Anxiety is a tense, diffuse, unpleasant feeling of worry and unease: an amorphous sensation of dread or impending doom, even in the absence of an obvious external trigger. Anyone can experience anxiety, but it’s often heightened for women around the time of the menopause, or just before (perimenopause). Anxiety differs from fear, which is specific, time-limited and generally has a concrete base, although sometimes fear is based on false evidence appearing real.
This article was included in issue 101 (Summer 2024) of The Menopause Exchange newsletter.
What are the possible causes?
Fluctuations in oestrogen, progesterone and testosterone, which regulate serotonin (a natural mood-booster) and endorphins (feel-good hormones) may lead to volatile emotional responses to even the smallest things. When stressful life events are added, such as family and life changes, financial worries, difficulties at work or health conditions in ourselves or significant others, on top of ubiquitous fears about aging, the primary stress hormone cortisol can also become activated. This further contributes to racing thoughts, feelings of anxiety, irritability and worries of ‘going mad’.
The impact of symptoms
Physical symptoms of the menopause, such as hot flushes/night sweats, sleep disturbance, muscle aches and pains, pounding heart, skin irritation, headaches and brain fog, and caffeine in our system, can intensify anxious ruminations and even catastrophic worries, for example about the future. So it’s unsurprising that situations may feel overwhelming. Together, these create a potent and unpleasant cocktail, resulting in the often-expressed view of feeling ‘unlike my former self’. Our self-confidence becomes dented at what feels like a particularly vulnerable time.
Who is likely to be affected?
The above concoction affects a proportion of women in or around the menopause, sometimes quite severely. Those affected in particular, but not always, may have strong physical symptoms, have experienced multiple health conditions such as endometriosis, undergone surgery such as a hysterectomy where hormonal changes have happened abruptly, severe PMS/PMDD or other gynaecological problems, or have experienced unresolved trauma.
What can help?
The most recent government NICE guidelines have somewhat downgraded their 2015 suggestion that a course of CBT (Cognitive Behavioural Therapy) can be extremely useful for anxiety around the time of the menopause. They maintain it can continue to be helpful particularly for those for whom HRT is medically contraindicated and as a possible adjunct alongside medication.
There are several things you can do yourself, in particular making time for self-care. Rapid breathing is part and parcel of anxiety, so using slow, diaphragmatic breathing to calm down can be helpful. Meditating or prayer (if you’re spiritual) can make a significant difference too, as can eating a diet that reduces or even eliminates spices, alcohol and caffeine, while eating foods rich in magnesium, a naturally occurring relaxant.
If you enjoy writing or drawing, keeping a mood log or diary can be helpful to reduce the impact of toxic thoughts and replace them with more realistic ones. This can be done by first noticing the thought and recognising that it’s a negative one, and then distancing yourself from it. You could say out loud or to yourself, depending on the context, “I notice that this is the thought I am having, and it may not be true. For example, everyone is noticing my discomfort/hot flush etc.” While this may feel a bit strange at first, it can help over time – as can talking to someone who can relate easily to what you’re experiencing.
Because disturbed sleep is a common experience at this time and is often impacted by anxiety, making a plan for a sleep-friendly night-time routine, and importantly, sticking to it, is another useful tool. It’s been found that breaking the cycle of feeling anxious if you wake in the night due to night sweats or having to go to the loo, and getting frustrated at not being able to get back to sleep, increases anxiety, making it harder for you to return to sleep.
For night sweats, try cooling your body down by, for example, putting your feet on the cold bathroom floor, having a change of (cotton) bed clothes handy, lying back in the dark for a minimum of four hours no matter what, and breathing in a relaxed manner, by focusing on and lengthening your out-breath while waiting to drift back to sleep. Some women have mentioned ice-baths or swimming; these produce a natural high, forcing you to focus on the present. Others listen to sleep books – no one size fits all.
Additional lifestyle changes such as increasing physical activity (daily walking, particularly in nature’s green spaces: parks, ponds), tending a window box or just gazing at trees and listening to the birds while paying attention to your body and your breathing can be calming. Watching a sunrise or sunset, or two, can help to recalibrate your internal clock to help with sleep, as can dancing, (Hatha) yoga, Pilates and the like, depending on your personal preference and ability. Any and all are worth considering: try them alone or with friends, family or even your pet! The main thing is to start small and slowly, then gradually build up.
Moving forwards
Like everything, perseverance is key. It’s worth remembering that you are the expert on your own condition and deserve to collaborate with your medical and or psychological healthcare professional as an equal and active partner in managing your own care. The menopause is an unavoidable life stage for half the world’s population, but experiences vary hugely. Taking positive action will help you to feel empowered.
About the author
Dani Singer is a specialist menopause counsellor and psychotherapist at the menopause clinic at Northwick Park Hospital in Harrow, Middlesex.
Created Summer 2024
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