Anxiety, panic attacks and menopause
Do you regularly have sudden attacks of panic or nervousness? Do you sometimes feel anxious for no reason? You are not the only one. Changes in mental health can accompany the transition into menopause. This is because hormonal changes that occur during this time can make you prone to emotional instability and panic attacks. What exactly is happening in your body? And, more importantly, what can you do to stabilise your emotions?
"A sudden feeling of panic came over me. I felt as if I could burst out in tears at any moment. All I wanted was to get away from this intensely overwhelming feeling.” - Marlène (age 47)
Not every woman will experience anxiety and panic during menopause. Research shows that between 10 to 25 percent of women suffer from menopause-related anxiety and panic attacks. Also, women with severe menopausal symptoms experience higher levels of stress and anxiety.
Symptoms are most likely to occur in perimenopause, when hormonal fluctuations are more pronounced. They may come unexpectedly or for no obvious reason. The closer to menopause you are, the more your oestrogen levels drop, and the less serotonin is made.
What is happening in your body?
Big hormonal shifts during menopause can make some women more prone to mental restlessness, anxiety and panic attacks. Declining levels of oestrogen and progesterone and changes in cortisol levels play an important part in this respect.
First of all, fluctuating oestrogen levels can affect how the happiness hormones serotonin and dopamine work in the brain, triggering feelings of anxiety, low mood or stress. Progesterone has a calming effect on the nervous system. Hormonal imbalances and a fall in progesterone can also contribute to increased feelings of anxiety and restlessness. These feelings may manifest in various ways, such as constant nervousness, panic attacks or irrational fears, such as hypochondria (the fear of being seriously ill).
What’s more, when oestrogen and progesterone levels start to decline, cortisol levels rise. Elevated cortisol levels can trigger stress responses. Stress in turn can exacerbate menopausal symptoms and make anxiety or panic attacks worse. Or panic attacks may occur more frequently, even for no obvious reason.
Other causes
When it comes to mental issues and mood swings during menopause, hormonal changes are usually a significant factor, but they may not be the only factor. Other menopausal symptoms, such as (nocturnal) hot flashes, sleep problems and fatigue, can also take a toll on your emotional well-being.
Menopause is a time when many women experience significant life changes – empty nests, loss of parents, a career change, changes in relationships, a body that looks different. These changes can be hard to manage, causing you to feel overwhelmed or restless. In short, menopause and its emotional impact should not be underestimated.
How does menopause affect you mentally?
- Irritability
- Low mood
- Anxiety
- Feelings of hopelessness
- Reduced concentration
- Fatigue
- Lack of motivation
- Mood swings
- Restlessness
- Crankiness or dissatisfaction
- Insecurity
- Crying spells
- Panic attacks
- Not feeling like yourself
- Sleep problems
What can you do?
Feelings such as anxiety and panic can be managed. There are some proven ways to improve your emotional well-being:
- Make time to relax. In situations of stress, your adrenal glands will prioritise the production of cortisol (the stress hormone) over progesterone. This can create a vicious cycle: the more stress you have, the more cortisol is produced at the expense of progesterone, and the more stress you will experience. Break the cycle by carving out moments in your day to rest. Whether it's a breathing exercise or a more active form of relaxation such as walking, yoga or reading, do whatever you find relaxing. It will do you good.
- Exercise regularly. Exercise triggers the release of neurotransmitters and endorphins, which has a positive impact on mood and lessens restlessness, anxiety and panic symptoms.
- Stabilise your blood sugar. Limit your intake of fast carbohydrates to keep your blood sugar levels in check. (White bread, cakes, cookies and other sugary foods are high in fast carbs.) Fluctuations in blood sugar, whether high or low, can impact your mood and cause restlessness.
- Eat fibre-rich foods. Our guts and brains are far more interconnected than previously presumed. A diverse gut microbiome, the ecosystem of microbes (bacteria, yeasts) that live in your intestines, can benefit overall psychological well-being. Eat a variety of colourful fruits and vegetables. Eat a rainbow every day! Eating fibre-rich foods, such as vegetables, fruits, whole grains, nuts and legumes, results in higher levels of 'good bacteria' in the gut. Prebiotics and probiotics also support a diverse gut microbiome.
