Anxiety and Menopause

So many women struggle with anxiety during peri and menopause. Read more about how to recognise and understand it and some suggestions for how to cope with it.

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Anxiety can make us worried, overthink and interrupt our sleep; it can make the heart race, our chest tight and our palms sweat. And for many women it is a major symptom of menopause. Although it can be distressing there are numerous ways to help manage it.

Feelings of anxiety are a normal part of human experience and healthy anxiety helps us by drawing our attention to things in our lives that need to be taken seriously. Used well it can motivate us to make changes and positive decisions but when it becomes overwhelming it can be disturbing or even paralysing, affecting us physically, mentally and emotionally.

Hormonal changes during peri and menopause can exacerbate feelings of anxiety. A combination of low progesterone levels (which have a calming effect) and fluctuating oestrogen levels result in lower levels of serotonin, often referred to as the feel-good hormone, and our ability to cope with stress is undermined.

This is why women who have previously experienced healthy levels of anxiety may be surprised by how much they are affected.

"Hand in hand with insomnia came crushing and inexplicable anxiety - an irrational feeling which I'd normally associate with being stressed, even though during lucid moments I knew I didn't have that much to be so agitated about.' Mariella Frostrup

What is anxiety?

Anxiety is an uncomfortable feeling of worry or unease about something with an uncertain outcome. It can affect our thoughts, feelings, behaviour and physicality. We may worry excessively about events that may or may not unfold in the future, things we feel we aren’t managing well, health-related fears, relationship worries or harbour a belief that the worst will happen. During peri or menopause we may experience it unexpectedly or it may creep up without warning, and we can struggle to find a clear rationale for it.

Understanding Anxiety

Anxiety can be experienced on its own or along with other mental health issues such as depression. It may be experienced in brief and intense episodes or over a longer period of time.

During peri and menopause our bodies undergo a huge transformation and concerns about our changing health can contribute to anxiety. This includes learning how to cope with hot flushes, erratic or heavy periods, fatigue, sleep disruption, low libido or weight gain to name just a few symptoms.

Life is full of choices to be made, and whilst this offers many advantages it can also provoke fears about making the ‘wrong’ choice. Each choice we make says something about who we want to be and what we believe we ‘should’ be doing. Our choices reflect our goals, values and ideals. Am I in the right job or should I pursue something more meaningful? How do I choose between work and quality time with my family? Am I unreasonable to raise an issue with my friend or partner? When we act we make a commitment to a particular outcome, when we don’t we can become immobilised.

Below are some behaviours and thinking styles that contribute to anxiety:

·       Trying to control everything in order to ward off uneasy feelings.

·       Fearing that every possible negative consequence will become a reality.

·       Procrastination. Distracting yourself from taking decisions or doing what really needs to be done – making lists, cleaning, going on social media.

·       Being a perfectionist. Having a high standard is one thing but perfectionism can result in good enough solutions and situations being dismissed. Excessive time is taken up and you berate yourself for minor issues. Anything less than perfect is perceived as failure.

·       You fixate on questions like ‘what if’ and ‘if only’. You might spend inordinate amounts of time imagining particular scenarios rather than taking action. 

·       You second guess yourself. When you don’t trust yourself you are unable to draw on your intuition, knowledge and experience. No decision may be seen as preferable to a bad decision but it prevents you from realising what you truly desire.

Emotional signs of anxiety are:

·       Irritability or persistent bad mood.

·       Low, depressive or hopeless feelings.

·       A pessimistic outlook.

·       Ruminating on mistakes, personal failures, fear of things going wrong.

·       Feeling overwhelmed and helpless.

·       Seeking frequent reassurance.

·       Struggle to priortise.

 Physical signs are:

·       Sleep disruption – trouble falling asleep, night waking, early waking or nightmares.

·       Difficulty concentrating.

·       Muscle tension and headaches.

·       Rapid heart rate and breathing.

·       Panic attacks.

·       Digestive issues.

·       Low libido.

·       Dry mouth, difficulty swallowing.

·       Sweating or trembling.

Panic Attacks

Many, though not all, people who experience high levels of anxiety also experience panic attacks. These can be frightening episodes characterised by an intense rush of anxiety and physical symptoms. They can occur suddenly and often without warning. Although they often feel terrifying, sometimes causing people to believe they are dying or having a heart attack, they are usually harmless. They typically last between 5 – 20 minutes.

Panic attacks are caused when our bodies go into ‘fight or flight’ mode, when we perceive a threat, although we may not be aware what the threat is. As our bodies try to take in more oxygen our breathing quickens and adrenaline is released, causing our hearts to beat faster and our muscles to tense.

The NHS advises seeking medical advice if you are regularly having panic attacks, if the panic attack continues after 20 minutes of slow breathing, if you feel unwell after your breathing returns to normal or if you continue to have a rapid or irregular heartbeat. 

