Can Perimenopause Cause Anxiety?
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!
The 4-1-1 on Perimenopause Symptoms
Women go through different stages as they progress through their menopausal years. There are four different stages: pre-menopause, perimenopause, menopause, and post-menopause. Perimenopause can feel like a rocky road to menopause because it is met with some intense perimenopause symptoms. Typically, women are more prepared for menopause because it is talked about more openly compared to perimenopause. Unfortunately, many women are caught off guard by how they feel and what they feel for almost a decade before reaching menopause.
What is perimenopause?
Perimenopause marks the beginning of a woman’s transition into menopause. The word itself means “around menopause.”
Some people refer to perimenopause as premenopause. However, premenopause is a stage of its own that refers to the time before a woman enters perimenopause. Most women in premenopause do not notice any significant changes in their symptoms. As a woman gets closer to perimenopause she may notice subtle changes in her period. A woman’s premenopause symptoms age varies and she may even be asymptomatic until perimenopause.
In perimenopause, your hormones start to change. Rather than a gradual and slow decline to menopause, estrogen and progesterone levels can jump around erratically. This can lead to a number of frustrating symptoms caused by hormone fluctuations. Many women start to notice a change in their menstrual periods that signals the start of perimenopause. With changing hormone levels, your menstrual cycle will begin to change. Many women start to notice irregularities in their periods which can include changes in flow, duration, and time between periods.
Perimenopause ends when a woman reaches menopause. A woman is considered menopausal when she has been period-free for at least one year. Once women reach menopause, many perimenopause symptoms decrease in the severity or greatly improve. However, menopausal women can still experience symptoms that are related to low estrogen including hot flashes and vaginal dryness. Indeed, once a woman is post-menopausal, she will have to manage symptoms and even health conditions related to low estrogen, including vaginal dryness and osteoporosis.
When does perimenopause start?
Every woman is different and her perimenopause age of onset will likely differ from the woman next to her. Perimenopause most commonly starts in your 40’s but can begin as early as your 30’s. Also, it lasts roughly 8-10 years and is usually accompanied by menopause symptoms.
The average age a woman reaches menopause is 51. Like perimenopause, the age of onset for menopause can vary. Many women experience an increase in the severity of their symptoms as they approach menopause. Fortunately, once menopause is reached, many symptoms resolve.
Symptoms of perimenopause
Your symptoms can vary based on your age and can get more severe as you get closer to reaching menopause. For example, perimenopause symptoms age 48 may be more severe than your symptoms of perimenopause at 44.
There are many symptoms that you might expect in perimenopause because it is associated with changes in your menstrual cycle, However, many women are caught off guard and even surprised by many of the symptoms that women in perimenopause can experience.
Women in perimenopause can experience 34 perimenopause symptoms to be exact. Here is the rundown of all the symptoms that are related to perimenopause: (Don’t worry – they are categorized!)
Most Common Perimenopause Symptoms
Irregular periods
Hot flashes
Night sweats
Loss of libido
Vaginal dryness
Physical Perimenopause Symptoms
Hair loss
Dizziness (unrelated to other health conditions)
Fatigue
Difficulty sleeping
Perimenopause bloating
Weight gain
Stress incontinence
Brittle nails
Osteoporosis
Irregular heartbeat
Allergies
Changes in body odor
Painful Symptoms
Headaches and migraines
Aching joints
Burning mouth
Electric shocks
Digestive problems (including perimenopause nausea and constipation)
Dry, itchy skin
Tingling extremities
Muscle tension
Mental Symptoms
Mood swings
Brain fog
Panic disorders
Irritability
Depression
Difficulty concentrating
There are many symptoms that women are likely already aware of such as perimenopause periods closer together and hot flashes, but what about those symptoms that are less often talked about but are equally debilitating like depression, anxiety, brain fog, and irritability? Women who are unprepared for these symptoms in perimenopause can feel lost, frustrated, and even isolated. Some women have worried their mental symptoms are early signs of dementia. Other women have worried their breast soreness is related to cancer.
If you are experiencing any of the above symptoms, they may be related to perimenopause. No matter what is causing your symptoms, it is important to meet with your doctor to rule out other health conditions and to help you manage your symptoms so you can fully enjoy life during your perimenopausal years.
How to treat perimenopause symptoms
Perimenopause is a natural transition that, unlike diseases, does not require treatment. However, we know that sometimes the symptoms can be debilitating. Therefore, women often try a number of different methods to manage their perimenopause symptoms.