- Increase your protein intake. Protein is found in a wide range of foods such as meat, fish, eggs, nuts, seeds and legumes. The neurotransmitters dopamine and serotonin are made from protein, and both play an important role in regulating mood and emotions. For optimal health, women should consume 0.83 gram of protein per kilogram of body weight. So if you weigh 75 kilos, you need to eat 62 grams of protein a day.
- Get enough sleep. Sleep deprivation can worsen anxiety. If necessary, improve your sleep hygiene. Cut down on caffeine and alcohol, avoid looking at screens before going to bed, and make sure your bedroom is dark and cool.
- Limit your intake of caffeine and alcohol. Alcohol and caffeine have an effect on the nervous system and can increase anxiety.
- Talk about your problems. Sharing your worries with someone you trust, like a friend, family member or professional, can be a relief. Therapy can help you uncover the underlying causes of your anxiety and provide you with coping strategies. There are different types of therapy available. Choose one that best suits your needs.
- Make sure you get enough Vitamin D. Vitamin D is involved in the production of serotonin, which plays a significant role in the regulation of mood and stress. Low serotonin levels in the brain are thought to contribute to mood changes, anxiety and panic symptoms.
- Try supplements to support your mental health. Magnesium, Vitamin B complex and omega-3 fatty acids provide support during times of hormonal fluctuations and can help keep your body balanced and healthy.
Your path to a smooth menopause starts here
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What treatments can help?
Hormone replacement therapy (HRT) is widely used as a treatment for relieving all kinds of menopausal symptoms, including psychological symptoms.
Can hormone therapy help?
Changes in mental health can be caused by hormonal fluctuations. Mind you, menopausal symptoms are not always recognised. If your psychological symptoms are entirely or partly related to menopause, then hormone replacement therapy (HRT) might help. HRT replaces the female hormones that are at a lower level as you experience menopause. HRT can alleviate symptoms like hot flashes, sleep problems and mental health symptoms. Explore the options and find out if HRT is right for you.
Sources
- NHS. (2023). Panic disorder. https://www.nhs.uk/mental-health/conditions/panic-disorder/
- Casseb GAS, Kaster MP, Rodrigues ALS. (2019). Potential Role of Vitamin D for the Management of Depression and Anxiety. PMID: 31093951.
- Grigolon RB, Ceolin G, Deng Y, Bambokian A, Koning E, Fabe J, Lima M, Gerchman F, Soares CN, Brietzke E, Gomes FA. (2023). Effects of nutritional interventions on the severity of depressive and anxiety symptoms of women in the menopausal transition and menopause: a systematic review, meta-analysis, and meta-regression. PMID: 36576445.
- Martín-Rodríguez A, Gostian-Ropotin LA, Beltrán-Velasco AI, Belando-Pedreño N, Simón JA, López-Mora C, Navarro-Jiménez E, Tornero-Aguilera JF, Clemente-Suárez VJ. (2024). Sporting Mind: The Interplay of Physical Activity and Psychological Health. Sports. PMID: 38275986.
- Utian WH. (2005). Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. PMID: 16083502.
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FAQ
I'm going through menopause. Why am I feeling so anxious all the time?
Hormones like oestrogen, progesterone and cortisol can have a significant impact on mood. During perimenopause, these hormones start to fluctuate. This can lead to feelings such as anxiety and panic.
I suffer from panic attacks. What can I do?
Anxiety and fear are natural reactions that help us stay safe. Panic attacks often appear out of the blue and for no apparent reason, which can be very scary and debilitating. Relaxation techniques, such as mindfulness, can help with panic attacks. Experts also recommend exercising regularly and prioritising sleep. When you're feeling a panic attack coming on, sit down, focus on your breathing and think positive, calming thoughts. Try to use the 333 rule: look around you and name three objects and three sounds in your environment, then move three parts of your body. This can help bring you back to the present.
Can hormone therapy help with mental health symptoms during menopause?
Hormone therapy is recommended for many bothersome menopausal symptoms. In fact, it’s the most effective treatment for hot flashes and night sweats. Hormone therapy can also help with vaginal symptoms, sleep problems, mental health problems (panic attacks, anxiety, mood swings and restlessness), and prevent or slow down osteoporosis. Read more about hormone therapy.
