How to manage anxiety during the menopause.
Did you know that anxiety is one of the lesser-known symptoms of the menopause? Fluctuating hormones can cause feelings of anxiety or depression but what can you do about it? As part of our Lunch & Learn series, we were joined by Dr Clare Spencer of My Menopause Centre.
Henpicked: Anxiety can happen at any time in our lives. But why is it around menopause this can feel like it’s peaking?
Dr Clare Spencer: Yes, anxiety is common in life, indeed it’s almost normal to be anxious about certain things. But it can be an issue if it becomes overwhelming. It’s a really common symptom of menopause, too. In fact, in a recent poll over 50% of women reported it as a troublesome symptom of menopause. If we think about the start of the menopause transition when hormone levels are flying around, oestrogen is fluctuating, with big highs and lows. This and the ultimate drop in oestrogen can be one of the triggers by itself for anxiety. Plus there’s whatever is going on in your life, add in teenagers, elderly parents, exams, work, and you can see how a perfect storm is created. But anxiety can happen without triggers in the menopause transition.
Henpicked: What do we mean by anxiety? How might symptoms manifest?
Dr Clare Spencer: There are three main ways it can manifest. There’s the emotional response, fear, panic, stress, our brain is frazzled and we feel overwhelmed and like we can’t cope. Then there are physical symptoms like adrenaline, racing heart, dry mouth, feeling sick, dizzy and lightheaded. And behavioural consequences. For example, you might avoid doing things or only do them if you’re with someone else. The emotional and physical symptoms are most common in menopause. Hot flushes can get worse with anxiety. And vice versa, if you’re having a hot flush, that can make you feel anxious. Another perfect storm and vicious cycle.
Henpicked: Are heart palpitations a symptom of anxiety?
Dr Clare Spencer: Yes they can be. In the menopause transition you can get palpitations, where your heart feels fluttery in your chest, but you can also get them when you’re anxious. And a lot of people start to feel anxious when they feel palpitations. It all goes hand in hand.
Menopausal palpitations tend to be short lived and go quite quickly. But if they are exercise induced or you get chest pain and it’s not settling down, or if you’re finding it worrying, it’s a good idea to see your doctor. There are some investigations they can do which is reassuring.
Henpicked: Is it possible that during menopause we don’t cope as well with anxiety as we once did?
Dr Clare Spencer: We do know that something happens to your resilience as you go through menopause, and there are hormonal changes that are causing these symptoms. This is an over-simplification but as oestrogen levels drop and fluctuate the serotonin levels – our happy hormone – drop in our brain, cortisol levels – our stress hormone – rise, and so the behind-the-scenes changes can make you feel vulnerable. This is a feeling you might not have had before the menopause. Smaller things can tip you into a downward spiral.
I commonly hear ‘I have been fine all my life and suddenly I feel anxious’. Maybe early or mid 40s, it’s just crept up, that horrible feeling in the pit of your stomach, or you may not be sleeping, which can make things worse. It might be a moment of realisation that something has changed in your life, like not wanting to drive on the motorway, that wasn’t there before. Some women are more susceptible to hormonal changes, and may have always had increasing anxiety before periods or post-natal anxiety.
Henpicked: And it’s easy to understand how this can affect us at work, isn’t it?
Dr Clare Spencer: Yes, work responsibilities and family, juggling that you may have been okay dealing with before menopause can really knock you for six and induce quite extreme feelings like panic. You do hear of women giving up work where they might not have done with the right support and treatment. There are positives if it’s just that you’re having a rethink, but if you’re feeling forced out because of the way you feel that’s not good. Help and support can make all the difference.
Henpicked: What can we do about it, either in the moment or thinking ahead?
Dr Clare Spencer: There are lots of in-the-moment techniques that can be really helpful, such as Cognitive Behavioural Therapy, which can help you breathe and reframe the way you think about what’s going on. There’s great evidence that some of the techniques from yoga can help in the moment, learning to breathe deeply, counting in slowly in through your nose and out through your mouth. It can be difficult though in the moment of blind panic to do that, so recognition is a big part of it.
There are lots of lifestyle factors that can help manage anxiety, exercise and relaxation, yoga and Pilates, whatever it is that you can find that turns your brain down. For others, meditation can be really helpful. Speaking to your GP can be also helpful as they can talk to you about medication. If you suffering from high levels of anxiety it may be that you need antidepressants. There’s also great evidence for HRT, putting oestrogen back can address some of those biochemical changes, helping to keep things at a calmer level.
Henpicked: Is testosterone an option?
Dr Clare Spencer: The evidence isn’t amazing but some testosterone is converted to oestrogen so it can have a positive effect. The body identical progestogen Utrogestan which, if you have a womb you need to take with the oestrogen, can for some women help to take the edge off anxiety as well as help sleep. You wouldn’t necessarily prescribe it for anxiety specifically but it can help.
Everyone is different but the rule of thumb is wait a maximum of three months to see what the results are. But really if there’s no improvement in 6-8 weeks you may need your dose adjusting. You might be started on a low dose that needs increasing. Or you may get side effects from one type of HRT – for a small minority it can even trigger some anxiety – so you may need the type of HRT adjusting.
Henpicked: We do expect a lot of ourselves, don’t we?
Dr Clare Spencer: Yes and it’s really important to switch off sometimes, especially when your body is undergoing a transition. Think about prioritising, we can’t do everything. You do have to give yourself some space and time to just work out your way through menopause and find new balances.
Henpicked: When do we know our anxiety is at a point we need to seek help?
Dr Clare Spencer: If it starts to get in the way of your ability to live your life go and ask for help. Don’t wait until you have severe symptoms.
Henpicked: Can anxiety make other symptoms worse?
Dr Clare Spencer: It can often impact on sleep. We do often ruminate in the middle of the night, because we have time to think. You might wake up feeling anxious or due to a hot flush, then that has a knock-on effect and everything seems worse because you’re tired and less resilient. Anxiety can make many of the physical symptoms worse, you produce adrenaline, which can push your heart rate up, or it can increase your basal body temperature and trigger a hot flush.
Try to look at what makes you anxious and develop your own coping techniques. For example, if it’s brought on by hot flushes, try wearing cotton instead of man-made fibres. Have an exit strategy for a room so you’re not feeling trapped or panicked. Practise your breathing techniques. Forewarned is forearmed.
Henpicked: A lot of people think ‘this can’t be menopause as I’m too young’. This is often a myth, isn’t it?
Dr Clare Spencer: Perimenopause can start in your early to mid 40s. 1% of women go through menopause under the age of 40 which is still a big number. The average age of menopause is 51 but there will be people either side of it.
Watch the video here:
Henpicked’s Deborah Garlick was joined by Dr Clare Spencer of My Menopause Centre.
Dr Clare is a registered menopause specialist and an NHS GP. She qualified from Cambridge University and holds membership of the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners. She initially trained in obstetrics and gynaecology where she gained a Doctor of Medicine for research in fetomaternal medicine.
As well as her role of Clinical Director at My Menopause Centre, she currently runs an NHS menopause service and is a GP partner in a practice in Leeds. She is also a British Menopause Society menopause trainer and is involved in educating GPs about the menopause transition through talks, lectures and seminars. She wrote the menopause training module for doctors.net and has written for the Primary Care Women’s Health forum publication, Her Life Her Health, on a variety of menopause-related topics.