Some women opt for hormonal stabilization through hormone replacement therapy (HRT) whereas others turn to herbal supplements to help diminish their symptoms. Many symptoms can be improved with lifestyle changes such as decreasing stress, improving sleep hygiene, increasing exercise, and watching your diet. But oftentimes your symptoms can get in the way of you being able to make certain lifestyle changes. Commonly, women try a combination of remedies to help alleviate their perimenopause symptoms.
Perimenopause is a natural transition that, unlike diseases, does not require treatment. However, we know that sometimes the symptoms can be debilitating.
Related: These are the top rated products for perimenopause
How do I know if I am in perimenopause?
There is no medically-proven perimenopause test that can confirm if you are in perimenopause. Indeed, there are many perimenopause tests on the market but none to date are supported by the medical community. Rather, perimenopause is diagnosed with your doctor by looking at your symptoms and your age. Hallmark symptoms of perimenopause such changes in your menstrual period, vasomotor symptoms such as hot flashes and night sweats, mood instability, and breast tenderness can signal both you and your doctor that your hormones are changing.
Every woman’s journey to menopause is different. Some women enter menopause naturally whereas others reach menopause abruptly such as if they have a hysterectomy with ovary removal. No matter your journey to menopause, there can many physical and emotional hurdles in this season of life.
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Fertility, Perimenopause, & Beyond - Podcast Transcript
‘Fertility, Perimenopause, & Beyond’ is the focus of today’s episode on the Perimenopause WTF! podcast. Listen to Dr. Somi Javaid and Dr. Asima Ahmad talk about everything related to fertility and perimenopause, from IVF treatments and appointments to female sexual function and health.
They talk about the importance of taking care of your health and finding the right care provider, so tune in as these two powerhouse MDs advocate for women’s sexual health and fertility. They underscore the need for more open conversations about fertility and sexual health, suggesting that women who have concerns about their sexual health have the right to take necessary action to ensure their wellbeing.
Listen to the full podcast here:
https://open.spotify.com/episode/6iDZn4JL6wdhWUACi0Fcod?si=frlp12pbSgC56FBVsqgAIw
Let’s introduce the speakers!
About guest Dr. Somi Javaid MD:
Dr. Somi Javaid is a board-certified OB/GYN, leading women’s sexual health thought leader, and menopause advocate. She is the Founder and Chief Medical Officer of HerMD, a team on a mission to make women’s healthcare exceptional by educating, advocating for, and empowering patients to take control of their health concerns. Dr. Javaid has been featured in Forbes, Vogue, Well+Good, InStyle, Parents, Refinery29, Mashable, Adweek, and Popsugar. In August 2020, Dr. Javaid spoke about Gender Bias and the Female Sexual Health Revolution on the TEDx mainstage, and in January 2021, she was featured in Women on Top for her work as a trailblazer and pioneer in women’s sexual health.
About guest Dr. Asima Ahmad MD:
Asima Ahmad, MD, MPH, is Co-founder and Chief Medical Officer (CMO) of Carrot Fertility, the leading global fertility care platform. Dr. Ahmad leads clinical strategy, overseeing the company’s expansive network and telehealth program, which offers access to more than 10,000 reproductive endocrinologists, urologists, adoption experts, mental health experts, OB/GYNs, doulas, and midwives. Dr. Ahmad is also a practicing reproductive endocrinologist and infertility specialist. Dr. Ahmad is double board-certified in reproductive endocrinology and infertility and obstetrics and gynecology. She earned a combined medical and public health degree from the University of Chicago’s Pritzker School of Medicine and the Harvard T.H. Chan School of Public Health.
Key takeaways
When it comes to choosing the right healthcare provider, Dr. Somi Javaid says that less than 20% of OB-GYNs have special menopausal training. So make sure to do your research and go to a doctor that has taken specialized training in this area. Also make sure that your doctor is passionate enough to listen to your concerns and give you the space to be open about your symptoms.
Dr. Asima Ahmad says that as long as you are still ovulating, you can get pregnant. So take birth control if you don’t want to get pregnant.
Dr. Asima Ahmad also clarifies that IVF does not cause menopause. When you're doing IVF treatment, you're taking medications that can sometimes make your own level of hormones go up, mainly the FSH hormone. Or you could be injecting higher levels of that hormone into your body, and sometimes that can mimic symptoms that are similar to menopause.
Dr. Asima Ahmad also states that you might need to take additional medication if you’re perimenopausal and going through IVF.
Dr. Somi Javaid adds that there is an FDA-approved validated tool called Female Sexual Functional Index (FSFI) that helps to record sexual activity with a comprehensive questionnaire.
Podcast transcript
You can find the full transcript here.
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