Why can the menopause trigger anxiety?

Anthea*, 51, started to have anxiety and low mood when her periods began to get more erratic and heavy, before they stopped completely. She couldn't sleep and had to be signed off work five times in a year.

However, it was only when she began to read about the menopause and its effects that she realised it might be contributing to her mental health problems.

"I felt tearful all the time," she says.

After speaking to several different healthcare professionals, Anthea eventually started counselling and hormone replacement therapy (HRT). This eases the symptoms of the menopause by replacing hormone levels that have dropped. After six months, her mental health had improved and she was sleeping again, seeing friends and back at work.

Dr Radhika Vohra is a medical advisor for The Menopause Charity and an NHS and private doctor in Surrey. She explains that the hormone levels of oestrogen, progesterone and testosterone - all produced by the ovaries - start to decline up to seven years before the menopause starts.

This is called the perimenopause.

"The changes in hormone levels and the drop in them have varying effects on your brain and body," she says. "There are so many recorded symptoms and anxiety - along with low mood and brain fog - is a very common one."

How hormone changes affect mental health during menopause

Shifts in the levels of female hormones are one of the key causes of mood changes for many.

Vohra says: "The falling levels of oestrogen, progesterone and testosterone influence your brain. The resulting imbalance of lower chemicals such as serotonin and endorphins - and increased ones such as cortisol and adrenaline - can lead to feelings of anxiousness and irritability."

Usually, progesterone and oestrogen can ease the effect these stress hormones have on the body, but once their levels drop during perimenopause, this weakens. The result can be sustained high levels of stress hormones, which can harm your mental health.

Often, psychological symptoms can appear during the change to menopause too.

Vohra says: "During the perimenopause, whilst still having periods - even if irregular - you may find that your mood changes during the second half of the cycle. This again is due to the lower levels of oestrogen at this stage."

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Other causes of anxiety during menopause

On top of hormonal changes, various physical symptoms of menopause can trigger anxiety and low mood.

You may not feel like yourself and have low self-confidence.

Vohra explains: "Juggling many roles with home and work, and trying to carry the burden of all these expectations whilst not feeling yourself is a source of anxiety for many.

"These can be really debilitating despite not being visible," she says. "This can result in a lack of pleasure in everyday life."

As a result, you may lose interest in activities that once made you happy, such as exercise or socialising. This can worsen feelings of anxiety and low mood.

How to cope with anxiety during menopause

Speak to a health professional

Vohra advises you speak to a health professional if you are having these symptoms, as getting help can start the process to differentiate symptoms of menopause affecting your mental health from depression.

She says: "If you have a past history of sensitivity to your own hormone changes - such as premenstrual syndrome or postnatal depression - you may be more likely to experience these types of symptoms during the menopause."

Explore hormone replacement therapy (HRT)

It's also a good idea to read up on HRT.

HRT can also help prevent weakening of the bones - known as osteoporosis. Some types of HRT can increase your chance of developing breast cancer. However, the benefits of HRT are believed to outweigh the potential health hazards for many.

"These hazards are smaller than previously published, but your medical history, risks and family history all need to be taken into account," says Vohra. "If your anxiety is hormone-related, then replacing the hormones with HRT could help. Do consider what medicines or contraception you are taking - this includes over-the-counter medicine as it can help your health professional evaluate your need."

Access therapy

Talking therapies and cognitive behavioural therapy (CBT) can help you change problematic thought patterns, while helping you think through any problems.

Vohra says you can in many areas self-refer for CBT through your local mental health service - or consult a doctor or health professional to refer you.

"If you are experiencing anxiety during your perimenopause or menopause, first be reassured that you are not alone", she advises. "So many will feel like you and the more this is talked about and understood, the more likely it is you can work through this stage of life."

Keep a mood diary

Keeping a mood diary can also help you track your feelings and identify any triggers.

"Record how you are feeling in a journal or app - either as a word, a scale out of five, or any other way," says Vohra. "Track what your periods are doing - are you missing them? Are they heavier? This will help piece the jigsaw together."

Make time for self-care

Menopause is a tough time, so it's important to look after yourself and make time for things you enjoy or find relaxing. Exercise can boost feel-good endorphins, but if you aren't feeling up for strenuous activity, try a daily walk.

Vohra suggests: "Enjoy music, read, have a bath, talk to your partner, friends or family, and be open and honest. It's good to take the support of others."