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The Links Between Anxiety And Premenopause

Micah Abraham, BSc

Written by

Micah Abraham, BSc

Last updated October 10, 2020

The Links Between Anxiety And Premenopause

Premenopause is a stressful time in a woman's life. The hormonal shifts that take place in your body during pre- as well as peri- menopause (a more advanced stage of premenopause) cause your body to shift and change dramatically whether you're ready for it or not.

Unsurprisingly, both pre- and perimenopause can cause anxiety, and in some cases worsen pre-existing anxiety conditions. If you are a woman in your 40s who experiences anxiety on a regular basis, or even if you've just started to experience the symptoms, it may be difficult to discern regular symptoms of anxiety from those caused by premenopause, which means you may not even realize it is happening. Read on to find out if your anxiety may be premenopausal, and how to keep premenopausal anxiety under control.

Premenopausal Anxiety Symptoms

Women have been proven to feel higher levels of anxiety in general than men. A woman in her 40s may not even register that the anxiety she is feeling now and has probably often felt in her life is premenopause-related.

Premenopause symptoms are essentially regular anxiety symptoms. If you have ever felt intense anxiety or had anxiety attacks before, the following symptoms of premenopause anxiety may sound familiar:

  • Nervousness
  • Trouble sleeping
  • Heightened emotional sensitivity
  • Rapid heart rate
  • Shortness of breath/difficulty breathing
  • Sweating
  • Weight gain

However, if you have noticed the following symptoms in combination with the above, it may mean you are going through premenopause.

  • Irregular Menstrual Cycle Any significant change in your cycle, whether they stop happening regularly, happen more regularly, last for a shorter or longer time or are notably heavier or lighter than normal can be a sign of premenopause.
  • Hot Flashes This is often where the sweating comes in. If you find yourself experiencing mini attacks which seem like anxiety: a rapid heart rate, sweating and even the feeling that you are about to faint or pass out lasting anywhere from 2 minutes to a half an hour, or wake up to similar experiences during the night, it is a good indication you may be in a stage of premenopause. However, not all premenopausal women experience hot flashes, and many people with anxiety do, so this isn't the biggest indicator.
  • Vaginal Dryness or Inflammation Vaginal dryness can be quite uncomfortable: if you have it, you have probably noticed. The discomfort may be due in part to inflammation, which can result in bladder and/or urinary tract infections. If you have experienced unusual discomfort during sex or the inability to have sex, this is likely a symptom of premenopause. Being less or even unable to have sex is another cause of increased anxiety during this time. Once again, however, in some cases anxiety alone can lead to vaginal dryness, so it may not mean that your anxiety is related to premenopause.
  • Difficulty Losing Weight The weight gained (usually around the midsection) during this time in response to bodily stress is hard to keep off. Diet and exercise may seem less effective than usual. However, it is very important to eat right and exercise during this time, even if it seems like it's not working as well as it should, to keep your body happy and functioning smoothly (and to avoid causing it further stress).
  • Irregular Hair Growth Patterns A blood test will show increased levels of FSH (follicle-stimulating hormones) in the blood, but the physical signs of this symptom include a reduced rate of head-hair growth and an increased rate of facial hair growth. These tend to occur during pre-menopause.

Unfortunately, all of these symptoms - including irregular periods and in rare cases hair growth issues - can be caused by anxiety alone. So you will still need to talk to your doctor about these symptoms in order to know if you may be going through premenopause stages.

Why Premenopause Causes Anxiety

Premenopause can cause anxiety directly, through changes in hormones. But note that not all changes are going to be related to hormones. Some anxiety is going to be simply a reaction to your symptoms.

Limited sleep, difficulties having/the inability to have sex and unexpected bodily changes seemingly caused by nothing are stressful even for people whose hormones aren't suddenly fluctuating. The symptoms of premenopause themselves can increase your susceptibility to anxiety.

But premenopause can also directly cause anxiety as well, and it's important to understand your symptoms in order to correctly address and identify what they mean. The reality is that your body is doing exactly what it is supposed to do (as difficult as it is to experience). A good analogy is the menstrual cycle itself: your body knows what it's doing, even though it may feel strange and uncomfortable.

