When I’m road cycling, I’ll find myself randomly braking on a long fast descent where I used to just bomb down it with gleeful excitement. During my commute home, the reckless driving I see others do will cause me to freak out and before I know it my heart rate is racing, my breath is short, and I feel like I’m about to have an anxiety attack.
If you’re like me, you may have started to notice more often a swift increase in heart rate, maybe some shortness of breath and that feeling of impending doom with just the slightest fear, or maybe it just came out of nowhere. Your mind starts circling about who knows what, but instead of calmly letting it go, you feel that anxious sensation you didn’t used to feel. You brush it off to a busy stressful life. But wait, did you know that is a symptom of changing hormone levels associated with peri and post-menopause?
“Women will say they just thought they couldn’t cope, or they were getting stressed, or they just started dropping balls. They don’t realize it’s menopause. They blame themselves and think it’s their fault. It’s not your fault,” according to Dr. Clare Spencer, Clinical Director of My Menopause Centre. Listen to her interview with Selene Yeager on the podcast Hit Play Not Pause.
First thing women need to understand about hormonal fluctuations, as happens in perimenopause, then the near absence of hormones in postmenopause, all manner of symptoms can crop up. Dr. Spencer explains how estrogen has a very important role in our brain chemistry as it helps coordinate the neurotransmitters like serotonin, dopamine, GABA, and others that affect our mood. Before perimenopause, our ovaries produce estrogen each month, through a rising and falling system in combination with progesterone. However when our transition begins, aka perimenopause, estrogen fluctuates quite erratically between its highs and lows and can have a more pronounced high and more pronounced low. These changes can cause anxiety to hit you when you least expect it.
In addition to the estrogen dropping, cortisol, which is released at times of stress, can rise, and that keeps your body in a bit of a heightened state of excitement or anticipation. Research shows about half of women suffer from “unspecific anxiety” (meaning you don’t have a specific reason to be freaking out inside) during the menopause transition.
Can You Find Your Inner Calm Again?
First you have to understand that treating your anxiety isn’t going to look exactly like anyone else's treatment. Remember, if one treatment doesn’t work after enough time, try something else. You’ll notice there are many people talking about mindfulness, adaptogens and lifting heavy. These are all important and a great place to start, you don’t need a doctor's prescription for any of this and they all have a low cost of entry.
However, some of us may need a little more help to get through it. This is where Hormone Therapy (HT) comes in handy. First thing you need to know is your general practitioner, nor your OB-Gyn is knowledgeable in peri and postmenopausal symptom treatment. They received no more than a day's worth of training on it during their years in school. This is to say, you need to find a SPECIALIST, someone who has gone the extra step to learn about the physiological difference and requirements of women in the peri and post menopause stages of life.
Admittedly, the research is a bit mixed (due to lack of studies, poor studies, not enough money being set aside for this research, etc…) on what used to be called Hormone Replacement Therapy (HRT), now referred to as Hormone Therapy (HT). This is because we cannot replace the hormones lost. Instead we are trying to keep things at an even level, avoiding the massive peaks and valleys that can cause the nasty symptoms we all deal with to different degrees.
The hormones we are talking about are Estrogen, Progesterone and even Testosterone. I’m not going to get into what you would need, or even the best way to take it, oral, gel on skin, internal. That is up to you and your specialist. If you don’t have a specialist, I would highly recommend checking out Midi Health. I recently started going through them for my perimenopause symptom issues and in my fist 30 minute visit I got more out of it than years of talking with my GP.
Something to note is that testing your hormone levels isn’t useful either. The hormones in our bodies are literally fluctuating daily and hourly. What IS important is that you track your symptoms with as much detail as possible (time of day, length of symptom, food that may be associated with the spike, etc.). All these details will help your specialist create the right plan for you.
Mindfulness and Therapy Can Help
You may have heard of Cognitive Behavioral Therapy (CBT). It seems to be the go-to now for anxiety issues. Mindfulness can significantly lower stress, not just in the moment, but also can have long-term stress benefits when practiced daily. It can take some time, ranging from 6 to 9 months before you really notice a significant difference.
What About SSRIs?
Selective serotonin reuptake inhibitors (SSRIs) and/or serotonin and norepinephrine reuptake inhibitors (SNRIs) have been shown to help manage anxiety. SSRIs and SNRIs can also provide mild to moderate relief from night sweats and hot flashes. Knowing whether to utilize HT or SSRI is based on your symptoms. If your symptoms are more physiological in nature, hot flashes etc then HT would be the route. If your symptoms are of clinical anxiety and or depression then SSRI would be the way to go. Then there are the few of us who may need both.
Adaptogens?
Alternative therapy such as adaptogens like ashwagandha can help increase your durability, or put another way, your resilience to stress. When it comes to these types of herbal therapies, the research isn’t as solid as with western medicine studies. Though there is still some good evidence out there on this.
Though there is not the same level of hard research on herbal therapies as there is on pharmaceutical therapies, they are not without scientific evidence, and a February 2023 review on ashwagandha reports that studies suggest the adaptogen may help in the treatment of sleep disorders, improve stress resilience, and reduce anxiety. A side note from it, evidence also suggests it can be helpful for hypothyroidism, so you shouldn’t take it if you’re on thyroid medication.
As with any alternative therapies, it’s important to do your research to know what you’re getting. These industries are poorly regulated and you aren’t given the full details of what you are actually getting. Resources I use to find out whether a product is living up to its promises, are Labdoor.com and ConsumerLab.com. These resources are reputable, and do independently tested supplement brands.
Lifting Weights for Stress Relief
I know from first hand experience that when I do my strength training consistently and with good focus I feel a big difference in my mental and emotional happiness. Good news there is science here, to back this up as well.
Scientific Reports found that regular weight training substantially reduces anxiety. The study involved younger adults (of both genders) who were in good mental health, no specific anxiety disorders, and had positive results. The participants who lifted twice a week for eight weeks scored about 20 percent better on tests of anxiety than their peers who didn’t follow the weight training plan. While this study does focus on younger adults, I’m hopeful this will spur more age-specific studies.
Wrap Up
The best advice I can give, you shouldn’t be suffering. Try something, seek help, try multiple things. Don’t give up. There is something out there for everyone. Just remember what works for your friends might not work for you. Keep trying until you and your specialist have found what works for you.
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