Perimenopause can be a time of heightened anxiety for some. Mindset and fitness coach Sue Tetley looks at ways to stay calm and in control during perimenopause anxiety
Words: Sue Tetley | Images: Shutterstock
Anxiety is a common symptom affecting women, especially during perimenopause and menopause, yet it is often not recognised as being directly linked. Mental wellbeing can be hugely impacted during this phase of life, with women experiencing an increase in both anxiety and depression. Disturbingly, women aged 45-55 also have the highest suicide rate of all female age groups – an age range that coincides with the average onset age of perimenopause and ending just after most women have reached menopause.
Anxiety is a state of worrying, self-doubt and a feeling of being overwhelmed by a perceived threat. Symptoms can include poor sleep and concentration, irritability, rapid breathing, sweating, trembling, stomach pains, panic and fear.
Some women first experience anxiety first during perimenopause, whereas for others, existing anxiety symptoms worsen. The causes of increased anxiety are multi-faceted; however, hormones play a large part.
The role of hormones
Your body has a finely tuned system of hormones that are meant to be in balance. When the perimenopause hits, this system is disrupted, creating anxiety in some. The production of oestrogen, testosterone and progesterone starts to decline in an irregular way, whilst follicle stimulating hormone (FSH) rises to get your ovaries to produce more oestrogen.
Oestrogen has a big role to play in mood, and has been dubbed “the feel-good hormone”. It rises during the first half of your menstrual cycle and declines during the latter half. Lowering levels in the second half of your cycle can lead to irritability, anger and anxiety. With the fluctuation in hormone levels during perimenopause, symptoms of pre-menstrual syndrome (PMS) and low mood can worsen.
Another important hormone is progesterone, which helps enhance your mood and relieves anxiety, acting as a natural antidepressant. It helps your brain and body relax. A drop in progesterone during the second half of your cycle can lead to PMS, mood swings and cravings. With further hormone fluctuations and declining levels of progesterone in the run up to menopause, these PMS-like symptoms are exacerbated.
Testosterone also plays a significant role in mood regulation. Low levels have been associated with increased anxiety and a feeling of impending doom that can lead to panic attacks.
Calming the cortisol
Stress hormone cortisol, responsible for the fight or flight response, gets thrown out of balance during perimenopause. While you need a certain level to get you up in the morning, you don’t want it to be high late in the day, when your body needs to unwind for sleep, which can happen when you’re chronically stressed. In situations of danger, you need cortisol to respond in an appropriate way, but constant high levels can lead to increased anxiety.
Progesterone is good at keeping cortisol under control, however, with the onset of perimenopause and a drop in progesterone, the effects of cortisol and the stress response are felt more keenly, which again leads to greater levels of anxiety.
Finally, your mindset can hinder or help anxiety, as how you view menopause can impact your mental and physical wellbeing. Although some people choose to take HRT, you can’t control what is a natural bodily process and the inevitable decline in hormones. Clinging on to how you used to be, or wanting to reverse the clock, only leads to more anxiety. However, there are lots of ways you can help yourself. Get the support you need to take care of your own mental and physical wellbeing.
Control the controllable
If you’re experiencing symptoms of anxiety, it’s important to acknowledge them and take control of the situation where you can. It may be tempting to bury your head in the sand, however, this will make you feel more powerless.
If you’re struggling, seek advice from professionals. Look up a menopause health professional at your local GP surgery. Or, go to the British Menopause Society website (thebms.org.uk) for a list of accredited professionals.
It’s also worth mentioning that a 2021 survey of 5,000 perimenopausal and menopausal women found one-in-four were given antidepressants for low mood and anxiety. NICE guidelines state that menopause symptoms should be treated first with HRT, and not with antidepressants.
TRY IT: When you do see a doctor, take a list of questions and mention menopause. You only have a limited time with a GP so it’s important to get your point across clearly. Seek a second opinion if you’re not happy with the treatment offered.
Challenge limiting beliefs
Limiting beliefs are any beliefs that stop you living the life you want.
If you are viewing the menopause in a negative way, try to gently challenge this view and change your thoughts about it. This can be a time of greater self-knowledge and confidence. It’s a time to “spring-clean” your life and look at what’s important. Think about all the things you would love to do and how you can make them happen. You have a choice about how you think about a situation. Ditching unhelpful beliefs can help you to transform your life in a positive way.
TRY IT: Use a diary at night to write down new positive beliefs, and focus on things for which you are grateful.
Choose your words carefully
You really are what you think, and your language is an expression of your thoughts. Watch negative self-talk and what you say out loud. Is your speech kind and charitable or vicious and nasty? Start giving yourself a break and talking to yourself as you would a loved one or a young child. If your language is catastrophic and negative, your brain will believe it’s true and you’ll feel more anxious.
TRY IT: Write down some calming words or phrases on notes and sticking them where you will see them.
Visualise a positive outcome
Your mind is so powerful that you need to make it work for you, not against you. So in a similar way to point number three, just as you mind your language, also visualise and imagine what you want to happen rather than what you fear. If you worry about how difficult and stressful something is going to be, then it will be. Confirmation bias will then kick in, telling you that you knew you wouldn’t be able to deal with that situation.
TRY IT: If you are starting to feel anxious, visualise and imagine being calm and in control. Use positive self-talk to bolster your feelings.
Get moving
Increasing your level of physical activity has huge benefits for your mental and physical wellbeing by helping to lower levels of anxiety and releasing endorphins. Exercising in nature is particularly beneficial as it really helps you get some perspective and clear your mind as you get away from your everyday environment and connect with something bigger.
TRY IT: You’ll most benefit from a regular fitness habit. Start small and be realistic. It can take several weeks to consolidate a new routine so think about what you can realistically do and how to are going to stick to it.
