When you struggle to fall asleep at night due to racing thoughts, you might brush it off as just another side effect of stress. When you wake up every morning feeling dread for the day to come, you might think it’s just because of your tight work schedule. But when you start feeling anxious for no reason at all, you might start to worry that something’s wrong. As those worries compound exponentially alongside uncomfortable physical and emotional symptoms of hormonal change, you finally realize that you need outside help to escape this painful cycle.
Anxiety is a common experience shared by many women who are approaching menopause. In fact, according to a 2016 study, over 30% of women experience symptoms of anxiety during perimenopause. For many women, these symptoms are new. For others, they are an aggravation of an existing anxiety disorder. In either case, they can be deeply disruptive and cause significant distress.
So why does perimenopause cause anxiety? Hormonal changes and the symptoms they cause definitely play a contributing role, as do the life changes that are common to women of menopausal age. Understanding these causes can help you establish a comprehensive treatment plan and regain a sense of peace and well-being in your daily life.
Why Does Perimenopause Cause Anxiety?
If you’ve experienced surprising emotional symptoms during menopause, you know from firsthand experience that hormones have a significant impact on mood—and an extensive body of scientific data confirms this connection.
One study found that the long-term absence of sex hormones was the number one cause of psychological distress among the women surveyed—going so far as to state that the “typical symptoms associated with menopause critically deteriorate[d] the mental health of the women.” The authors—like many others in the medical sciences—hypothesize that this deterioration is due to the impact of sex hormones on key structures and functions in the brain. In other words, diminishing amounts of estrogen and progesterone could cause the psychological symptoms women experience during perimenopause.
While the specific mechanisms are still unclear, researchers from Binghamton University have found that estrogens could impact two distinct functions in the brain: the synthesis of proteins and the balancing of serotonin, a neurotransmitter believed to play a critical role in mood and anxiety. Meanwhile, the authors of a German study suggest that because the amygdala and hippocampus have more receptors for estrogen and progesterone, those areas are most impacted by their absence. Significantly, these are the two areas of the brain that are most actively involved with anxiety.
Any or all of these hypotheses could explain how perimenopause directly causes or aggravates anxiety due to hormonal interactions in the brain.
Other Potential Causes of Anxiety During Perimenopause
While these studies help us understand perimenopause-related anxiety from a biological standpoint, they don’t explain all the other elements that may be in play during this critical time in life. It’s possible that the uncomfortable, embarrassing, or discouraging symptoms of perimenopause can cause you to feel anxious all on their own.
First and foremost, sleep disturbances are known to be a powerful trigger of anxiety; if you’re not getting enough sleep for days, months, or years, you’re not going to feel your best. While sleep disturbances may be experienced at any time in life, perimenopausal women are particularly susceptible due to symptoms like hot flashes, which could go a long way toward explaining the prevalence of anxiety in the years leading up to menopause.
The mood swings that often come along with fluctuating hormones aren’t helpful for mental health either. Emotional highs and lows can cause us to feel deeply out of control—which is a highly anxious state for most people. The psychological symptoms of perimenopause may also have a profound impact on your most important relationships, your functionality, and even your ability to experience joy—all of which can cause anxiety to surface.
Finally, we have to consider the life changes that can occur alongside perimenopause for many women. The midlife years are often an important time of transformation and reflection. Your children may be leaving home for the first time, bringing a host of emotional and practical changes for you and your family. Your career may be at its apex in terms of both success and stress—or you may be struggling to feel relevant in the professional world. You or your loved ones may experience health scares for the first time, and you may be taking on new responsibilities for aging parents.
Any of the normal markers of midlife could produce anxiety under the right circumstances. And, on top of all that, you might be experiencing complex feelings over the loss of fertility itself; even if you do not want more children, the closing window of opportunity can be difficult to face and can affect how you see yourself in the world. Meanwhile, the aging process can have a very real impact on your sense of identity, your self-esteem, and your relationships. All of these factors can contribute to feelings of anxiety and psychological distress.
How to Find Relief From Perimenopause-Related Anxiety
The anxiety you experience during perimenopause can be painful and disruptive. What’s more, it may have no single cause or simple fix. Instead, perimenopausal anxiety is often a nuanced and layered pattern that emerges from physiological, emotional, and social phenomena, and a comprehensive approach to treatment may be necessary to find meaningful relief from your symptoms. Most mental health professionals recommend pursuing some combination of the following:
- Psychotherapy, particularly cognitive behavioral therapy (CBT)
- Antidepressant medications such as SSRIs
- Hormone replacement therapy
- Mindfulness practices
- Avoiding caffeine and alcohol
To learn more about the treatment options available to you, start by seeing a qualified mental health professional. They’ll be able to help you identify the root cause of your anxiety and find a treatment plan that works for you. They’ll also be able to refer you to other specialists—such as hormone health experts—who can help you regain balance and take back control. With the support of your health team, you can weather the storm of anxiety and create a richer, more fulfilling future.
If you’re interested in pursuing hormone replacement therapy as part of your treatment plan for anxiety, BodyLogicMD can help. The practitioners in the BodyLogicMD network are experts in hormonal health and specialize in helping women achieve hormonal balance through innovative treatment options customized to your needs. Using an integrative approach, they will create a personalized treatment plan that combines bioidentical hormone replacement therapy with health and wellness counseling to help your whole body function at an optimal level. To learn more, contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones may be affecting your health.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.