Menopause, Anxiety and Panic
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Menopause and Anxiety

Many women report increased symptoms of anxiety during the period leading up to their final period, as well as the year following menopause. This time is called perimenopause, and it is a time of many changes, both internally and externally. Identifying the symptoms of anxiety is easy, but understanding the cause of the conditions is a bit more difficult.

In fact, the source of mental health conditions has been a major debate for thousands of years. Some believe the mental illness is brought on by problems in the biology or physiology of the person. This is referred to as the “nature” position. Others believe that poor psychological health is brought upon by the environmental surroundings the person interacts with on a daily basis, including their upbringing and typical routines. This is known as the “nurture” position.

So, with menopause and the associated anxiety, what is the culprit? What is to blame: nature or nurture? The anxiety of perimenopause is an interesting case because there is clear evidence to support both biological and environmental contributors to these symptoms later in life.

Biological Contributors

Perimenopause is known to be a period of change and transition of your hormonal functioning. The levels of your estrogen will change in significant ways. These changes will likely trigger some of the common side effects and symptoms of menopause like:

These symptoms may look normal and expected to you, but look again. The seven symptoms listed above are typical for perimenopause, but do they remind you of anything else? How about anxiety?

Like anyone, there have been times where you experienced some levels of anxiety. Maybe you were preparing for your college finals or planning for your wedding day. Maybe you felt nervous about sending your kids to school. You worried about the outcomes. You felt hot, flushed, irritable, and dizzy. These are ordinary signs of anxiety.

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Your brain has a very interesting ability, though. It can gather information about your current feelings and compare them to previous instances where the symptoms were present. Most of the time, this is an extremely helpful capacity as it aids in your protection by keeping you aware of dangerous situations. But what your brain does here is confuse the menopause symptoms with anxiety symptoms.

You begin to worry about how you are feeling and may even panic that your status will only get worse with no hope in sight. You may fear that you will never have a restful night’s sleep, or you may stress about the thought of having a hot flash at work or around your friends. These worries begin to complete the picture of anxiety.

In the worst cases, your worry and physical symptoms create a storm of anxiety in you that leads to panic. During a panic attack, you will have the sensation that you are losing control of yourself. You may fear that you are dying because of the tightness in your chest and difficulty breathing. You may be so dizzy that you will need to sit down as you have trouble seeing clearly.

This is just one example of the brain’s misinterpretation of anxiety triggered by the biological changes of menopause escalating to panic.

Environmental Contributors

Your life changes during perimenopause. This duration of time, that can last for seven years, brings about many life events. These events can impact your anxiety, both directly and indirectly. Consider these perimenopause stressors:

  • Changing self-image. Directly, perimenopause and menopause are not only associated with inward changes, but outward as well. Many women report unwanted transitions with their weight. Others report problems with thinning hair or areas of balding. These issues will force you to revise the way you perceive yourself and your self-esteem. Decreased self-worth leads to higher levels of stress, depression, and anxiety.
  • Changing sex life. Another unwanted, direct result of perimenopause is a changing sex life. While some women report enjoying the newly liberating sex life that is not associated with risk of pregnancy, other women report decreased sexual desire and vaginal dryness. This change can impact the relationship with one’s partner and alter the level of satisfaction you find in it. If the relationship destabilizes, there is risk of increased stress, depression and anxiety.
  • Empty nest. The time around and included in perimenopause is related to other life changes as well. During this time, many women experience their children growing and moving from the home. What was once something to be looked forward to is now met with sadness and uncertainty. As children leave the home for college or a life of their own, you face a drastic shift in responsibilities, needs and wants. Some do well to find a productive use of their extra time and resources while others struggle to find hope and direction for the future. Those who struggle will have increased mental health symptoms that can trigger feelings of anxiety.
  • Changing work life. During the time where children are leaving the home, many women either reenter or reinvest in the workforce. Again, this transition could be met with resistance from your partner or yourself. For your husband, he may be uncomfortable with the lack of time and attention devoted to him. For you, you may find work to be more stressful and less fulfilling than expected. Unmet expectations will lead directly to anxiety.

Anxiety Solutions

Solutions for mental health issues are never simple. Solutions for something as complex as the anxiety and panic triggered by perimenopause is quite complex and often requires professional treatment to resolve fully.

Consider seeking a mental health therapist to assist with the transition through the stages of menopause and the anxiety that accompanies it. They can provide information and interventions to improve your symptoms like:

  • Psychoeducation about the stages of menopause to outline the complications of each step.
  • Relaxation techniques to calm your body and your mind.
  • Cognitive retraining to learn to accurately perceive menopause symptoms as menopause and not anxiety.
  • Coping skill training to find a number of helpful skills to engage in when symptoms are high.


Like with other health conditions, learning more about the symptoms and the triggers of the symptoms of anxiety related to perimenopause can give you a better understanding of your situation.

With this increased knowledge, you can find measures to improve your status. If the changes of menopause have been creating high symptoms, seek treatment. These problems may grow and develop further if untreated. You deserve to feel better than this.