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April 16, 2015

Menopause and Anxiety

Published in: Aging, and anxiety, Anxiety and Menopause, Depression and menopause, Happiness, Hot flashes, Menopause, Midilife, Mood swings, Moods, Staying Healthy

Why do some women going through menopause feel like they’re out of control, irritable, short- fused and just plain crazy? And why do others pass through seamlessly with nary a hot flash or mood swing?

Menopause: It's wild out there.  (Shutterstock.com)
Menopause: It’s wild out there.
(Shutterstock.com)

Back in 2005, when blogging was still fairly new, I created the blog, Midlife Matters. As a health writer, I was excited about sharing accurate and timely health information in an intimate setting which fostered a dialog with other like-minded midlife women, something that’s not possible via standard print magazines and websites. I wanted to share my experiences, and the experiences of my friends, and how they dealt with their mid lives, what they expected, and how they reacted to it. I wanted to remind everyone that there was no right or wrong way to handle their midlife, especially when it came to how they were feeling about menopause and their options on alternative treatments such as cbd for menopause symptoms, especially when it comes to treating anxiety.

To date, my most popular post was about Menopause and Anxiety http://www.healthywomen.org/content/blog-entry/menopause-and-anxiety-whats-connection, published in August of 2011. Almost four years later, the post still brings in comments – quite unusual in the blogosphere, so long after publication date. The comments – all 127 of them (and climbing!) – have taken on a life of their own, spawning conversation between my readers, who clearly find comfort in knowing they’re not alone. Women are desperate for answers as to why they’re feeling the way they’re feeling when they pass through menopause: like they’re losing their minds.

Nancy, now 56, recounts a bit of her experience:

“When I was 48, I experienced what I thought was another anxiety attack – but I now realize was my first hot flash. I got really hot and shaky; my stomach was churning. I felt like the bottom had dropped out, which is the same way I feel when I get anxious.

Once I started getting regular hot flashes I realized that anxiety frequently went along with them. I’d feel anxious about the hot flashes themselves: what would trigger them, would they embarrass me; how long would they last, would they wake me up in the middle of the night?

“This past January, while on a flight to Iceland, I had a bad hot flash/anxiety attack that seemingly came out of nowhere. Suddenly I got really hot, sick to my stomach and shaky. It almost felt like my nerves are on the outside of my body. I wanted to get up but I knew if I did, I’d faint. I had anxiety about the anxiety-feeling so bad physically and mentally, afraid I was going to faint and be embarrassed, afraid there was something really wrong with me. So I turned on the overhead fan as high as it would go and put my head down between my legs as far as I could in the cramped seat and waited it out. It took a good 20 minutes and I felt horrible, but I kept telling myself that it would pass…and it did and I was fine.”

Now it’s time to re-visit the topic of menopause and anxiety. I’ve interviewed two women who have dedicated their careers to the study of one of life’s biggest transitions: Margery Gass, MD, the executive director of The North American Menopause Society, and Sheryl Kingsberg, Ph.D, chief of behavioral medicine at University Hospital’s Case Medical Center and professor in Reproductive Biology and Psychiatry at Case Western Reserve University School of Medicine.

Q. Are some women affected by anxiety and depression during menopause more than others?

A. Dr. Gass: Although there’s not a direct correlation between menopause and anxiety, women who are more prone to anxiety disorders – or have a prior history of them – are more prone to experiencing them around the menopause transition. It’s not uncommon for some women to feel like they’re experiencing PMS all over again – there’s that intense feeling of worry, rumination and anxiety. One interesting report from the SWAN study (Study of Women’s Health Across the Nation) found that women with high anxiety before menopause continued to have high anxiety during the menopause transition and that some of the women with low anxiety premenopause experienced higher anxiety during the transition.

Dr. Kingsberg: There are also women who are more sensitive to the shifts of reproductive hormones; women who might have experienced PMDD (premenstrual dysphoric disorder) or post-partum depression. They’re the ones who might feel their mood affected during menopause, too.

Dr. Gass: Yes, some reports say women who are pregnant may also be more prone to panic attacks and anxiety – it stems from a change of hormones from what their baseline was.

How long does this go on? Should we wait it out?

Dr. Gass: I wouldn’t want a woman to wait if she is bothered by her symptoms; she should get relief from them. It’s a woman’s choice. The good news is that once menopause passes, there will be a new plateau of steady hormones. A lot of women will find their level of anxiety decreases markedly.

Editor’s Note: While that’s good news, the not-so-good news is that a new published in JAMA Internal Medicine in February reported that women may experience symptoms of menopause, including hot flashes and night sweats, for a long time – up to 14 years!