During premenopause, your body's hormones begin to shift. More specifically, they reduce: both the estrogen and progesterone in your system (what are known as the sex hormones) begin to be produced less and less. This is because your body realizes you are becoming less physically able to bear and raise children in a way that does not endanger your health. In order to protect you, it sends signals to your sex hormones saying okay, we should stop producing these now.

Estrogen usually decreases more than progesterone, which leads to what is known as a hormonal imbalance. Hormones are your body's messengers that tell the brain and body how to act and feel. This hormonal imbalance can confuse your system, telling it to make more to bring things back into the balance it is used to. When it can't, it sends worried signals like the anxiety symptoms listed above. Just like you, your body may need some time to adjust to the changes, which is why premenopausal anxiety occurs.

Can Anxiety Make Premenopause Worse?

Being anxious not only because of but on top of premenopausal symptoms can actually make the symptoms of menopause worse. Perhaps you have an anxiety disorder, or you are experiencing stressful external factors such as a change in a love, familial or friend relationship, or feelings of missing kids who have moved out (if you have them), or simply the anxiety that comes from having reached midlife that we all experience at some point.

These types of external stressors can mean that you are even less likely to reach REM sleep, can disrupt your menstrual cycle even further, and can cause more weight gain (particularly if you are prone to stress eating). If you want to prevent feeling additional anxiety on top of that which your body may already be causing you to feel, consider the following tips:

How to Minimize Premenopausal Anxiety Symptoms

While premenopause is a force of nature that you don't actually have much control over (in that you can't keep it from happening), there are some steps you can take to take control of and limit the unpleasant side effects you may experience.

  • Avoid Significant Caffeine Caffeinated beverages such as coffee and soda are hard on your body, and particularly hard on a body that is already stressed out. You want to avoid aggravating conditions such as rapid heart rate and edginess as much as you possibly can. Granted, some people are addicted to coffee, and withdrawal from addictions can be hard to cope with too. Low doses of healthy caffeine (such as through black coffee) may even be beneficial. However, trying decaffeinated coffee or tea as a substitute can help you with the transition and make your body feel better (and will also help you sleep better).
  • Make Smoothies Even if you don't like eating healthy, you probably do like smoothies: you can't really go wrong with fresh fruit flavors blended together in a cool, refreshing beverage, and they just so happen to be great for your health (especially if you add in superfood supplements like spirulina or flaxseed, which barely alter the flavor but make your body feel good). Making smoothies for yourself can be fun (there are so many recipes and combinations to try), and can help keep your weight down and your spirits up.
  • *Exercise Regularly *This is a tough one, but it's worth it. If part of your symptoms is a decreased frequency in your periods, take advantage of this and see what your body is capable of without the limitations of feeling cramped and uncomfortable once a month. You have even more time in the month to work in all the physical activities you want to do: whether it's swimming, hiking, biking or just walking around the block, it will release endorphins in your brain and make you feel happier and more relaxed. Ideally, you should exercise for at least 30 minutes 3 times a week.
  • Drink Warm Milk It's a cliché, but warm milk undergoes a chemical change that really can help you fall asleep. If you are experiencing trouble getting to sleep, drinking warm milk may help your brain to relax (especially if you combine it with listening to soothing music or soundtracks with calming nature sounds (all of which are available for free on YouTube). If you are lactose intolerant, be sure to take pills to counteract the lactose; using warmed soy or hemp milk unfortunately does not have the same sleepiness effect. There is some evidence that the warm milk theory may be an urban legend, but it is also a harmless and easy to implement strategy that is worth trying.
  • Appreciate Your Body This may seem like quite a challenge when your body seems to be going nuts on you, but really, your body is trying to do you good. It is removing all the stress and inconvenience associated with periods, keeping you from panicking about having more kids who will require your time and money, and telling you it is time to devote your time and energy to your own interests and goals. These are all valuable and special things that can change your life for the better. Hating your body will only increase your stress and make you feel trapped. Appreciating it for what it is trying to do will make you feel more aligned with yourself, and more in control of your life.

When your body causes you anxiety it means that it needs your attention. Whether you are simply feeling anxious, are feeling anxious because you are premenopausal, or are feeling anxious on top of your premenopausal symptoms, it's time to listen to your body and treat it right so that it will treat you right in return.

Questions? Comments?

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Where can I go to learn more about Jacobson’s relaxation technique and other similar methods?

– Anonymous patient


You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process.

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