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Around 15%-50% of women go through a myriad of psychological and emotional conditions during their menopause, and one of the most problematic is anxiety. Interestingly, people with hypothyroidism also have a twofold increased risk of developing anxiety disorders compared to those without the condition. Additionally, autoimmune thyroid disease is linked to 29.8% of all anxiety disorders. The physical and mental health issues caused by an underactive thyroid can also contribute to hormonal balances that make the menopausal transition even more difficult for some women.

In this article, we’ll explore the topic of menopause-related anxiety, how hypothyroidism comes into play, and how to treat the anxiety effectively.

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Women in their 40s and 50s can experience anxiety during perimenopause and after menopause, the point when it’s been one year since the last menstrual period. Menopausal-related anxiety can be unpleasant as it includes episodes of stress, confusion, fear, nervousness, and other uncomfortable symptoms, including: 

• Palpitations and chest pain
• Difficulty going to sleep, insomnia
• Sweating
• Muscle tension
• Dizziness
• Nausea and headaches
• Panic attacks
• Episodes of forgetfulness

Heightened anxiety during perimenopause and menopause is common. The onset of anxiety isn’t the same for every woman during the menopause transition. Some can experience it very early on in their 40s while still having menstrual periods. For others, it comes at a later stage. The intensity also differs from person to person and is influenced by various factors, including diet, physical health, mental state, and overall lifestyle.

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Ovaries – a woman’s key reproductive glands –  make the most estrogen during the reproductive years. When puberty begins, the ovaries release estrogen at the time of each menstrual cycle, peaking during the ovulatory phase. Estrogen levels start dropping during perimenopause and drop even further when a woman stops ovulating and menstruating, and menopause is concluded.

The declining estrogen levels also affect the production of other hormones, namely serotonin, which is responsible for boosting mood, and cortisol, the primary stress hormone. As the body makes less and less estrogen during the menopause transition period, the number of serotonin receptors in the brain reduces, and excess cortisol triggers more stress responses.

Progesterone – the hormone that supports menstruation, mood, and pregnancy – also decreases as ovaries stop regularly releasing eggs during perimenopause. As the amount of this ‘feel-good’ hormone lowers, mood and energy suffer, which can lead to anxiety. A low estrogen-to-progesterone ratio can also cause undesirable changes in mood as the brain chemistry gets altered.

Here are some other factors that can also spike anxiety during menopause.

Major physical changes

One of the symptoms of menopause is vaginal dryness. When estrogen levels aren’t sufficient enough to moisturize the vaginal lining, the vaginal walls can turn dry and thin, causing irritation and pain.  Loss of bone density is also more common and can increase joint pain, stiffness, and the risk of bone fractures and osteoporosis. In the US, osteoporosis affects about 53 million adults, and women are at higher risk. Fatigue, body aches, and skin allergies in perimenopause and menopause can also aggravate your mood and induce feelings of anxiety. Weight gain and bloating are also common symptoms that can give rise to self-image issues, generating anxiety around it.

Weaker immune system

The immune system also experiences a general age-related decline. Menopausal and postmenopausal women are particularly vulnerable to this reduced immunity. Estrogen deprivation that occurs during menopause affects other health conditions because various immune system indicators are dependent on this hormone to function normally. This shift in the immune system can cause the buildup of excess pro-inflammatory cytokines. These small proteins are responsible for controlling inflammation responses, and the resulting increase in inflammation can affect the chemical neurotransmitters that balance mood and anxiety levels.

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Various psychological symptoms

Hot flashes and night sweats can occur throughout the perimenopausal period and into menopause. A hot flash is a feeling of intense warmth in the upper body, followed by sweating, face reddening, a fast heart rate,  and sometimes, a chilling sensation afterward. When they occur at night, they are called night sweats and can disrupt your sleep. The sudden and intense experience of hot flashes or night sweats is unpredictable and can lead to feelings of anxiety. Other psychological complications such as anger, poor concentration, tiredness, and lack of interest can also be sources of stress.

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Before opting for hormonal therapies, it’s important to learn that sometimes thyroid conditions can also have similar symptoms to menopause and perimenopause.

Thyroid conditions can cause depression and anxiety. In some cases, optimal thyroid treatment can resolve these symptoms. However, during perimenopause and menopause, if these symptoms are not resolved with thyroid treatment, treatment for the imbalance in reproductive hormones may be recommended.

Menopausal women with thyroid conditions can try hormone replacement therapy, commonly known as HRT, to control menopause-induced anxiety if it’s disrupting even basic life activities and bodily functions. HRT can reduce menopausal anxiety by balancing estrogen and progesterone levels.

For women with hypothyroidism – an underactive thyroid –  it is crucial to choose a form of HRT that does not interfere with thyroid hormone replacement therapy. Estrogen-based HRT may have an impact on the effectiveness of thyroid hormone replacement medication, so it is essential to discuss the options with your healthcare provider. Progesterone-based HRT may be a better alternative for some women with hypothyroidism, as it is less likely to interfere with thyroid medication.

In some cases, a combination of estrogen and progesterone may be recommended for women with thyroid conditions, as this can help to provide a balance of hormones and reduce the risks associated with either type of HRT on its own. 

Vaginal estrogen therapy estrogen can also be looked into if the anxiety is specifically caused by vaginal dryness, pain, bleeding, and vaginal discomfort. It’s a topical, localized hormonal treatment that’s generally considered safe.

