Can Menopause Cause Anxiety And Panic Attacks?​

The hormonal imbalance that starts in perimenopause not only causes physical symptoms but can also cause psychological ones. The psychological symptoms that impact on your mental health can be even more distressing than the physical symptoms. Anxiety and panic attacks are often part of a woman’s psychological symptoms as she goes through perimenopause and into menopause.

What Female Hormone Causes Anxiety?

During perimenopause the sex hormones oestrogen and testosterone fluctuate, so do the levels of progesterone (progesterone thickens the lining of the uterus in preparation for a fertilised egg). The ups and downs in the level of these hormones starts to disrupt the monthly cycle of bleeds. Your periods become irregular until they stop altogether. The fluctuating hormone levels can also disrupt the way you feel, both physically and psychologically.

So, is anxiety a side effect of perimenopause and menopause? 

The answer is, yes it can be. Both anxiety and panic attacks are common during the transition through perimenopause into menopause. But not all women will suffer anxiety or panic attacks. 

Women who have a history of depression, postnatal or otherwise, anxiety or panic attacks, are more likely to find that the hormonal imbalance during perimenopause will trigger episodes of anxiety and/or panic attacks. But it’s true to say that any woman can experience these episodes regardless of her history.

What Is Anxiety?

Anxiety is a common symptom in perimenopause and menopause. It leads to feelings of unease, worry and even fear about everyday things that never bothered you before. A little bit of anxiety can be useful in certain situations, a job interview for example, as the anxiety keeps you more alert. Too much anxiety though is destructive.

Anxiety can cause both psychological and physical symptoms. Some of the most common psychological symptoms include:

• Feeling on edge/unable to relax
• Lack of concentration
• Feeling worried/uneasy with no apparent reason
• Feeling tearful
• Difficulty sleeping
• Needing a lot of reassurance from other people
• Being short tempered/irritable
• Being extra alert

When you’re suffering with anxiety or stress your body releases stress hormones such as adrenalin and cortisol. These stress hormones cause physical symptoms. Some of the most common physical symptoms include:

• A rapid, pounding heartbeat
• An irregular heartbeat (palpitations)
• Breathing faster
• Chest pains
• Feeling faint
• Sweating
• Headaches
• Loss of appetite/ feeling sick
• Feeling of ‘butterflies’ in your tummy
• Needing the toilet more often

Other Factors That Can Cause Anxiety During Perimenopause And Menopause

Anxiety is often caused by a variety of factors. Not all of which are hormonal. As we reach our middle years we often face big changes in our lives. 

One of the biggest factors for mothers at this stage of their lives is that their children leave home. Even if you’ve been looking forward to getting your freedom back once your children have flown the nest, it can come as a bit of a shock when your children actually start out on their own. Empty Nest Syndrome might not be a clinical condition but is nonetheless a real experience. Not just for mums but for fathers too.

Parents can be left feeling that their lives are aimless and lack focus. Feelings of uselessness and ‘what am I supposed to do now?’ are all too common. It can be a really upsetting and disturbing experience. It can take some time to adapt to your new situation but you do build a new life for yourself. You create a new ‘normal’ with the focus switching more to your own needs and wants.   

Women in their middle years can find that they become carers for elderly/sick parents who need more help and support.  Whether your children have left home, or you still have a house full of teenagers, the added pressure of caring for parents places extra demands on your time and energy. The extra responsibility and worry can all add to feelings of anxiety.

There are many things that can add stress to your everyday life as you get older.  Being unhappy with signs of our own aging for one. Concerns about how you look and how you are feeling add extra stress and can knock your self confidence. A career change or promotion,  relationship breakdown, death of a loved one, even moving house. All of these can have psychological effects at a time when you may be feeling more vulnerable.

On top of this your hormones are likely to be causing you difficulties. Whether it’s hot flushes, aches and pains, memory lapses or any other hormone induced symptom it all adds to the stresses of everyday life and can affect your ability to cope with it. Leading to feelings of anxiety and possibly panic attacks.

