HRT for Anxiety in Menopause

Anxiety and low mood are common, and sometimes debilitating, symptoms that can arise during perimenopause and in the early postmenopausal years (when periods have finally stopped).

These symptoms may be more likely to occur in people who have a history of premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), attention-deficit/hyperactivity disorder (ADHD) and/or perinatal anxiety/depression. However, anxiety can also worsen in people with a pre-existing anxiety disorder such as generalised anxiety disorder (GAD) or obsessive compulsive disorder (OCD) and in those who have suffered from low-level symptoms in the past. Sometimes, these symptoms can seemingly develop out of the blue.

Panic attacks may become more common – sometimes in response to tasks that may have been considered straightforward in the past, such as driving. Anxiety can trigger – or be triggered by – other perimenopausal symptoms such as insomnia, hot flushes, palpitations and low mood. This can be very alarming for people, but there are lots of options that can help.

Can menopause cause anxiety?

Anxiety in perimenopause and menopause is a common mental health symptom. Between 15% and 50% of perimenopausal and postmenopausal women experience psychological and emotional symptoms including anxiety, depression, stress, forgetfulness, low mood, loss of confidence and insomnia.

There are several reasons why menopause can cause anxiety:

Hormonal changes

During menopause, oestrogen and progesterone levels fluctuate. While this causes irregularities to your menstrual cycle, it can also impact other mechanisms in your body.

Oestrogen plays a significant role in regulating your mood. The amygdala, located in your brain, plays a pivotal role in regulating your emotions and is sensitive to oestrogen levels. When oestrogen levels drop during perimenopause, this can elevate anxiety.

Physical symptoms

Many women experience physical menopause symptoms including hot flushes, night sweats and aches and pains. These can disrupt your day-to-day life which can increase stress and lead to anxiety about carrying out your usual activities.

Hot flushes, for instance, can cause your heart rate to increase and your adrenaline to surge, triggering your body’s ‘fight or flight’ response. In addition, anticipating the occurrence of hot flushes can leave you feeling anxious that they will happen at troublesome moments, such as at work or when socialising.

Sleep disturbances

Sleep problems during menopause are incredibly common due to such symptoms as hot flushes and night sweats, restless leg syndrome and a more frequent need to urinate.

Sleep quality and mood are closely related, with a lack of sleep or disturbed sleep leading to a variety of mental health difficulties including depression and anxiety.

Psychosocial factors

Menopause is a life stage that marks the end of a woman’s reproductive years. This in itself can cause anxiety about ageing, social perception and stigma and shifting life roles.

Life stressors

Although menopause can cause anxiety, it is also possible that other stressors in your life occurring at the same time as menopause are impacting your mental well-being.

Menopause usually occurs between the ages of 45 and 55 and at this age, many women are working full-time, raising children and caring for ageing parents simultaneously. Understandably, this can put a strain on your mental health, leading to low mood, stress, anxiety and sometimes even panic attacks.

Menopause anxiety symptoms

Symptoms of menopause anxiety can be physical and/or mental and can range in severity between individuals. Menopause anxiety symptoms include:

Feeling nervous, irritable or ‘on edge’
Restlessness
Chronic worrying or overthinking
Difficulty concentrating
Brain fog
Muscle tension
Sweating
Trouble falling or staying asleep
A churning stomach
Pins and needles
Lightheadedness or dizziness
Faster breathing
Feeling sick
Needing the toilet more frequently
Teeth grinding, especially at night
Increased heartbeat or a thumping heart
Feeling disconnected from the world around you

Panic attacks are also a symptom of anxiety which can be very frightening. They are sudden episodes of intense fear that trigger physical reactions even when there is no immediate threat or danger. Symptoms of a panic attack include:

Heart palpitations or a racing heartbeat
Shortness of breath or rapid breathing
Chest or abdominal pain
Feeling faint
Feeling very hot or cold
Sweating
Trembling or shaking
Feeling like you’re losing control
Tingling in your fingers or lips
Nausea
A jelly-like feeling in your legs

Menopause anxiety is different for everyone. For some people it may last a short time, perhaps just a few months, while for others, it can last much longer and persist until other menopause symptoms settle. There’s no fixed timeline and how long menopause anxiety will last depends on numerous factors including:

Hormonal changes

Fluctuations of oestrogen contribute to menopause anxiety but hormone levels and how they decline will vary from one person to another.