HRT medication options include:

• Estradiol pills, like Estrace and Estrofem
• Conjugated estrogen pills like Premarin
• Progestin pills like Prometrium and Provera
• Estradiol transdermal patches, like Climara, Vivelle-Dot, Estraderm, Alora, and Menostar
• Combination estrogen-progestin patches, like Combipatch
• Estrogen creams, like Premarin cream, Estrace cream, and Estrasorb
• Compounded prescription hormone creams, like Bi-Est and Tri-Est

Women with thyroid conditions need to work closely with their healthcare provider to monitor their hormone levels and adjust their HRT regimen as needed. Consider consulting with a Paloma Health doctor to help determine your safest and most effective treatment plan.

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Your doctor can prescribe one of the following antianxiety medications to treat anxiety:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are the first ones to get prescribed as they cause the fewest side effects. They work by increasing the serotonin intake in the brain. These drugs include Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), and Citalopram (Celexa).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): They are a class of antidepressants that also help with managing anxiety by increasing the serotonin and norepinephrine levels in the brain. These drugs include Venlafaxine (Effexor XR), Duloxetine (Cymbalta), and Desvenlafaxine (Pristiq).
• Tricyclic antidepressants (TCAs): While they’re used to manage major depressive disorders, they can also treat a wide variety of anxiety disorders. Amitriptyline (Elavil), Imipramine (Tofranil), and Nortriptyline (Pamelor).
• Beta-blockers: Though primarily used for hypertension, are sometimes prescribed off-label for anxiety, with examples including Propranolol (Inderal), Atenolol (Tenormin), and Metoprolol (Lopressor).
• Benzodiazepines: A class of medications widely employed in the short-term treatment of anxiety disorders, are valued for their swift onset of action and efficacy in alleviating anxiety symptoms. The roster of benzodiazepines includes Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin), Chlordiazepoxide (Librium), and Clorazepate (Tranxene). Caution is warranted in the usage of benzodiazepines, however, because long-term use carries the risk of tolerance, dependence, and withdrawal symptoms.
• Buspirone (Buspar): a medication with unique pharmacological properties used specifically for anxiety treatment.

Out of these, only the first two get prescribed the most, SSRIs being the first choice, as others can cause some side effects.

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Menopause can be a challenge, but it can be better managed with some dietary and lifestyle upgrades:

1. Journaling: Conscious stream of journaling where one writes unfiltered thoughts, feelings, and sensations, no matter how heavy they might seem, can help release stored anxiety from the body. Writing affirmations and even letters to oneself can be calming.
2. Connections: Whether in person or virtual, connecting with women going through the same changes and challenges can be valuable, as solidarity and support can be comforting. There are various online communities and in-person meet-ups that one can join/attend to form meaningful connections amidst this difficult time.
3. Exercise: Different types of physical activities work for different people. From jump rope to brisk walking to dancing to spinning class, any form of exercise can be beneficial as it has proven to elevate the positive neurotransmitters in the brain.
4. Food: Pick food/meals that can reduce anxiety, such as avocado, leafy greens, dark chocolate, berries, turmeric, nuts and seeds, legumes, whole grains, and asparagus. Green tea, coconut juice, hot chocolate, and smoothies can also help soothe anxiety.
5. Massages: Massages can be therapeutic, diverting, and very relaxing. While it may get associated with pampering oneself, it’s medically proven to lower the cortisol levels in the body while promoting serotonin at the same time. This can balance out anxiety-related emotions.
6. Sleep: Maintaining sleep hygiene is essential to foster a steady state of mind. Anxiety can interfere with sleep, and poor or insufficient sleep can magnify anxiety. Improving sleep health can improve mental health.
7. Meditation: Meditating and practicing mindfulness can alleviate stress and symptoms of anxiety. A variety of techniques, such as mind awareness, self-love, breath work, and body scans, can bring relief from both mental and physical anxiety.
8. Therapy: Cognitive behavioral therapy (CBT) and psychotherapy can assist in altering unhelpful mental habits. Anxiety and other menopausal issues that contribute to anxiety can be tackled with therapy/counseling sessions.

With managing stress levels, working out, proper intake of medications, avoiding environmental toxins, and eating healthy, it’s important to get thyroid blood tests done at least twice a year and consult with practitioners once a year.

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When you’re going through perimenopause and menopause, it’s crucial to check for signs of an underactive thyroid regularly, and if you’re diagnosed with hypothyroidism, to ensure that your treatment is monitored and optimized.

If you’re experiencing symptoms of menopause and/or hypothyroidism, the first course of action is to get a thorough thyroid evaluation. Undiagnosed thyroid conditions – and changes in thyroid function during treatment –  can be detected via testing thyroid stimulating hormone (TSH), Free T4, Free T3, and thyroid peroxidase (TPO) antibody levels. A convenient and easy way to get thyroid testing is by using Paloma’s Complete Thyroid Blood Test kit. It includes everything you need to successfully and painlessly test your thyroid at home and get the results back quickly and securely.

You can create a successful plan to manage symptoms of menopause and hyperthyroidism together, working with the right healthcare provider.  Reach out today to involve Paloma’s highly experienced doctors for your hormonal health care, including perimenopause, menopause, and hypothyroidism.

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