Perimenopause Anxiety At Night Or In The Morning

It’s common during perimenopause to suffer anxiety just before you snuggle up for the night. Worries and fears come creeping into your thoughts just as you’re trying to wind down and sleep. The thoughts and fears are often irrational but are nonetheless disturbing, even frightening. Such worries can cause anxiety and prevent you from getting a good night’s rest which in turn adds to your feelings of anxiety. 

For some women the thoughts and fears, irrational or otherwise, begin as soon as they wake up in the morning. Again this can cause anxiety. The feeling of worry and anxiousness often disappears once you are up and about. A bit like the fading memory of an unpleasant dream. 

How Long Does Perimenopause Anxiety Last?

There’s not a definite answer to this because all women experience perimenopause and menopause in their own unique way. Despite the fact that the most common symptoms are experienced by a large percentage of women the combination of symptoms and their severity will be different for each woman. This is true for both psychological and physical symptoms.

Anxiety, like other symptoms during perimenopause, can come and go with the fluctuation of your hormones. Progesterone in particular has a natural antidepressant and calming effect on the brain so when levels fluctuate it can disrupt your psychological well being.  Feelings of anxiety can also be caused by other things that are going on in your life. A difficult or stressful time in your life can make anxiety more likely regardless of hormonal activity, or make hormone induced anxiety worse.

It is possible to reduce the recurrence of anxiety attacks by addressing any life issues that might be causing you worry and stress. Physical symptoms during perimenopause such as hot flushes, night sweats and insomnia can all add to feelings of anxiety. By taking steps to lessen the impact of these symptoms you will help to reduce the frequency of anxiety attacks.

Take a look at my other articles for Tips and Tricks to help you manage your perimenopause/ menopause symptoms. Also see my article about products I recommend for easing anxiety. I hope you find them helpful.

Does Anxiety Go Away After Menopause? 

The symptoms that you experience during perimenopause don’t suddenly stop once you reach menopause. They can continue for several years after. The good news is that because your hormone levels become more stable after menopause the symptoms you have been experiencing usually calm down and may, for the most part, disappear. Again all women are different so what will happen to your symptoms will be unique to you. 

If you suffered bouts of anxiety during perimenopause you may find that they become less frequent, less severe or no longer happen at all. Anxiety caused by other factors in your life won’t just disappear though. You will still need to address any life issues that you have to solve the problem and reduce your anxiety.

Menopause Anxiety Disorder

Women who suffer bouts of anxiety during perimenopause and menopause due to hormonal fluctuations are not usually considered to have Generalized Anxiety Disorder. Occasional short periods of anxiety and an occasional panic attack that occur during hormonal fluctuations are not considered a disorder. 

If you are experiencing weeks or months of intense worry or fear, with no apparent reason in your life to cause it, or it’s making it difficult for you to function normally and ruining your quality of life you may be suffering from an Anxiety or Panic Disorder. Particularly if you are also having panic attacks that are linked to your feelings of anxiety.

Persistent high anxiety and frequent panic attacks need professional attention and/or medical treatment.They are not a normal part of perimenopause and menopause. You need to see your doctor for help and advice. Treatment may be offered in the form of medication, counseling, lifestyle advice/ changes or possibly HRT. (see my article ‘What Is HRT?’ for more information). 

What Is A Panic Attack?

Panic attacks are upsetting and even frightening. The symptoms of a panic attack can make you think that you are having a heart attack or that you are dying. A panic attack usually lasts for between 10-40 minutes but some will only last for a few seconds.

There are a lot of different things that can trigger a panic attack. Stress, low mood and depression can leave you feeling unable to cope and can sometimes trigger a panic attack. For those of us who have phobias such as enochlophobia (crowds), claustrophobia (small spaces) or acrophobia (heights) for example, a panic attack can be triggered if we find ourselves in a situation closely linked to our phobia.