Tools to manage Anxiety

Look after your health. High levels of anxiety can affect us physically, weaken our immune system and leave us run down, exhausted and even less able to cope with everyday stressors. Getting sufficient sleep, rest, exercise and good nutrition provides a strong personal foundation - more energy, greater mental clarity, focus and improved mood.    

Avoid unhelpful coping strategies. During times of stress we are more likely to turn to quick fixes to make ourselves feel better but often these undermine our ability to cope, and may lead to additional problems, if we rely on them long term. Examples are drinking, overeating or undereating, impulsive shopping or gambling.  

Remove sources of stress where possible. Take some time to reflect on your life, identify sources of stress and see where you can make changes. Even small changes like leaving work half an hour earlier to avoid the rush hour or asking for help at home can ease the overall burden and pressure. Ask yourself what would make your life easier.

 Prioritise. Decide what is important to you in life. Choose to devote your time and energy to the things that matter and let go of the things that don’t.  

Talk to others. Talking about our feelings can help us to think through our problems, make connections, see other perspectives, allows us to unburden and feel acknowledged. You could choose a trusted friend, family member or colleague or you may find it helpful to speak with a trained professional. Sometimes anxiety has roots in distressing events such as childhood difficulties, abusive relationships or traumatic experiences. In these instances it can be helpful to work through things with a psychotherapist.  

Be compassionate towards yourself. Sometimes we get things wrong. We do things we regret. We make mistakes or we don’t live up to our expectations. That’s just being human. If we give ourselves a hard time every time we slip up we create even more anxiety for ourselves. If we treat ourselves kindly we will be better able to recover from difficulties, give ourselves what we need, and move forward.

 Keep a diary. Note down the times when you feel anxious or experience panic attacks and see if there are any patterns or triggers. Which situations or people trigger your anxiety? Journaling, which is essentially writing about how you feel, is a useful tool to help process emotions and make sense of things.

 Accept this feeling won’t last forever. Focus on getting through the next minute, or hour or day. 

Breathe. Breath is a powerful tool for calming anxiety. Breathe in through your nose and out through your mouth. Place your hand on your stomach and feel it rise and fall as you breathe in and out, relax your shoulders. Try counting in for 4 and then out for 4 and then you can adjust this according to what is comfortable for you. 

Use relaxation techniques. There are many to choose from such as yoga, mindfulness, breathing exercises and creative visualisation. Spending time in nature, listening to music or taking a walk can also help us unwind. Try apps like Calm or Headspace. 

 Develop positive self-talk. If you find you frequently tell yourself negative or critical things e.g. ‘I always mess things up’ or ‘People won’t respect me’ start to challenge those beliefs. Find examples of when you have done something well, or of people who value you. Instead say ‘when I put my mind to it I can do a good job’ or bring to mind the people who appreciate you. We become what we tell ourselves so if we tell ourselves that we are capable and worthwhile we will begin to feel it too.  

Distract yourself from repetitive over-thinking. We can only concentrate on one thing at a time so if you turn your attention to something neutral or pleasant you can learn to distract yourself from worrying thoughts and images. Three ways of doing this are physical exercise, refocussing and mental exercise. The key is to find something which needs a good deal of attention, is specific and holds your attention.

·       Physical exercise can be a structured activity such as running or yoga or could simply involve moving your body, walking, doing activities in the house or workplace.

·       Refocussing involves directing your attention to what is around you e.g. counting windows, listening to passing conversations, noticing the detail on a person’s clothing.

·       Mental exercise requires more mental effort and imagination. Suggested exercises are recalling a happy memory, studying a passing stranger and guessing their occupation, reciting song lyrics or creating an imaginary scene in your mind such as your dream home.   

See your GP. If you continue to struggle it is worth speaking with your GP. HRT is the first treatment of choice for menopausal symptoms according to the NICE guidelines. If you have a longer or more complex relationship with anxiety they may suggest different options. Any treatment offered should be discussed clearly with you and take into account your needs and preferences so you can make an informed decision. 

Alternative Treatments. Some studies have suggested that acupuncture can help to alleviate symptoms of anxiety. Massage is known to promote relaxation and may help. There are many other alternative possibilities that are anecdotally supported, although there may be less research to support them such as reiki, craniosacral therapy, herbal medicine.  

Further Resources

Overcoming Anxiety: A self-help guide using Cognitive Behavioural Techniques by Helen Kennerley

Hardwiring Happiness: How to Reshape your Brain and Life by Rick Hanson

Mind, the Mental Health Charity has details of relaxation exercises and more advice on dealing with anxiety.










Melissa Cliffe

I am an experienced Gestalt psychotherapist and work with a range of issues including midlife, highly sensitive people, Third Culture Kids, depression, anxiety, relationships, identity, low self esteem, existential questions and more.