I am frequently asked about anxiety during menopause. How are the two linked? Is it that you feel anxious about menopause and life stresses during it? Or, is it the other way around: does menopause cause anxiety?

The simple answer is yes … to both. You probably are anxious about what menopause may bring to you next and what is going on in your life during menopause. There is also no doubt that menopause causes anxiety.

How anxiety affects your symptoms

Researchers suspected that women with higher levels of anxiety, experienced more frequent hot flashes. A study was conducted to examine the affect that anxiety has on hot flashes. The researchers found that women who rated themselves as “moderately anxious” due to life stresses experienced three times as many hot flashes compared with women who were within “normal” anxiety range. Those with “high” anxiety scores experienced five times as many hot flashes.

Another study found that women who had a high level of anxiety prior to menopause tended to have lower levels of anxiety during menopause and women who had low levels of anxiety prior to menopause tended to have higher levels of anxiety during menopause.

Women who suffer more physical symptoms or who experience negative life events or who are less functional are more likely to experience anxiety during menopause, than women without these additional stressors.

How menopause causes feelings of anxiety

Research has revealed that anxiety becomes more prevalent during times of hormonal upheavals, such as during adolescence, pregnancy and perimenopause. The link between menopause and anxiety is most evident during perimenopause, when a woman’s hormones are fluctuating frequently. Once a woman passes into post menopause, anxiety levels usually decrease. This is because hormone levels are no longer fluctuating and they come to rest at a lower level.

During perimenopause not only are your hormones out of balance, but your neurotransmitters are out of balance as well. Your brain has ten billion neurons (brain cells). Between each of these neurons are neurotransmitters. They are chemical messengers that transmit thought from one cell to the next, allowing your brain cells to “talk to each other.”

Your hormone levels affect your neurotransmitter levels and your neurotransmitter levels affect your hormone levels. In order to feel right emotionally, it is critical that both your hormones and neurotransmitters be in proper balance.

The relationship between hormones and your neurotransmitters can best be described as one of master and servant. Your hormones send messages to your body, instructing it to do certain functions. Your neurotransmitters carry those messages to your body.

It may be helpful to think of your hormones as being similar to the furnace in your home and the neurotransmitters as being similar to the fuel on which the furnace operates. When that fuel level gets very low, the furnace may begin to sputter and not function very well. When the levels of your neurotransmitters are low, your brain, which controls your nervous system (the entire system of nerves in your body), does not function well.

While all menopause symptoms stem from changing levels of hormones, it is actually the changing levels of your neurotransmitters that causes the feelings associated with anxiety during menopause. Neurotransmitter imbalance can be caused by hormonal imbalance, poor diet and stress.

Here is a free online test you can take to see if your anxiety is in normal range.

Which neurotransmitters affect anxiety during menopause?

The neurotransmitters associated with anxiety during menopause are epinephrine, norepinephrine, serotonin, and GABA

• Epinephrine and norepinephrine are the neurotransmitters linked to the “fight or flight” instinct. When their levels are too high it may result in heightened anxiety or panic attacks. The hormone connected with “fight or flight” is cortisol. It takes seconds for epinephrine and norepinephrine to prime your body to respond to a threatening situation. It takes minutes for cortisol to do the same
• Serotonin is a calming neurotransmitter. It is the most well known neurotransmitter associated with anxiety during menopause. Low levels of serotonin are linked to anxiety during menopause
• Like serotonin, GABA is a calming neurotransmitter. Low levels of it are linked to anxiety during menopause
• When you feel anxious, your body has high levels of cortisol and higher levels of epinephrine and norepinephrine than serotonin and GABA. When you calm down, your body has higher levels of serotonin and GABA than epinephrine and norepinephrine

How to relieve anxiety during menopause

1. Re-balance your hormones. I recommend that you begin with a free online hormone assessment. Two options are available here and here. 

   You can do the hormone tests with either of the above sites. Alternatively you can ask your doctor to arrange for the tests. Here is a directory of labs that do hormone tests in the US. It is important to have the test results interpreted by a hormone expert. 

   Once your test results have been interpreted, you can remedy the hormonal imbalances that occur during the menopause transition.
2. Eliminate processed food from your diet. It contributes to hormone and neurotransmitter imbalance. Base your diet around real food. Real food does not need labels (ie. unprocessed meat, fish, milk, eggs, legumes, fruits, grains and vegetables). Real food helps your hormones and neurotransmitters to re-balance and stay balanced.
3. Exercise replenishes depleted neurotransmitter levels. Researchers recommend that 30 minutes of aerobic activity every day is the best dose of exercise to relieve depression and keep it at bay.
4. Do yoga, meditation, relaxation therapy or some other stress reduction technique. Stress and anxiety go hand in hand. Stress reduces the levels of calming neurotransmitters and increases the levels of epinephrine and norepinephrine. By reducing your level of stress, your neurotransmitter levels will encourage a calmer feeling.

It is always important to discuss your symptoms and level of distress with your healthcare practitioner as well.

This post is reproduced with the permission of Menopause Matters.