Perimenopausal, menopausal and pregnant women are more likely to experience panic attacks than at any other time in their lives. The imbalance in oestrogen and progesterone levels can trigger an attack.

There are other possible reasons why perimenopausal and menopausal women are more prone to panic attacks at this stage in their life. Hot flushes, weak bladder and other symptoms that you may find embarrassing in public can create a fear that it will happen when you are out and about.  Fear can turn into panic and trigger an attack. Major changes in your life such as children leaving home, a new job or relationship problems when you are trying to cope with the menopause can cause extra pressure and stress. Again, this can all lead to panic attacks.

Symptoms of a panic attack include:

• Dry mouth
• Breathing faster (hyperventilation)
• Dizziness due to hyperventilation
• Getting the shakes
• Rapid heart rate
• Palpitations
• Paralyzing terror
• Sweating
• Feeling sick

These symptoms are mainly caused by the fight-or-flight hormone adrenalin which increases in situations that we find threatening. Because hormones are fluctuating and imbalanced during perimenopause and menopause it makes adrenalin surges more likely. Regardless of the fact you are not in a threatening situation at the time.

I’ve had a few panic attacks myself over the years. These were mainly due to stressful situations that I was finding difficult to cope with emotionally. 

The worst one came as a nasty surprise though. I hadn’t been stressed at all and I was on holiday for a few days in Blackpool to see the Illuminations. We decided to visit the Blackpool Tower and Dungeons. I have a fear of heights but over the years I’ve developed a coping strategy. As long as I can hold on to something, sit on the floor if I need to and someone goes in front of me going back down any steep flights of stairs, I’m fine. A bit wobbly maybe but I’m determined not to miss out.

We started with the Dungeon Experience first so I could psyche myself up for the Tower. Despite the weather there were quite a few people visiting the Tower and Dungeon Experience that day. We were greeted by a young woman dressed in period costume and made up to look like she had the plague. 

There were two lifts to take us in groups to the dungeons below the Tower. We were part of the group in the first lift to be filled. The lift was dimly lit and decorated inside to look as if plague victims were peering in at us through the walls. There was a young couple between us and the lift doors, everyone else was further back. Everybody was in a holiday mood, talking about the artwork in the lift and enjoying the spooky effect. Our lift was waiting until the second one was filled and ready to go down at the same time. So we waited . . . and waited . . . .

It was now getting very warm with all that body heat building up in such a small space. I started to feel a little anxious that we still hadn’t moved. I could see the lift doors between the heads of the young couple in front and told myself not to be so daft. My partner said not to be surprised if the lift dropped suddenly as part of the effect. I didn’t reply. I just kept on waiting for the lift to move.

It had got even warmer by now and I started to concentrate on my breathing. I turned my head to look at the lift doors again. As I turned back a wave of what I can only describe as hot black mist passed through my head. It wasn’t a Dungeon special effect, it was actually inside my head. My heart was pounding at double speed. I could hardly breathe and couldn’t speak. I wanted to scream and hammer on the doors so they would let me out. But I was paralyzed by the sheer suffocating terror of being trapped in a lift. No air. No escape.

At that point the lift jolted and moved downwards. Because I knew the lift was moving now I tried to concentrate on my breathing. I tried to keep myself together. It was so hard I almost couldn’t do it.

The lift doors opened from the opposite end to the way we’d come in. People started filing out. I wanted to push through them so I could get out first. But I couldn’t move. My heart was still pounding. I was shaking. My legs felt like jelly and I could hardly move them. I managed to stagger out of the lift slowly. It took me quite some time before I felt nearer to normal and could carry on with the tour. 

The Dungeon Experience ended inside an ‘Olde Worlde’ pub. And despite the early hour I had a stiff drink to further calm my nerves (naughty I know, but it was medicinal!). After a bit of a breather I was ready for the Tower. I admit I was hanging onto the metal girders up there. But after my experience in the lift the height of the Tower was easy to cope with. 