The stage of menopause

Although menopause is often spoken about as one period, it has distinct stages: perimenopause, menopause and postmenopause. Anxiety can be more prevalent during perimenopause as hormones fluctuate but can continue into menopause and postmenopause for some women.

Mental health history

If you have previously experienced mental health issues such as postnatal depression, or acute stress disorder, you may be more susceptible to anxiety during menopause. A family history of mental health issues can also mean you have a predisposition for menopause-related anxiety.

Social network

Friends, family, colleagues and other forms of support such as mental health groups can significantly contribute to your emotional well-being, potentially reducing the severity of anxiety symptoms or the length of time you experience them.

Lifestyle factors

Your overall physical health and lifestyle can impact menopausal anxiety symptoms and their duration. Maintaining a healthy diet, regular physical activity and lowering stress can reduce how long anxiety lasts.

HRT and anxiety

As the hormone fluctuations that occur during menopause can have such a significant impact on mood regulation, hormone replacement therapy (HRT) may help alleviate the symptoms of anxiety as it stabilises oestrogen (and sometimes progesterone) levels.

Does HRT help with anxiety?

HRT is a treatment option for managing the symptoms of menopause, although it isn’t typically prescribed specifically for reducing anxiety. However, HRT can improve anxiety symptoms because it helps balance hormones that play a part in mood regulation.

Oestrogen has a significant impact on serotonin, a neurotransmitter known as the ‘feel-good’ chemical in the brain. Lower oestrogen levels result in lower serotonin, which can make you feel anxious, irritable, or depressed. By supplementing oestrogen through HRT, levels of these mood-related neurotransmitters often become more stable, helping to reduce feelings of anxiety.

Progesterone also plays a role in mood by having a calming effect on the brain, promoting relaxation and even aiding in sleep. Some HRT regimens include progesterone, which can help women feel more at ease and support anxiety relief.

Further, menopausal symptoms like hot flushes and night sweats often disrupt sleep, leading to fatigue and heightened anxiety. By reducing these symptoms, HRT can improve your sleep quality, which in turn can improve your mood and emotional well-being.

The best HRT for anxiety

Although all women who have periods will go through menopause, it is a distinctly unique experience for every individual. So, when it comes to menopause and anxiety treatment, what works for one person may not be as effective for another.

Combined HRT with oestrogen and progesterone can help with anxiety during menopause as oestrogen can reduce the body’s fear response and progesterone can help with sleep and anxiety because its breakdown products bind to gamma-aminobutyric acid (GABA) receptors. GABA is known to produce a calming effect and is thought to play a role in controlling anxiety, stress, and fear.

Limited studies have been conducted on how different forms of HRT impact anxiety symptoms. One clinical trial included two groups of menopausal women. One group received 17 beta-estradiol and the other group was prescribed tibolone. The results indicated that HRT with 17beta-estradiol and tibolone improves menopausal anxiety and depression.

There are also different types of HRT, such as tablets, patches, gels and creams. Oestrogen tablets deliver the same hormone as oestrogen patches and therefore, can help alleviate anxiety much in the same way. However, if you are dealing with symptoms such as constant worrying, brain fog and forgetfulness, the patches, which need to be applied once or twice a week, may be preferable over tablets, which may need to be taken daily.

Can HRT cause anxiety?

The risks of HRT are largely outweighed by the benefits but like most medications, there are some side effects. Both oestrogen and progesterone have mood changes, including low mood, nervousness and depression, as a listed side effect.