What about hot flashes? Many women feel especially anxious while they’re experiencing them.

Dr. Gass: We do believe that hot flashes stem from what’s going on in the brain and the thermoregulatory center. And that center is being communicated via neurotransmitters, which also relates to mood states.

Dr. Kingsberg: If your menopausal symptoms – like hot flashes – impact your sleep, that can be a problem. When sleep is negatively impacted, some women will be more sensitive to the disruption of these neurotransmitters and thus be at greater risk for anxiety symptoms.

Can you offer some suggestions that might help with the anxiety and mood disorders women experience around menopause?

Dr. Gass: Hormone therapy (HT) may help with anxiety, but it should only be taken if a woman is experiencing hot flashes too. There are also antidepressants that can help, and if anxiety and mood disorders are the primary symptoms, I’d suggest going with those first. Finally, there is an antidepressant that has recently been approved for hot flashes (but not anxiety), called Brisdelle.

Dr. Kingsberg: HT can help with hot flashes, but we don’t use it to treat mood disorders, as there’s no data to suggest it would be effective. But I agree that it can be helpful for women who have significant hot flashes along with symptoms of anxiety. To treat a mood disorder, some women do fine with psychotherapy alone; others need antidepressant medication, like Prozac or Effexor and some do best with a combined treatment of psychotherapy from somewhere like www.psychcompany.com and medication. Hot flashes may trigger anxiety in some women (you start to worry about when they’re coming, and how they’ll make you feel). However we don’t treat anxiety and expect that hot flashes will resolve because anxiety resolves. When antidepressants are used for hot flashes it is because there are data showing that they reduce hot flashes. In fact Brisdelle, a low-dose form of the anti-depressant Paxil has a specific indication for the treatment of hot flashes.

How do you feel about alternative or non-drug therapies?

Dr. Gass: There’s no problem in trying them if they’re not harmful, but if you don’t derive help by six weeks or so, abandon them and go on to something else.

Dr. Kingsberg: I definitely recommend alternative and adjunct therapies such as acupuncture and mind-body approaches; they can only help, and I can’t even figure out how they’d hurt. Remember, it’s not a one-size-fits-all solution which is why terpenes and cannabis products should not be ruled out. It’s important to find the best approach for you. If even one person has found success in one of these alternative therapies, then perhaps it should be looked at in more detail. What worked for your friend or sister won’t necessarily work for you.

**********

The National Center for Alternative and Complementary Health, part of the National Institutes of Health, has valuable information on alternative ways to deal with and ease menopause symptoms. Among them are mind and body practices, like yoga, tai chi, qi gong and acupuncture.

As for herbal supplements, they state that researchers are currently studying them to identify their different compounds and active ingredients, to gain a better understanding of their effects in your body. They caution that some of these supplements may have serious side effects. (Some women turn to things like gingko, kava, lemon balm, lavender, melatonin, passionflower, German chamomile and St. John’s Wort).

And what of “Bioidentical Hormone Replacement Therapy” (Or BHRT)? Their stand on it is that it’s a marketing term that describes medications made in specialized pharmacies, and that they may contain “any variations of hormones, including estrone, estradiol, progesterone and testosterone.” Be aware that these are not approved by the U.S. Food and Drug Administration.

To ensure coordinated and safe care, make sure to inform your health care providers about any complementary health approaches you use.

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Reader Interactions

Comments

  1. Lisa at Grandma's Briefs says

    April 16, 2015 at 2:30 pm

    Thank you for all the great info. I’ve been lucky so far, with minimal issues despite not having a period in nearly two years. (I hope I didn’t just jinx myself!)

    • SherylK says

      April 17, 2015 at 7:01 am

      Lisa, Lucky you, yes! So many women suffer and it’s nice to hear a positive story for a change.

  2. Doreen McGettigan says

    April 16, 2015 at 3:41 pm

    I am one of those women that had anxiety and panic attacks, migraines and hot flashes all at once.
    Luckily after some diet changes my symptoms disappeared.
    This is such wonderful information. I wish I could have read it back then.

    • SherylK says

      April 17, 2015 at 7:01 am

      You went through it all, didn’t you? But it’s really good to hear that diet changes helped.

  3. Mary says

    April 16, 2015 at 4:02 pm

    I am going to Pin this. I know one day in the not so distant future I will be going through what you have written about. Thank you for the information.

    • SherylK says

      April 17, 2015 at 7:02 am

      I truly hope you won’t have to refer back to this in the not-so-distant future!

