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Menopause and Anxiety: What's The Connection?

Menopause and Anxiety: What's The Connection?

By Sheryl Kraft

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After writing about menopause and hot flashes and stress/anxiety being a possible culprit, I started wondering about the link between menopause and anxiety. How are the two linked? Are women feeling anxious about menopause? Or, is it the other way around: does menopause cause anxiety? Is it a by-product of shifting, dipping, all-over-the-chart hormones?

And how can we control our anxiety? As someone who has had her fair share of anxiety over the years (especially around menopause), I decided to ask an expert some key questions about it all. Is it a disorder, I wondered, or a normal life passage?

For some answers, I turned to psychiatrist and UCLA anxiety expert Jason Eric Schiffman, a graduate of the MD/MBA program at the University of Southern California. Dr. Schiffman is affiliated with the UCLA Anxiety Disorders Program where he has helped to develop the web-based, self-directed Cognitive Behavioral Therapy program for Anxiety Disorders found on Anxiety.org.

Q. I'm well aware that anxiety can occur at any time during a woman's life, but it does seem that panic attacks become more prevalent during times of hormonal upheavals: during adolescence, pregnancy and perimenopause and then menopause. In my experience, I've seen teens and women who never before suffered anxiety be suddenly hit with an increased incidence. Is it merely coincidence or is it indeed hormonally related?

A. Yes, there is absolutely a connection between hormonal changes and psychiatric symptoms in general, and women undergoing specific hormonal changes have increased risk for particular psychiatric disorders. With respect to anxiety, women in the perimenopausal period are more likely to experience panic attacks and other anxiety symptoms than other women of the same age who are either pre- or postmenopausal. The postpartum period is another time when women appear to be more vulnerable to psychiatric symptoms, particularly depression, which is often associated with anxiety.
Q. If increased anxiety is hormonally related, does that mean it will pass once a woman gets through menopause? Does the anxiety need to be treated?

A. Once menopause passes, many women find that their level of anxiety decreases. However, in addition to hormonal changes, there are often many other factors that contribute to the development of anxiety during menopause. For example, women who suffer more physical symptoms, experience negative life events or who are less functional are more likely to develop an anxiety disorder during menopause than women without these additional stressors. So, it is important not to ignore other possible causes of anxiety—just because a woman may be experiencing menopause. Treatment of anxiety is always warranted if there is significant distress or functional impairment.
Q. Once a woman experiences an anxiety attack does this mean she will be more likely to experience them more often?
A. Someone who has experienced panic attacks in the past is more likely to experience them in the future than someone who has never had one. That being said, panic attacks respond very well to a type of treatment called cognitive behavioral therapy (CBT); someone who gets into treatment may have very few or no panic attacks in the future.
Q. Oftentimes women may be able to feel an anxiety attack coming on. Do you have any advice as to how to recognize the start of one and how to stop it in its tracks before it progresses further?
A. There are very effective techniques for treating panic attacks but they need to be tailored to each individual. There are now self-help versions of CBT available online which walk someone through the creation of a personalized treatment plan. One that I have worked with that is based upon the approach we use in the UCLA Anxiety Disorders Clinic can be found at www.Anxiety.org.

Q. Anxiety can manifest itself in many forms: sleeplessness or frequent waking during the night, nervous energy, difficulty concentrating, irritability, even depression. What do you suggest for a woman who is feeling any one or a combination of these things? Are there different therapies for different types of anxiety and, if so, what are they (from a behavioral, medical and/or psychopharmacological and/or nutritional viewpoint)?

A. It is important that menopausal women identify the symptoms of anxiety they're experiencing so they find the best ways to allay them. As I mentioned, CBT is one of the most effective treatments for anxiety. There are also medications that can be prescribed by a psychiatrist. These are often used in conjunction with CBT. Practical things you can do to help reduce your anxiety include reducing or eliminating caffeine, exercising on a regular basis, eating healthy foods, getting enough sleep and setting aside time twice a day to do relaxation exercises.
More reading:
8 Ways to Deal With Hot Flashes in the Heat (Or Is-It-Hot-In-Here-or-Is-It-Just-Summer?)
Natural Approaches for Easing Anxiety
An Overview of Menopause


I have been taking medication for anxiety and panic attacts, but still suffer from them on a daily bases, I have a fear of being alone and I don't do well. I don't like to go anywhere by my self. offten when i'm asleep i am woken up in such a panic and can't breath. i'm not able to sleep well at all.

i been suffering the loss of my dad last week then hot flashes night sweats i feel like i am losong my mind i dontwantto take a anti depressant i feel lost it comes in waves i find myself ina pool of sweat cant sleep i no my hormones are way out of whack i want to try hormonal replacement i am 56 i was happy i feel so alone it comes in waves heart races sweating i need some kind of relief its not all in my head

This is very helpful. Another factor that may link anxiety and menopause is the other physical changes that can happen at this time. There's just a lot going on.

