This post was originally published on 29/09/2019 and updated on 26/03/2020.
This week I am focusing on anxiety during the menopause and the years leading up to it (the perimenopause).
You’ve always been a little bit anxious but now it’s worse than ever, especially with everything going on in the world currently. Even making simple choices can become a challenge. And then there’s that weird bodily sensation that comes on just before a hot flush - sometimes it’s so extreme it ends up in a full-blown panic attack. What on earth is going on? You may start to think you are going mad.
Rest assured you’re not. It’s simply those hormones starting to fluctuate as menopause takes hold. As you enter the perimenopause, levels of the stress hormone cortisol start to rise while those of the sex hormones oestrogen and progesterone start to decline and fluctuate, with progesterone declining faster than oestrogen, creating an imbalance between the ratio of the two. And with lower levels of progesterone, sometimes known as ‘the calming hormone’, it follows that that you may feel more overwhelmed, stressed, anxious, edgy and suffer from more low moods than you did before.
Add to this the fact that for many of us at mid-life, nutrient levels are at an all time low after bearing children, breastfeeding, navigating stressful life events, stints on weight loss diets and generally living life in the fast lane and it becomes easier to understand what’s triggering your anxiety.
But it’s not all downhill from here. Understanding and learning to meet the needs of your body at this time of life through good nutrition and self-help techniques can make all the difference between an angst- ridden ride and a plain sail through the menopause. Here are some things you can do to increase your chances of a smoother journey.
Tweak your diet: Eating a wholesome diet should be top of your list. Avoid fatty, sugary and processed foods and include those in your diet that are rich in omega-3 fatty acids and B vitamins, as well as plenty of fruit and vegetables. Cut back on coffee and tea as well as fizzy drinks. These often contain caffeine that can heighten the physical effects of anxiety such as headaches and stomach problems. And tempting though it may be don’t drown your sorrows- alcohol is a depressant and can disrupt sleep, exacerbate menopause symptoms and block the uptake of important nutrients that are already in short supply. Finally, eating little and often will ensure a constant supply of good nutrients reaching your brain and nervous system.
Get up and get going: Exercise is a great stress and anxiety buster. Clearly, this is going to be difficult at the moment. However, there are still virtual classes you can join and do try and get outside for some fresh air once a day if appropriate. Once life returns to normal, find some exercise you enjoy: go for a run, dance to your favourite music, try yoga, go hiking, enrol in a class at your gym, swim a few lengths in the pool. It doesn’t matter what you do as long as you choose something you enjoy to boost those endorphins, the body’s own feel-good hormones.
Laugh: Bring some joy into your life with a good laugh. Watch a funny movie, do something fun and playful or ring a funny friend and share a joke. Alternatively, try some laughter yoga - a type of exercise that uses laughter to release stress. You’ll discover how to learn to laugh for no reason until it becomes real!
Make time for yourself: You may have prioritised others for so long that you have forgotten how to look after yourself. Now it’s your turn to do something specifically for you that makes you feel good inside. Again, options are limited at the moment but some of you may find you do have some extra time right now. Importantly, plan for the future to go out to lunch with friends, book a pampering session at your local spa, visit a beautiful garden or make a date with a favourite family member.
Talk about it: Don’t bottle up feelings. Share them with your family and friends. Once they know what is going on they could be more understanding than you think. You may find they have been through something similar or know someone who has and can suggest some useful coping strategies. You can arrange virtual ‘catch-ups’ with friends and families to offer mutual support.
Write it down: Anxious thoughts come and go in a flash and it can be difficult to work out what’s behind them. Keeping an anxiety diary can help you better understand what’s triggering them. Rank your anxiety on a 1-to-10 scale. Jot down any feeling or thought you had just before you got anxious. Keep track of things that make you more anxious or less anxious.
Keep mentally busy: Treat your brain like a muscle - keep it occupied by completing word searches, Sudoku games, doing the crossword or even playing a brain-game on your phone. Knitting is also great for the brain as it involves hand and eye coordination.
Relax, relax: Physical relaxation allows your mind to rest and let go of what’s troubling you and significantly reduces hot flushes. Pick a quiet time of day and go to a place where you won’t be disturbed, if you can. Sit or lie down and consciously work your way up from your toes to your head, first tensing then relaxing each group of muscles. The Pzizz App, designed by a group of neuroscientists, takes us into a deep relaxed state and brings us out again, feeling recharged. It’s worth trying the free version to see if it works for you.
Stay positive: Try to replace ‘negative anxious self talk’ with ‘coping self talk’. When you catch yourself thinking something negative like "I can't do this, it's just too stressful," try to change it to something more positive, like "This is making me feel anxious but I can get through it." I love the affirmations at the end of the book All is Well by Louise Hay and Dr Mona Lisa Shultz. Find the ones that feel right for you and use them regularly when you feel anxious.
Sleep well: Aim for at least eight hours a night. Lack of sleep can quickly magnify a problem out of all proportion. Establish a good sleep routine. Going to bed and getting up at the same time each day, winding down before turning in and keeping all electronic devices out of the bedroom are good starting points. If your sleep is disrupted by night sweats get some tips on coping with insomnia.
Supplement it: Low levels of nutrients, as well as hormones like oestrogen, often can’t be replaced with diet alone. I recommend standardised research-based supplements that have been shown to help overcome symptoms. There is a wide choice available, depending on your symptoms. You can find my top supplements in my web shop.
 Jennifer L Gordon et al. Naturally occurring changes in Estradiol concentrations in the menopause transition predict morning cortisol and negative mood in perimenopausal depression. Clin Psychol Sci, 4(5), 919-935 Sep 2016
Take a deep breath
Try this quick and simple exercise if you start to feel tense and anxious. Keep your breathing smooth and regular throughout.
- Sit or lie in a comfortable position with your arms and legs uncrossed and your spine straight.
- Breathing from your abdomen, inhale through your nose, slowly to a count of five.
- Pause and hold your breath for a count of five.
- Exhale through your mouth or nose to a count of five
- When you have exhaled completely take two breaths in your normal rhythm then repeat steps two to four.
- Repeat exercise for at least three to five minutes
For further help and understanding check out my short film Anxiety at Midlife.
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