Menopause & Anxiety

Menopause and the years leading up to this transition can take women on an emotional roller coaster of mood swings and mental health concerns including depression and often anxiety. Irritability, tension, and nervousness may be present in as high as 51% of women age 40-55 years old (1). Menopause may even trigger a new-onset of panic disorder, or worsen a preexisting panic disorder (2). These experiences can be distressing, and even scary at times.

Why is mental health compromised during menopause?

Hormonal changes, debilitating hot flashes, and lack of sleep creates a vicious cycle that puts mental health in a precarious position. Not to mention the fear around going through such a pivotal life transition.

Female hormone changes in estrogen and progesterone begin during the years leading up to menopause known as peri-menopause. Menopause is defined as the cessation of menses for 12 months, but fluctuations in estrogen and progesterone begin years prior to this. During this peri-menopausal period, progesterone levels begin to drop, while estrogen (or estradiol) levels fluctuate up and down creating a relative estrogen dominance and progesterone deficiency.

This progesterone deficient state plays into anxiety and sleep issues. Progesterone is important for mental health, particularly anxiety, since it increases activity of the neurotransmitter GABA (3). GABA is an inhibitory neurotransmitter meaning it is involved in calming the mind. Therefore, a deficiency in progesterone created during peri-menopause leads to feeling a "lack of calm". Progesterone is also required for healthy sleep for similar reasons. The calming actions of GABA means it helps sedate the body to promote sleep. Estrogen contributes to sleep as well by metabolizing, or breaking down, the neurotransmitters norepinephrine, serotonin, and acetylcholine, which allows for increase in REM cycle sleep (4). Difficulty initiating sleep is associated with further anxiety, and 40-50% of women in the menopausal transition experience insomnia (5).

You can start to see this domino effect between hormones, sleep, and anxiety. And then we throw hot flashes into the mix.

Anxiety can actually be a trigger for hot flashes, often preceding that sudden rush of warmth. One study looking at over 400 women found that women with moderate anxiety are 3x more likely to experience hot flashes, while women with severe anxiety are 5x more likely to experience hot flashes than those women with mild anxiety (6). After controlling for factors such as body weight, estrogen levels, and smoking, among others, anxiety still remained strongly associated with hot flashes. Furthermore, anxiety scores were higher in those women with more severe and frequent hot flashes (6).

What about feelings of depression?

Some women going through menopause are plagued by low, depressive feelings. This may be in combination with anxiety. Hormonal changes as well as sleep disturbances may play into this. Women experiencing symptoms of depression may be unable to achieve restorative sleep, which is associated with depression (5).

How can you support mental health during menopause?

During this life transition, experiencing feelings of anxiety and depression is common, but not necessarily normal: your mental health doesn’t have to suffer.

Naturopathic doctors aim to treat the underlying cause of concerns, which in this case, is the hormonal fluctuations. The tools we have at our disposal to address these mood changes are plentiful. The beauty of naturopathic medicine, is that all treatments are individualized specifically for your needs.

References:

1. Bromberger, J., Kravitz, H., Chang, Y., Randolph, J., Avis, N., Gold, E., Matthews, K. (2013). Does risk for anxiety increases during the menopausal transition? Study of women’s health across the nation (SWAN). Menopause, 20(5), 488-495. doi:10.1097/GME.0b013e3182730599

2. Bhatt, N. (2019). Menopause and mood disorders. Medscape: https://emedicine.medscape.com/article/295382-overview#a1

3. Reddy, D., O'Malley, B., Rogawski, M. (2005). Anxiolytic activity of progesterone in progesterone receptor knock out mice. Neuropharmacology, 48(1), 14-24. doi:10.1016/j.neuropharm.2004.09.002

4. Tal, J., Suh, S., Dowdle, C., Nowakowski, S. (2015). Treatment of insomnia, insomnia symptoms, and obstructive sleep apnea during and after menopause: therapeutic approaches. Current Psychiatry Reviews, 11(1), 63-83. doi:10.2174/1573400510666140929194848

5. Terauchi, M., Hiramitsu, S., Akiyoshi, M., Owa, Y., Kato, K., Obayashi, S., Matsushima, E., Kubota, T. (2012). Associations between anxiety, depression, insomnia, in peri- and post-menopausal women. Maturitas, 71(1), 61-65. doi:10.1016/j.maturitas.2012.01.014

6. Freeman, E., Sammel, M., Lin, H., Gracia, C., Kapoor, S., Ferdousi, T. (2005). The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 12(3), 258-266. doi:10.1097/01.GME.0000142440.49698.B7