For the past 4 years I have been going through menopause and post menopause with extreme anxiety (perserverating & ruminating over things) which I have never done before. This is also leading to depression. Our money situation hasn't been the greatest, but I got a new job making more money, but I am still doing this. I'll go through a couple of months while I'm good, then somehow I slip back into the anxiousness again. I really think it's caused by the post menopause and I don't know what to do. Therapy isn't helping and I'm taking a high dose of Effexor which isn't helping. Any suggestions

I have developed severe anxiety for a year now. The doctor put me on Effexor at 75-150 -175-225--300. It did not help. I finally ended up admitting myself to a hospital where they changed the medicine to paxcil. I am now up to 40mg but it has yet to work. I am writing this because I can empathize. I feel like I am going crazy at times and I don't think friends understand how extreme it is. Has anyone found something that works? I know body chemistry is different in people but I rather try it than not.

I use lorazepam clodinpin r good n xanax

I'm smack dab in the middle of the menopause age group, so reading this with interest. One thing I've learned in yoga is how our breathing is tied to anxiety. Whenever I feel anxious, I focus on breathing long, slow breaths, rather than the shallow breath that anxiety brings.

Interesting. I can see how the anxiety might ramp up like this. I wonder if that's that reason for increased grumpiness too. Or, do women just reach a certain age and simply no longer "suffer any fools"?

Thanks for such a helpful explanation of what I've been feeling!

I had never heard of CBT. Will check into it. Thanks.

It's just talk therapy. I've been doing it for 4 years now and I say all of the time that it saved my life. My therapist has taught me how to think differently.

Thanks for this timely article - my friend's daughter is suffering panic attacks daily. She's an adolescent. I hadn't realized it can be hormonally triggered. I'll let her know.

I kind of think it's like PMS on steroids. Oh, wait, it actually is in a way.... Or off steroids as the case may be.

I just read an article yesterday about certain mental ailments--including anxiety--being linked to medical problems. The article pointed out thyroid conditions as an often undiagnosed problem linked to anxiety and depression. Any thoughts on that?

That is true. I'm not a nurse or doctor but I am well researched in these issues since I'm a long time sufferer. I would suggest that one of the first things you do if you suffer from anxiety is have your thyroid checked. Not just a TSH test but a Free T3 and Free T4 test. Thyroid issues, especially hyperthyroid can cause anxiety and many Americans have un- diagnosed thyroid issues. The bad news is however, that normal lab numbers does not necessarily mean that you aren't suffering from thyroid related issues. You can have symptoms but your numbers look fine. One of the best things you can do is focus on a healthy lifestyle - eating a diet full of a variety of nutrient dense foods especially vegetables, practice stress reduction techniques such as meditation, yoga and exercise and try to get a good night's sleep. I have trouble with anxiety and I have two nodules on my thyroid however, my thyroid numbers always show up in the normal range. So, the getting a diagnoses of thyroid issues is a tricky thing.

Good to know this sort of thing can be a hormonal issue, I suppose, but it seems like EVERYTHING we hear/read about menopause is completely negative. Isn't there something good about it we could hear about for once?

NOT. Looking. Forward. To. This. Particular. Menopause. Problem.


This is good information. I've been in peri-menopause for sometime and more recently have had more symptoms associated with huge hormonal changes at certain times of the month. A friend recently told me, "That sounds like a panic attack." I will have to check into this when I see my doctor next month.

I recently heard that nutrient depletion from medications may be the cause of a lot of symptoms related to menopause, anxiety, depression, etc. It's a big topic now because there's quite a bit of research that shows the connection between medications, nutrient-depletion and symptoms. It's definitely something to look into. One helpful resource is Mytavin, which is a calculator that shows how you might be depleting your body. It's free and I just typed in my symptoms and it populated the research and results that showed I was depleting zinc. Interesting right?

