Menopause and Anxiety: How You Can Cope

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

Menopause is a gradual process that is broken up into three stages. First is perimenopause, when your hormone levels start to drop and your menstrual cycles become irregular. This usually starts in your 40s and can last for several years. You officially reach menopause, the second stage, once you’ve gone 12 consecutive months without a period. The last stage is postmenopause, which refers to the years after menopause.

During all three stages, it’s common to have symptoms like hot flashes, mood swings, and trouble sleeping. Anxiety is also a common symptom. 

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, or heart palpitations. Although anxiety is common for many people, it’s twice as common in women as in men during the menopause years. 

What causes anxiety during menopause?

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

Hormonal changes

Starting in 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 help control your periods. As their levels drop, it can affect your mood — and leave you feeling anxious, depressed, or 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 being able to sleep — sometimes called 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. You may also be caring for aging parents while supporting 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 your body goes through many normal age-related changes. You may notice differences in your weight, skin, hair, and genitals. Even though menopause isn’t a health condition, this transition can cause anxiety — especially in a culture that overvalues youth. 

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Health problems

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

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 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, such as:

• Insomnia

• Muscle tension

• Fatigue

• Yawning

• Nausea

• Abdominal pain

• Appetite changes

• Diarrhea or constipation

• Jaw pain

• Dizziness

• Heart palpitations

• Tingling sensations

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

How long does anxiety caused by menopause last?

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

Keep in mind that anxiety can show up at any time — before, during, or after menopause. For some people, it’s worse during perimenopause. For others, postmenopause is when anxiety starts to worsen. And some people don’t have any anxiety at all during menopause. 

Treatment options for anxiety in menopause

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

• Hormone therapy (HT)

• Antidepressant medications

• Cognitive behavioral therapy (CBT)

Lifestyle changes can also help, which we cover in the next section. But first, let’s take a close look at each of these types of treatment. 

Hormone therapy

Hormone therapy (HT) — which used to be called hormone replacement therapy — is medication that increases the amount of estrogen and progesterone in your body. It can help with most symptoms of menopause, including hot flashes, mood swings, and anxiety. 

Hormone therapy comes with some risks. But for most healthy people who start it before age 59 (or within 10 years of menopause), the benefits usually outweigh the risks.

It typically takes several weeks to months for hormone therapy to improve menopausal anxiety. And keep in mind that hormone therapy can actually cause nervousness in some people as a side effect. These side effects usually go away after the first couple of weeks. 

Antidepressant medications

Antidepressants can also help treat anxiety during menopause. Common types include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). 

Antidepressants for menopause are also prescribed to help with hot flashes. So, it’s possible that they could help with both symptoms.

Brisdelle (paroxetine) is the only antidepressant that’s FDA-approved for treating hot flashes specifically. Other antidepressants commonly prescribed during menopause include:

• Effexor (venlafaxine)

• Pristiq (desvenlafaxine)

• Lexapro (escitalopram)

Antidepressants can help a lot with both depression and anxiety, though they can cause sexual problems as a side effect. 

Therapy

Talk therapy can also help with anxiety during menopause. 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 and natural remedies for menopausal anxiety

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, spending time in “blue” and “green” spaces (like the ocean or forest) may help ease stress and promote relaxation. 

• Get regular exercise. Moving your body can help decrease anxiety and improve sleep. Exercise also has many other health benefits for your heart, muscles, and brain. 

• Get enough sleep. Most adults need 7 to 9 hours of good-quality sleep each 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. A consistent bedtime routine is a good place to start to improve your sleep during menopause. 

• Eat a balanced diet. Eating nutritious foods may help keep anxiety under control. Focus on fruits, vegetables, healthy fats, protein, and other healthy foods. Foods with protein and complex carbs are especially helpful during menopause. 

• 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 and other mind-body practices can be helpful for menopausal 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.

When to talk to a doctor about anxiety during menopause

If you’re over the age of 40 and experiencing new or worsening anxiety, talk to a healthcare professional. Remember, perimenopause usually starts in your 40s. This means that menopause-related anxiety can start around that time, too. 

It’s especially important to talk with a healthcare professional 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. 

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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:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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