blue. A single or a few isolated panic attacks don’t mean you have a panic disorder.

However, people who were prone to anxiety in the past or who had postpartum depression are sometimes more likely to have a panic disorder during menopause. But anyone can develop one.

“Panic disorders can be hard to identify because some symptoms, such as sweating and palpitations, mirror many of the common symptoms brought on by perimenopause and menopause,” Dr. Viguera highlights. “But, just because a panic disorder is not easily diagnosed, that doesn’t mean that it doesn’t exist or that you can’t treat it.”

Another frequent anxiety disorder besides panic disorders is generalized anxiety disorder which means you are worried or anxious most of the day, nearly everyday for weeks and sometimes months. It is important to keep in mind that for anxiety symptoms to qualify as a disorder, they have to interfere with your overall functioning.

Managing menopause anxiety and depression

Menopause-related symptoms can be tough to manage. And when it’s tied to your mind and mood, it can be even trickier to tackle. But there are lifestyle adjustments you can make and treatments you can use to help manage your anxiety and depression.

Practice relaxation techniques

“Staying calm” while having anxiety may sound like a piece of advice you’re tired of hearing. But practicing relaxation and mindfulness techniques(which is another way of staying present in the moment and not catastrophizing) allows you to feel at peace with your mental health again.

While intense anxiety — especially during menopause — can feel like climbing a mountain, there are ways to soothe your nerves in small ways.

To help manage your anxiety in the moment or before it hits, you can try the following:

• Practicing relaxation techniques.
• Practicing gratitude
• Guided meditation.
• Yoga.
• Every day mindfulness.
• Journaling. 
• Breathwork. 

Having a healthy lifestyle

Another way to curb anxiety or mental health symptoms is to focus on everyday habits. With that, maintaining a healthy lifestyle can help ease the menopause transition. Make sure you’re:

• Exercising and eating healthy.
• Engaging in a creative outlet or hobby that gives you a sense of achievement.
• Stay connected with your family and community. Nurture your friendships.
• Take medicines, vitamins and minerals as prescribed by your healthcare provider.
• Getting enough sleep.

Considering hormone therapy

Hormone therapy is a treatment that boosts your hormone levels to relieve certain menopausal symptoms. While there’s growing evidence that hormone therapy can help with emotional symptoms, it alone is not effective in treating more severe mental health conditions.

“But if hot flashes and night sweats at bedtime are keeping you up at night, hormonal and non-hormonal treatments are available tohelp,” Dr. Viguera says. Depending on the severity of your condition, your healthcare provider may prescribe medication for anxiety or depression first.You may feel better after you reach menopause and your hormones level out.

See your healthcare provider or therapist

Lifestyle changes are important, but sometimes you need to be honest with yourself if your mental health is starting to weigh you down. When depression or anxiety affects your quality of life, it’s time to see your doctor.

More specific reasons to seek help include:

• You have suicidal thoughts or feelings.
• Your negative feelings last more than two weeks.
• You don’t enjoy things like you used to.
• You are isolating yourself from others.
• You’re experiencing persistent or intense anxiety or depression that interferes. with your ability to perform daily tasks, concentrate or enjoy activities.
• Your anxiety is accompanied by severe physical symptoms such as heart. palpitations, chest pain, dizziness or shortness of breath.
• You’re having trouble sleeping.
• You’re noticing significant changes in your mood, behavior or overall mental well-being, such as increased irritability, mood swings or withdrawal from activities.

“If you don’t have anyone to share your thoughts with, it’s hard to know if what you’re thinking makes sense,” Dr.Viguera says. “A good therapist will offer an invaluable perspective on the issues most important to you and providing you with some coping tools and strategies.”

The bottom line

If you’re going through the transition of menopause, it can be normal to experience mood changes and even some symptoms of anxiety. But frequent, troubling, high anxiety or panic attacks are not something you should have to deal with. That’s why it’s important to talk to your healthcare provider if you’re experiencing this. Regardless, handling anxiety and other mental health symptoms during menopause is possible through lifestyle changes, therapy and other treatments.