Menopause and Anxiety: Is There a Connection?

As you get older, your body goes through many changes — including menopause. Menopause is a natural process in your 40s or 50s when your period slows down and stops. 

Menopause doesn’t usually happen all at once. For most people, there are three stages to the process:

• Perimenopause: This is when your hormone levels start going down, but you still have a period. It usually starts in your 40s and can last for several years.  

• Menopause: This is when your period slows down and then stops completely. After you go 12 months without having a period, you have completed menopause. 

• Postmenopause: These are the years after you’ve completed menopause. 

During all three stages it’s common to have menopause symptoms, like hot flashes, mood swings, and trouble sleeping. And guess what? Anxiety is a common symptom, too. 

Anxiety is when you feel worried, scared, or tense — even when you aren’t in any immediate danger. It can also cause physical symptoms, like muscle tension, appetite changes, and heart palpitations. And though anxiety is a common experience for many people, it’s twice as common in women versus men during the menopause years. 

Can changes during menopause cause anxiety?

Yes. Anxiety is very common in the years before, during, and after menopause. It may affect as many as 1 out of every 2 women. Though experts don’t know exactly why this happens, it may be linked to many of the different changes that happen during menopause. Let’s take a closer look.

Hormonal changes

Starting with perimenopause (the years before menopause), your body starts making less of two important hormones: progesterone and estrogen. These hormones are made by your ovaries and control your periods. As these hormone levels start to go down, it can affect your mood — and leave you feeling anxious, depressed, and irritable. 

Sleep problems

Sleep problems are common during perimenopause and menopause. Many people have trouble falling asleep, staying asleep, or both. Hot flashes and night sweats can also make it hard to rest. And when you’re not sleeping well, it can make you feel depressed and anxious the next day. This can create a vicious cycle, where you start to feel anxious about sleep (sleep anxiety). 

Life pressures

Menopause often comes at a busy time in life. Midlife is often a time of transition for relationships, health, and career.  Adding to the responsibilities, you may also be caring for aging parents and children at the same time. All of these challenges can cause anxiety, or make it worse. 

Normal aging

Menopause happens at a stage in life when the body goes through many normal age-related changes. You may notice differences in your weight, skin, hair, and genitals. Though menopause itself isn’t a health condition, going through this transition can provoke anxiety — especially in a culture that overvalues youth. 

Health problems

It’s possible for new health problems to pop up during midlife and beyond. And your existing health problems can change or get worse, too. Dealing with health problems can trigger anxiety. And some health conditions can directly cause anxiety symptoms, like a low thyroid level (hypothyroidism).  

Symptoms of anxiety during menopause

Anxiety is when you feel worried or tense. It can show up during menopause in many different ways:

• Worrying about the future

• Worrying about daily responsibilities

• Replaying events or conversations over in your mind

• Feeling tense or irritable

• Struggling to concentrate

• Having memory problems

• Crying

• Experiencing anxiety attacks or panic attacks

• Having trouble relaxing

Anxiety can also cause physical symptoms during menopause:

• Insomnia

• Muscle tension

• Fatigue

• Yawning

• Nausea

• Abdominal pain

• Appetite changes

• Diarrhea or constipation

• Jaw pain

• Dizziness

• Heart palpitations

• Tingling

Sometimes, these symptoms could be a sign that you have an anxiety disorder — especially if they’re causing a lot of problems in your daily life.  

Can menopause cause anxiety attacks?

Yes. An anxiety attack is a period of intense anxiety. It’s different from a panic attack, even though people sometimes use these terms interchangeably. 

An anxiety attack is when you have a high amount of anxiety that lasts for longer than a few minutes and doesn’t settle. They’re usually linked to a stressful trigger and come on gradually. During an anxiety attack, you might feel very anxious and experience physical symptoms, too. 

Treatment options for anxiety in menopause

If you’re having anxiety symptoms, hang in there. Treatment can help. Common treatment for menopause symptoms — including anxiety — include:

• Hormone replacement therapy

• Antidepressant medications

• Cognitive behavioral therapy

Lifestyle changes can also help: 

• Quality sleep

• Healthy foods

• Regular exercise

Let’s take a close look at each of these types of treatment. 

Hormone replacement therapy

Hormone replacement therapy (HRT) is treatment that replaces the estrogen and progesterone in your body. HRT can help with most symptoms of menopause, including hot flashes, mood swings, and anxiety. Though HRT has some risks, for most healthy people who start it before age 59 (or within 10 years of menopause), the benefits usually outweigh the risks.  

Keep in mind: HRT can actually cause nervousness in some people as a side effect. Side effects from HRT usually go away after the first couple of weeks.  

Antidepressant medications

Anxiety during menopause can also be treated with antidepressant medications, like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Antidepressants can help a lot with both depression and anxiety, though they can cause sexual problems as a side effect. 

Therapy

Talk therapy can help with anxiety during menopause, too. One of the best choices is cognitive behavioral therapy (CBT). CBT can help you understand your thoughts, feelings, and actions. It can help you learn how to manage anxiety symptoms in the moment. 

Lifestyle changes

Making changes to your daily habits can be good for anxiety — and for your overall mental and physical health. Here are a few things that you can try:

• Spend time outside. Time in nature can improve mood and reduce anxiety. In particular, being around “blue” and “green” spaces (like the ocean or forest) may help ease stress and promote relaxation. 

• Get regular exercise. Moving your body can help to decrease anxiety and improve sleep. Exercise has many other health benefits, too. 

• Get enough sleep. Most adults need 7 to 9 hours of good-quality sleep every night to feel their best. When you don’t get enough sleep at night, it can make you feel sleepy, depressed, and anxious the next day. 

• Eat a balanced diet. Eating nutritious foods may help keep anxiety under control. This means focusing on fruits and vegetables, healthy fats, protein, and other healthy foods. 

• Spend time with others. Spending time with friends and family can help with anxiety. Some people also benefit from joining a support group where they can share their menopause experiences with others. 

• Try mindfulness meditation. Mindfulness meditation is the practice of being in the moment. It often involves sitting still and focusing on your thoughts and feelings. There’s evidence that this type of meditation can be helpful for anxiety.

• Practice yoga. Yoga is a practice where you use your body, breath, and mind. It can help with menopause symptoms, including anxiety.  

• Use your breath. Breathing exercises can help lower your stress and anxiety in the moment. They have a calming effect on your body and brain, and can help you escape the fight-or-flight response.  

How long does anxiety caused by menopause last?

It’s hard to say. After all, menopause can take different amounts of time in different people. Menopause symptoms can last from months to years and can change over time.  

But keep in mind: Anxiety can show up at any time before, during, or after menopause. For some people, it might be worse during perimenopause. For others, postmenopause might be when anxiety starts to worsen. And of course, some people don’t have any anxiety at all during menopause. 

When to talk to a doctor

If you’re over the age of 40 and experiencing new or worsening anxiety, talk to your healthcare provider. Remember: Perimenopause usually starts in your 40s. This means that menopause-related anxiety can start as early as your 40s, too. 

It’s especially important to talk with your healthcare provider if your anxiety is getting in the way of your daily life. Keep in mind that good treatments are available to help you manage anxiety. 

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Our editorial standards

Meet our experts