What does anxiety in menopause look like?

Anxiety in menopause is really common, with around 60% of menopausal women identifying it as one of their symptoms. For many women, anxiety, irritability, and low mood are their most challenging symptoms. Anxiety can come out of the blue for women who’ve never experienced it before, while for others it can be a worsening of previous anxiety.

So, what does anxiety in menopause look like?

Physical anxiety

Because changing hormones affect the nervous system, anxiety in menopause is often very physical. These physical symptoms include muscle tension and tightness, heart palpitations, sweating, shaking, nausea and shallow breathing. These symptoms are already unpleasant, and it’s common for women to then feel anxious about those symptoms, for example wondering ‘Why is my heart beating like crazy? What’s wrong with me?’ which can make the anxiety even worse.

Difficulty relaxing and problems with sleep

Anxiety gets your body ready for physical action – fight or flight – as part of your survival system. This can mean that our bodies feel keyed up and on edge, making it hard to relax and unwind. Sleep is difficult in menopause for many reasons, and this physical anxiety can make it even harder.

Anxiety about menopause and symptoms

Menopause often brings a whole bunch of challenging symptoms like brain fog, headaches and joint pains. These symptoms themselves can be a source of anxiety. Our brains look for explanations for things, and unfortunately sometimes the potential explanations our brain comes up with can lead to more anxiety (like ‘I’m getting this brain fog because I’m getting dementia like my Mum’, or ‘what if these headaches are really because of a tumour’).

Stress and worry about many different things

When we are already feeling anxious, that anxiety is often good at attaching to any and everything – work issues, family, finances, health, global conflict, what others think of you…. the list goes on. Things you may have felt minor concern over in the past can become much bigger worries, and it can feel like you’re worried about everything.

Greater reactivity

High stress and anxiety put us on edge. We all have a certain capacity before we stop coping well; you might think of this as a bucket. Challenges and stresses we encounter everyday add water into your bucket. When the bucket gets too full, we lose our ability to cope well, and often act in ways we would rather we didn’t, like yelling at your partner or kids, losing your cool, or crying. During menopause, many women find that their bucket has shrunk, and so things that may not have caused significant stress or ‘tipped them over the edge’ in the past, now make them much more reactive or overwhelmed than in the past. This reactivity can take many forms – stress, anxiety, irritability, tearfulness, and guilt.

Irritability

Irritability, frustration and anger are common along with anxiety. If you think of your fight or flight system, flight makes you want to run away and escape the anxiety, whereas fight drives you to fight against it. So, it makes sense that when we are in fight mode we feel angry and irritable. Unfortunately, the place we usually feel safest to express that fight mode is with our loved ones, so the people we care most about tend to cop it.

Self-doubt

Anxiety also tends to make us doubt ourselves. In menopause this is often compounded by other anxieties – things like weight gain, our changing bodies, and ageing. Many women experience a big hit to their confidence in menopause. Brain fog can leave you feeling less capable at work. Hot flashes and sweats can cause embarrassment in social situations. The emotional ups and downs can make you feel like you don’t recognise yourself. All of this leads to self-doubt and self-criticism for many women.

What can I do about it?

The good news is that there are lots of things you can do to help lessen the burden of anxiety during menopause. Everyday practices that calm your nervous system like deep breathing, mindfulness, and yoga can help. There are also many techniques to work more helpfully with your thoughts and feelings that psychologists like me use in talk-based therapy. If we come back to the bucket analogy, these tools help you to grow the size of your bucket and to get better at tipping water back out in order to increase your capacity before reaching overload. You’ll find lots of tools for both approaches in my online course. Many women also find HRT can make a big difference to their anxiety.