Serotonin is made in the gut so it makes sense that a healthy diet and healthy gut bacteria is critical toward the creation of this important chemical. I take a probiotic every day but if you have a really healthy diet (which most of us don't!) full of vegetables, you may not need it. But I think it's safe to say that most Americans are nutrient deficient.

Hi there, thanks for the great article. I have a question I'm hoping you might be able to answer. I was wondering, What is the difference between anxiety disorder and paranoia. I have bad fits of paranoia sometimes and I'm thinking I might look into anxiety medication. I would appreciate any insight you can provide.

I detected one piece of potential good news post-menopause in this story: The possibility that anxiety may subside. Amen to that sistah.

It's really comforting to know there are things women can do to deal with and even lessen bouts of anxiety. Several of my friends have found help at the Women to Women clinic (www.womentowomen.com) - not just for anxiety, but for lots of menopause related health issues.

Thank you so much for this post. I have always been really laid back until now - my perimenopause, when I seem to have a regular feeling of anxiety surrounding me. At first I thought it was my imagination, then I thought 'come on girl - snap out of it' and now I know (due to your post) that it is hormonal. Thank heavens for that! and thank you - it's nice to know I am quite normal after all!!!

Just stopping by in the name of Women's Health. Thank you for all you do, and please note that September is Menopause Awareness Month!

Dr Margaret Ferrante

This is interesting. I have been looking forward to reading this kind of article and also other remedy for menopause. In fact, I really needed it. Thanks for this post.

To the last commenter, and others...I had my first panic attack several months ago, my doctor told me no way it was hormone-related. I just turned forty, so it's very likely perimenopause! I found a very useful program called Panic Away that has changed how I look at anxiety, and how I resolve the accompanying feelings. I am a skeptic, so it was difficult for me to purchase the program, but it was cheaper than ONE session of CBT, so I figured I would try it. So glad I did. You can do a trial for a month for $5.00. Good luck! It is so unnerving to go through anxiety, but you aren't alone...the fear is REAL to you, but how you approach it can change your life!

I have been struggling with severe anxiety attacks for the past two years. It is no small coincidence that it started when menopause started with me like a freight train hitting a barn!What bothers me is that my doctor tries to help by prescribing this med and that but she has not gone through menopause so I feel she is stabbing in the dark. I'm going to see an ob/gyn soon and I hope to God that he will start to put me on the right path so I don't have to feel everyday my world is coming to an end.

Very interesting artical about
how to prevent panic attacks ,Thank u so much really amazing.


My husband doesn't understand why I am anxious. I am actually very happy in my life. We currently have enough money so we aren't too stressed with that. My children are grown and successful. But I do stress over things. I guess from what he's saying Imust be driving him nuts. I can't help it. I don't know what to do. I don't mean to be anxious. I've actually been this way forever. but normally I'm very happy go lucky. Am I not entitled to be a bit anxious about things?

There is a wonderful book called the Wisdom of Menopause written by
Christiane Northrop, MD. She covers the physical and psychological issues associated with this time of life and offers a lot of useful information about supplements. I actually started a woman's group - it really helps to know you are not alone. I am actually considering conducting my own research on the subject because there is so little information out there. Heidi

I really like what you guys tend to be up too. Such clever work and reporting! Keep up the awesome works guys I’ve included you guys to our blogroll.

I have been suffering from severe panic attacks since starting menopause two years ago, I have stopped driving, lost my job because of anxiety. I do not have medical.

I have been taking medication for panic and anxiety since 1996. In 2007 I weened myself off the meds. Later that year I crashed. Had to go back on the meds. Been a very hard uphill climb. Now I don't drive, don't stay by myself and cant work. In '07 I was 43. Could it be menopause related? Had a hysterectomy in 99, but still have ovaries. Does anyone know how to stop this madness!!!! Feel as thou I will be this way forever.