  4. Helene Cohen Bludman says

    April 16, 2015 at 4:09 pm

    I think it’s great that your readers used your post to engage in a dialogue about their struggles with menopause. I’m sure it was comforting to know they were not alone. Excellent info, Sheryl.

  5. Cathy Sikorski says

    April 16, 2015 at 4:23 pm

    I am in the midst of this now, with different therapies, both traditional and medical…I’m the sleep deprived poster child at this point. However, I must say, I am not experiencing anxiety, so there’s that plus. Thanks for the information. Always good to be more informed on this topic.

  6. Carol Cassara says

    April 16, 2015 at 5:10 pm

    I’ve had so few symptoms myself but I feel for my sisters of the same age.

  7. Carolann says

    April 16, 2015 at 8:25 pm

    I’ve been down that road in the beginning. Now, things have leveled off thankfully. It’s the hot flashes that are a nightmare still. Thanks for sharing such great info!

  8. Irene S. Levine, PhD says

    April 17, 2015 at 6:14 am

    I’m sure the topic resonated with your readers because the answers aren’t clear…

  9. Lilith says

    April 18, 2015 at 11:49 pm

    Hi Everyone. I am going through the menopause and it is like being hit by a train. Hot flushes are accompanied by what I can only describe as a very uncomfortable feeling being in my own body. I become physically irritable and lose concentration. I have to get up and walk around. Also I have generally become more emotional, not just in being irritable but feeling most negative emotions more negatively. Does this sound familiar to anyone?

  10. Laura says

    April 21, 2015 at 8:48 am

    Many of my friends are going through menopause. Some of them started in their late 40s. I’m 52 and waiting for it to hit. I won’t be able to use HRT because of a family history of breast cancer, so I”m hoping it won’t be too bad. My mom went through it pretty smoothly so I hope I get lucky too. If not, I’ll be looking for some homeopathic remedies. I have used natural products instead of RX drugs in the past and had good results.

  11. Deborah S. says

    May 11, 2015 at 2:29 pm

    I wanted to recommend a book to you and your readers that I think is incredibly helpful for women who are at the end of their rope with menopause, thyroid issues, insomnia, weight gain, etc. It’s called “Why is Mid-Life Mooching your Mojo” by author Dr. Joni Labbe (http://mojogirlfriends.com/). There are so many people out there trying to live their lives with symptoms they do not know how to alleviate. The author’s specialty is auto immune disorders such as Hashimotos and hypothyroid. The book is easy to read and she gives advice that is easy to implement. There are numerous resources and tips listed that work and it is also written in an enjoyable manner (just like your blog). It has an “over the kitchen table” kind of vibe that is entertaining and relateable. Thanks again and I hope you will check out her website or her book!

  12. Christina says

    December 15, 2016 at 8:11 pm

    The massive amount of comments really speaks to the feelings of women going through similar situations. Your decision to share your experience is probably well appreciated.

  13. McKenzie says

    January 13, 2017 at 10:40 pm

    Thank you for sharing this very helpful post! Menopause is an unfortunate inevitable and knowing what might happen (like anxiety attacks with hot flashes) can make it a little easier on us.

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What’s this so-called midlife, anyway?

It’s a time of tremendous change, growth and opportunity. A time to re-evaluate our choices, our experiences and ourselves. A time to take what we’ve accumulated up until now and put it to work.

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I think your website is GREAT!  It's hard to find an online space that speaks realistically about what happens when we approach our 50's and beyond.  Keep writing, and thanks for your support."
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A High School Student and Aspiring Writer from Australia Reaches Out…

I would love to hear a few things on the prospect from a first hand-perspective, and would be thrilled to learn more about it from you. Your advice is well valued and I’m very grateful to have such wise words from someone with such first hand experience.

I will be looking forward to reading more of your wonderful articles in the future!

Best wishes,

Mikayla

 
Sheryl Kraft
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I would love to hear a few things on the prospect from a first hand-perspective, and would be thrilled to learn more about it from you. Your advice is well valued and I’m very grateful to have such wise words from someone with such first hand experience. I will be looking forward to reading more of your wonderful articles in the future! Best wishes, Mikayla  
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On behalf of our entire organization, we'd like to thank you so much for featuring our product in last week’s Parade Magazine. Due to your article, traffic and sales have been great this past week.! We are a small business that prides ourselves on excellent product quality and customer service. We work hard to make quality products and market them effectively but then sometimes you get a gift like your article which really takes us to the next level. We will be eternally grateful to you for choosing us as one of your eye product recommendations.  
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