Despite my panic attack in the lift the Blackpool Tower and Dungeon Experience was good fun. We enjoyed the rest of our holiday too. I loved hopping on and off the trams along the seafront and fish and chips always taste more delicious at the seaside. 

Since then I refuse to use lifts. Where possible I take the stairs. I avoid being hemmed in as part of a crowd. Staying on the fringes where I can see an escape route helps. I hope I never experience another panic attack. Particularly one as horrifying as that one. I honestly thought I was going to die of sheer suffocating terror. By avoiding similar situations and triggers I hope to avoid it happening again.

Tips and Tricks

These Tips and Tricks are useful for anxiety and panic attacks and can also help to lift low mood. Give them a try. Remember though that if your low mood goes on for more than 2 weeks you could be suffering with depression so see your doctor. Also see your doctor if your panic attacks are frequent or severe or your anxiety is persistent and destructive.

Food And Drink

A varied and healthy dietand good hydration are important for your overall wellbeing, both physical and mental. Caffeine and alcohol should be kept to a minimum or avoided if possible. Caffeine is a stimulant and alcohol is a depressant. Both can trigger anxiety, panic attacks and low mood.

Exercise

Fresh air and regular exercise can help to lift your mood and also have a calming effect. Exercise releases your ‘feel good’ endorphins which make you feel happier and more relaxed. It can be hard to get yourself moving when you’re feeling down or anxious but it’s worth pushing yourself to do it. 

Green spaces whether it’s a country park or your local park really do lift your mood. Getting out into green spaces lowers the stress hormone cortisol. Even if you just potter about in the garden it will help.

Sleep

Sleep – Try to make sure you get enough good quality sleep ( see my article ‘Sleepy Head!’ for information and a few Tips and Tricks for a good night’s rest). Not getting enough sleep or having poor quality sleep affects all aspects of your health. It also increases feelings of anxiousness and low mood.

Change Things Up

Small changes to your routine can help. Do things in a different order. Take a different route to and from work. Do your food shopping on a different day. Try something new. These are just a few examples but by changing just one thing each day it can really lift your mood. Routine may be effective at getting things done but also leads to boredom and loss of interest. Change things around and see how you feel. It can really help to lift your low mood.

Talk

Talk to your friends or someone you trust about how you’re feeling. Getting it off your chest can help you to feel that your burden is lighter. Good friends will help and support you and may be able to offer advice. They may even be able to help you get at the root of the problem. A little help and understanding goes a long way.

Resolving any outstanding problems or sorting out any difficult situations you are in will really help. If it’s a work problem speak to the boss or your supervisor. If it’s a personal issue then speak to the person concerned. I know that’s not easy but your state of mind and quality of life are important. The sooner things are resolved the better for you. You may have a colleague or a friend who will back you up. Let them help.

Relaxation

Relaxation and breathing techniques can help to lessen feelings of anxiety and low mood. Calming your mind as well as your body has a positive effect on your state of mind. Take a look at my ‘Relaxation’ tab where you’ll find a few simple techniques you can try. 

Making regular time to do something relaxing away from the stresses of everyday life does wonders for your psychological well being. Grab a little ‘me’ time each day. Do something that you enjoy, something that helps you to wind down and feel more relaxed. It doesn’t matter whether it’s reading a book, doing a crossword, weeding the garden or dancing round the kitchen to a favourite CD. Anything you enjoy will make a difference to how you feel. Escape from the real world for a while.

Relaxing is easier said than done if you’re experiencing a panic attack. But if you focus on your breathing and slow it down it can lessen the severity of the attack. It will help your mind to slow down and help your body to relax.

• Breathe in to the count of 5
• Breathe out to the count of 7

Repeat until the attack is over and you feel calmer. Don’t try to rush off and carry on with what you were doing before the attack. Give yourself time to recover properly. Get some fresh air if you can and take a break. Slowing down and focusing on your breathing is also helpful when you are anxious or feeling low. It helps to focus the mind and calm your body.