I have been though something very similar. I went on SSRI's in 1998 and weaned myself off in 2012, at age 50. Was OK for a few months, and crashed. Had to go back on meds. It was a long way back for me, too. I felt that I recovered completely with the help of a good therapist. Now I am very anxious again, and am going to get my hormones tested next week. I can't blame the meds entirely, because I did have a depressive episode before I went off of them. I think that SSRI's can keep you from really bottoming out, but I would look into something called Estrogen Dominance - especially if you are overweight, it's a nasty culprit. I cope by eating VERY healthy, exercising, doing breathing exercises, and limiting alcohol. Hope that helps!

Thanks for sharing your story, Rachel. I do hope you continue to find relief.

I just started reading all the comments and your is the first to mention estrogen dominance. It seems like a lot of doctors leap to giving women birth control pills or HRT assuming a woman is short of estrogen. These meds can have terrible side effects when the issues could actually be a lack of progesterone (the calming hormone) which in turn, causes estrogen dominance. It makes sense that if you're short on the calming hormone and it's not balancing out the estrogen in your body, you could possibly suffer from nervousness and anxiety. I have used a topical progesterone cream that I found quite helpful and almost predictably when I stop using it for an extensive period of time, I have more trouble with anxiety. However, in my 30's I had fertility problems so my progesterone levels were tested with a endometrial biopsy which showed that my luteal phase was short, caused by not having enough progesterone, so I know that I'm already deficient. I would suggest that all women consider their progesterone levels and not just their levels of estrogen.

I am so sorry for what you are going through, Patricia, and hope you find help with your anxiety.

I too have been hit hard with severe anxiety attacks during menopause. I find taking deep breaths really helps and the support of other women in the same situation. Also, I had a sleep study done and found I have mild sleep apnea and will soon be wearing a mouth appliance at night which is supposed to help with the panic attacks as I will be able to breathe freely which stops the flight or fright reaction. The lack of estrogen in our bodies affects even the muscles and tissues in our throats making sleeping disorders worse. There's a 90% success rate in wearing the appliance. Anyone having problems with severe lower leg cramps at night and first thing upon awakening? Mine started 3 months ago and really add to my anxiety! I take calcium, magnesium and potassium at bedtime as well as do a routine of stretching. This helps the cramping only a little. I also have RLS and this too is out of control lately. Advice anyone?

Hi, Nettie - It sounds like you have been through a lot and are doing a lot to help yourself. I truly hope that you find the right relief.

I was just wondering what kind of mouth piece that you wear? When I am having the anxiety it feels like im going to hyperventilate...but it never does I just breath really shallow and Id like to overcome this. I am 45 and started the anxiety around my cycle about 1.5 years ago. I hope you are doing good. Thanks C.

I am 66 years old and post menopausal my doctor has told me. My menopause wasn't to bad I never took HRT as I had a breast lump which was removed but it was not cancerous glad to say. My main problem with the menopause was migraine and trouble sleeping. But recently I have been getting some anxiety shaking in my chest and stomach region and feeling anxious when left alone at home. I hope this situation passes as don't like feeling like that as it makes me quite ill. Sometimes I feel like screaming as I feel everything gets on top of me. I have started taking St John's wort a tablet once a day I am hoping this will help the symptoms. I try to keep calm but when I haven't slept most of the night it does make me very anxious.

Carole, It does sound like you're having a tough time. I hope you get the right help that you need for your anxiety. Please make sure to find a good mental health professional that can give you some advice.

Thanks for your comment Sheryl I have got some help from my GP and mental health professional and I am getting along much better glad to say my anxiety has improved and I am more relaxed now.

Hi Carole your not on your own I am 63 at the moment I am going through a very bad time suffering bad anxiety panic attacks and scary thoughts I have suffered migraines since I was eleven and got worse through my change it was a nightmare l have a doctors appointment tomorrow fingers crossed she can help me with my anxiety she is quite useless all the best hope you fill better soon.

Hi Carole it's been a while since l last emailed you, my doctor as put me touch with a councillor l hope it helps feel like l am living on my nervous and aniexty and going crazy it's a shame that people don't talk more about what's it's like to be postmenopause l feel worse now then l did going through the change how do you fill be nice to here from you as l feel quite alone all the best

Carol, you are 66 and you still have symptoms. I'm 56 and have had them since 40's when I had a hysterectomy. My doctor keep saying "it will pass". If your symptoms have not passed by 66 what hope is there for me? Just shoot me.

Thanks to all comments....just to say ...
I am not alone with all this...please add positive comments....

I hope that the group support gives you hope!


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