What Causes Menopause Anxiety?

Mood swings and loss of confidence are common menopause symptoms. Dr Stephanie Goodwin, a London-based GP and menopause specialist, explains what’s behind the anxiety and what can be done.

We know that anxiety is a huge challenge for many menopausal and perimenopausal women. And yet it’s a symptom that many of us didn’t know to expect.

We’ve all heard about hot flushes, but anxiety is just as common for many of us. We lose confidence in the workplace, feel nervous and on edge (especially at 3am, never a good idea) and often wake up with feelings of foreboding for no apparent reason.

Our medical advisor Dr Stephanie Goodwin is one of the UK’s leading menopause specialists. She explains why anxiety is a very real challenge for so many women.

Can menopause cause anxiety?

I often get asked by patients, can menopause cause anxiety? The answer is yes. Anxiety is a common symptom for many women in the perimenopause years. Anxiety symptoms typically come on in your 40s and can include:

  • Fearfulness or even full blown panic attacks
  • Tension headaches or even migraine
  • Chest pressure or pain
  • Lack of sleep
  • Feeling nauseous
  • Feeling irritable, jumpy or shaky
  • Feeling tearful
  • Getting hot flushes
  • Upset stomach or even IBS

READ MORE The difference between menopause and perimenopause.

Can menopause mood swings be blamed on hormones?

Remember when you were a teenager and your moods swung from euphoric to depressed and back again with regular monotony? Although we didn’t know it at the time, this was the result of hormonal mayhem when our reproductive hormones swung into action.

Unfortunately far too many of us forget how our hormones affect our moods. Getting hormone levels looked at is probably the very last thing midlife women think of when anxiety symptoms seem to come out of the blue.

Do those anxiety symptoms signify menopause?

The liklihood is that you’re in a time of transition towards menopause. This is called the perimenopause. Other symptoms around this time may include hot flushes and night sweats.

There are heart rending posts on many a menopause forum, like Hylda’s private Facebook group, where women are totally bewildered about what’s happening to them. They recount the overwhelming effect of anxiety symptoms on a previously happy life; the temporary success or failure of natural supplements; and the challenge of self-diagnosis in the absence of a sympathetic GP.

READ MORE HRT and sleep, does it help?

Is menopause and anxiety common?

Anxiety during perimenopause is a very common issue. During the perimenopause your levels of oestrogen and progesterone decline with each cycle as your body heads towards menopause. However this is not in a nice smooth transition and can occur in quite dramatic peaks and troughs. So it’s perhaps not surprising that fluctuations in hormone levels are going to cause fluctuations in you.

READ MORE What are the 34 menopause symptoms?

Can anxiety be blamed on declining oestrogen?

Scientists have discovered that oestrogen has a significant effect on the brain’s regulation of moods and emotion.

This relationship is pretty complex. It appears that a decrease in oestrogen causes a decrease in an enzyme called Monoamine oxidase (MAO). This in turn causes damage to the neuro transmitters which offer neuro chemicals like serotonin, norepinephrine, dopamine and melatonin that affect mood, emotions and behaviour.

Any other stress side effects during menopause?

If you are feeling stressed about the disturbing symptoms you may now be experiencing, the likelihood is that your body is going to start producing the stress hormone cortisol as well.

READ MORE What causes brain fog during menopause?

What effect does cortisol have?

The increased production of cortisol will lead to a reduced production of progesterone. So, the more stressed an individual is, the more suppressed progesterone production becomes. This means the more dominant oestrogen becomes, which causes further problems.

Is depression a menopause side effect?

In about 20% of people, anxiety can also cause “dysphoria”. This is an emotional state like a “funk” which can also manifest itself as poor concentration and even memory loss. It is often misdiagnosed as “depression.”  At this point you are likely to be put on anti-depressants which are then of course masking one symptom instead of addressing the primary cause. So this all becomes one horrendous self-perpetuating cycle.

What can be done to reduce the stress of menopause and perimenopause?

There are holistic things you can do of course, like decreasing your stress through meditation or relaxation techniques. Regular exercise and cutting down on alcohol will help – and are good lifestyle measures regardless.

READ MORE HRT and alcohol, this is what you need to know.

In my view it is essential to look at the root cause of all the problems, your hormonal imbalance. Addressing this is the best of all the treatments for menopause symptoms.

Let’s face it, when you are in the grips of this hormonal maelstrom, ignorance is definitely not bliss. So take control, don’t wait out years for the symptoms of perimenopause to sort themselves out; don’t wait to seek treatment until your symptoms are so severe that you can’t function. Please talk to a menopause specialist (the British Menopause Society has a helpful list) about addressing the problem.

Share this Article

About the Author
Sign up for Our Newsletter
About the Author


Stay to date with advice from medical and wellbeing experts, beauty and fitness tips, upcoming events and stories from brilliant midlife women just like you. We’re all in this together.