Menopause and anxiety

Menopause and anxiety are actually linked. Anxiety is one of the hallmark symptoms of menopause right up there with hot flashes. It may be surprising for some of you because it's not something your mother sits down and discusses with you, or your doctor, and therefore not something you are prepared for.  You may start to have symptoms of anxiety associated with menopause beginning with it's first phase perimenopause, which can occur as soon as your 30's (Masoodet al. 2016)!

Menopause and Anxiety: The hormone mood connection.

Most of what we talk about as menopause, is perimenopause, the years leading up to menopause. During this time women's hormones are fluctuating widely. Menopause is about hormone production shutting down, and perimenopause is the phase that leads up to that final stage. Levels of progesterone and estrogen are changing from month to month during the process of  hormonal depletion. On the outside, that can look like anxiety, depression, and a lot of uncomfortable physical symptoms. 

Forever the medical community has not fully recognized the role of hormones on women's mood. Many of my clients have experiences with medical professionals where they have asked about the possible role of hormones in their depression and anxiety and been shut down. This is just due to ignorance. Something as simple as a change in birth control can cause dramatic changes in mood. Addtionally we have specific categories of diagnoses in the DSM tied to hormonal changes such as pre menstral dysphoric disorder and postpartum depression. The medical community is lagging behind in women's mental health.

We do know that estrogen acts on several neurotransmitter systems,  which are involved in the regulation of mood ( Daniel et al 2006) and that estrogen fluctuations are considered a risk factor for some hormone based mood disorders ( HUO et al 2010). It seems clear that changes in hormone levels during perimenopause would have an impact on mood. 

It might be helpful to talk about the stages of menopause. So here is a brief outline below:

Menopause and anxiety: Stages of menopause

  • Menopause consists of  three stages: pre-menopause, perimenopause and post-menopause.
  • Perimenopause, or  the beginning of the transition into menopause, begins several years before menopause.  It usually starts in a woman's 40s, but can start earlier.
  • Perimenopause lasts up until menopause, which is defined by a women's ovaries not releasing eggs for an entire year.
  • Postmenopause is the period after menopause is completed.

Menopause and anxiety: Treatment

So what should you do if you are experiencing symptoms of menopause and anxiety?

Treatment for menopause and anxiety in perimenopausal and menopausal women includes cognitive behavioral therapy and other office based therapy techniques. This mid life stage of life is often associated with a tremendous amount of stress for women. Work pressure, child care and sometimes care for elderly parents are all figured into the mix. Women in particular are rarely good at caring for themselves or putting themselves first. Therapy that focuses on self care and role issues can be a necessary component to dealing with anxiety (Anderson 2001)

Health recommendations such as caffeine reduction, diet and nutrition changes and exercise can often be made by a women's health specialist. As well as hormone replacement therapy (HRT),  bioidentical hormones, or phytoestrogens ( plant substances that bind to estrogen receptors in mammals),  to adjust levels of hormones in a woman's body. Tests are available to gauge where hormone levels are. Additionally, other medications such as antidepressants can be prescribed to help with anxiety (Kopciuch 2017).

Anxiety and menopause: Natural Remedies

Naturopaths may  recommend phytoestrogens because it is believed that women in  cultures that consume a predominantly plant-based diet exhibit less symptoms in menopause because of phytoestrogens.  They may also recommend changes in diet or vitamins that may impact lactic acid, as this is believed to impact anxiety for menopausal women. Finally, fish oil, black cohosh, mother wart and maca have all been shown to decrease other symptoms associated with menopause. It is important to only use these supplements when directed by a doctor, as they have specific impacts on hormone levels and can make symptoms worse (Murray 2015). 

Andersen, E. (2001, Apr 15). Puberty in reverse. Lincoln Journal Star Retrieved from

Daniel JM, Sulzer JK, Hulst JL (2006) Estrogen increases the sensitivity of ovariectomized rats to the disruptive effects produced by antagonism of D2 but not D1 dopamine receptors during performance of a response learning task. Horm Behav 49 (1):38–44

Kopciuch, D., PhD., Paczkowska, A., PhD., Zaprutko, T., PhD., Michalak, M., PhD., & Nowakowska, E. (2017). Conventional or natural pharmacotherapy and the prevalence of anxiety and depression during menopause. Alternative Therapies in Health and Medicine, 23(2), 12-19. Retrieved from

Huo L, Straub RE, Roca C, Schmidt PJ, Shi K, Vakkalanka R et al (2007) Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor alpha gene. Biol Psychiatry 62(8):925–933

Murray M. T. N.D. (2015). MENOPAUSE & ANXIETY. Better Nutrition 77(4) 34-35. Retrieved from http:__nclive.org_cgi-bin_nclsm?url=http:__search.proquest.com_docview_1672885917?accountid=13217 

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