Some observational studies have found that the use of hormone therapy was associated with worse depression and anxiety in the following month, yet numerous other studies contradict these findings. It is likely to depend upon the type of HRT you are using i.e. which progestogen and which oestrogen.

Ultimately, the decision to begin HRT should be made after a discussion with a doctor about your symptoms, medical history and potential medication side effects.

Medication for anxiety

If your anxiety is persistent and is affecting your everyday routine, then it might be time to talk to your doctor about medications.

A type of antidepressant, typically a selective serotonin reuptake inhibitor (SSRI), is used to treat anxiety. Types of SSRIs include:

Citalopram (Celexa)
Escitalopram (Lexapro or Cipralex)
Fluoxetine (Prozac or Oxactin)
Paroxetine (Paxil or Seroxat)
Sertraline (Zoloft or Lustral)

These antidepressants and HRT can be safely taken at the same time and many women find them a highly effective combination for treating anxiety and other menopause symptoms.

Betablockers such as Propranolol can also be taken to help specific physical symptoms of anxiety.

Natural remedies for menopause anxiety

If you don’t want to or can’t take HRT or antidepressants, then you may wish to explore alternative treatments for menopause anxiety. There are a variety of lifestyle changes you can make and non-medication options that you can try.

Dietary changes

Adopting a balanced menopause diet with phytoestrogens (found in soy and flaxseeds), omega-3 fatty acids (in salmon and walnuts), and complex carbohydrates can stabilise blood sugar and mood, supporting anxiety relief.

Reducing caffeine and sugar intake may also prevent spikes in anxiety.

Protein contains essential amino acids, which your brain needs to produce neurotransmitters, so a protein rich diet may help regulate your emotions.

Incorporating antioxidant-rich foods, like leafy greens and berries, helps fight oxidative stress, which can impact mood.

Physical activity

Regular physical activity that you enjoy boosts endorphins and serotonin, improving mood and reducing anxiety. Low-impact exercises like walking, resistance training or even cold water swimming during menopause can relieve tension and promote better sleep. Aim for at least 30 minutes, five days a week to ensure the mental health benefits of exercise are consistent.

Supplements

Certain supplements, like magnesium, vitamin D, and B vitamins, support stress resilience and mood regulation, easing anxiety. Herbal remedies for menopause anxiety like ashwagandha, black cohosh and valerian may also offer calming effects.

Ensuring good sleep hygiene

Maintaining good sleep hygiene by creating a regular sleep routine, limiting screen time, and creating a cool, dark and quiet sleep environment can improve sleep quality and reduce anxiety. It also helps to:

Ensure you get outside during daylight hours for at least 30 minutes
Exercise regularly
Avoid caffeine, alcohol, and large meals for several hours before bedtime
Undertake relaxing activities, such as reading, listening to music, meditation or having a hot bath, before bed

Mindfulness

Mindfulness practices, such as observing thoughts without judgement, deep breathing exercises and menopause yoga, help regulate anxiety by fostering a calm, present-focused awareness.

Setting aside just 5-10 minutes for daily mindfulness can reduce stress response and improve mental clarity during menopause.

Psychological therapies

Cognitive behavioural therapy (CBT) for menopause anxiety and acceptance and commitment therapy (ACT) can be very beneficial. These forms of talking therapies provide strategies to manage anxious thoughts and build emotional resilience.

CBT in particular helps identify and modify anxiety-provoking thought patterns, empowering you to feel more in control during menopause and can also help with managing physical symptoms, such as hot flushes, which can fuel anxiety.

There is also evidence that medical hypnotherapy can reduce menopausal symptoms, including anxiety and low mood.

If you’re navigating menopause and its symptoms, including anxiety, it can help to seek support from someone who understands what you are going through. At Menopause Care, we have a team of menopause doctors and other specialists who are experienced in helping women make empowered treatment choices that can help improve their physical and mental well-being. To take control of your menopause anxiety, book a consultation with a menopause doctor.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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