Can Perimenopause Cause Anxiety?

January 20, 2020.

Here is the deal: anxiety is the most common type of psychiatric disorder experienced by people across the globe. During times of physical, mental, and emotional stress, anxiety is likely to develop. Thus, it is no wonder that many women in perimenopause struggle with anxiety. According to the American Psychiatric Society, perimenopausal anxiety is one of the most crippling symptoms in menopause. But, can perimenopause cause anxiety? Or, is something else causing increased anxiety in women ages 40-60?

Let’s talk about perimenopause

Approximately 90% of women seek treatment for the symptoms of perimenopause and menopause, primarily due to physical symptoms, such as hot flashes and insomnia. Like the postpartum period, perimenopause is a time of fluctuating hormone levels as menopause approaches. When your menstrual periods space out during the perimenopause, the symptoms of anxiety tend to increase. Women with a pre-existing mood disorder such as depression or anxiety may experience a worsening of the symptoms in perimenopause. Panic attacks are very common manifestations of anxiety in this transitional period.

In one study completed in 2013, women with high anxiety before perimenopause continued to have high levels of anxiety throughout the menopausal transition, but those with low levels of anxiety were more likely to become highly anxious as they progressed through menopause.

Wait wait wait … What is Anxiety?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety disorders include disorders with features of excessive fear, anxiety, nervousness, intense worry, restlessness, muscle tension, and difficulty concentrating.

Types of anxiety disorders are separation anxiety disorder, specific phobias, social anxiety disorder (social phobia), panic disorder, agoraphobia (fear of open places), generalized anxiety disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition such as excess thyroid hormone.

The brain or central nervous system (CNS) is the underlying source of the symptoms of anxiety disorders because levels of norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) can widely fluctuate. In perimenopause, these neurotransmitters depend on and interact with estrogen and progesterone.

Perimenopausal Anxiety and Insomnia

Insomnia occurs in 40–50% of women during the perimenopausal period, and this translates into an increase in mood disorders. Problems with sleep are often connected to mood disorders. Not surprisingly, women with insomnia are more likely to experience anxiety, stress, tension, and depressive symptoms.

Sleep disorders are related to estrogen, progesterone deficiencies, and elevated luteinizing hormone (LH) levels, both of which are implicated in affecting the thermoregulatory process and elevating the body temperature. Progesterone has a known calming or sedating effect, and with lower levels, the onset of sleep can be delayed. Night sweats occur more frequently at night in some women in the perimenopause and can lead to nighttime awakenings that disrupt overall sleep quality.

Treatment for Perimenopause Anxiety

One approach for managing anxiety during perimenopause is to use hormones such as estrogen and progesterone in the form of oral contraceptives. Oral contraceptive pills (OCPs) are safe and effective at managing abnormal or irregular bleeding. Also, OCP’s protect against pregnancy and normalize estrogen and progesterone levels, which may help relieve the symptoms of anxiety. Additionally, selective-serotonin reuptake inhibitors (SSRIs) may be useful in the short term for more severe cases.

Supplements for Perimenopause Anxiety

Besides vitamins, other possible naturally occurring substances that help anxious symptoms and can help perimenopause anxiety include the following:

  • Magnesium
  • L-threonine
  • Fish oil
  • 5-HTP
  • Bacopa
  • Ashwagandha
  • Lavender
  • Chamomile
  • Lemon balm
  • Valerian
  • Passionflower

How Long Does Perimenopausal Anxiety Last?

Most of the anxious symptoms of the perimenopause lessen or disappear a few years into menopause, especially if they were not present during the premenopausal years. If an anxiety disorder predates perimenopause, it will likely worsen until stabilizing in the years after menopause.

To recap, can perimenopause cause anxiety?

You bet it can! If you are struggling with anxiety in menopause, you are not alone. Join fellow women in perimenopause and menopause experts in the free perry community app  for support, menopause education, and a little humor!

Disclaimer: this is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment. 

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Julia Walker
perry expert Julia (RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations. She specializes in helping women optimize their health during perimenopause and beyond.

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