Anxiety is extremely common, especially during menopause, and it affects people in different ways. Some may worry about lots of different things to the point of distress. Others may have worries that focus on a particular issue, whether it is socializing, health, finances, or relationships. You may have struggled with anxiety on and off throughout your whole life, or it may just be rearing its head now. Hormone therapy (HT) might help. Read on to find out more.
What’s the link between anxiety and menopause?
Anxiety becomes more common during menopause. The exact numbers vary, but some studies have found that over half of women experience symptoms like nervousness, irritability, and tension at this time.
This is thought to be caused by a combination of:
- Life stress – including coming to terms with this new phase in life
- Fluctuating hormone levels and the physical symptoms that this causes such as hot flashes, poor sleep, or itchy skin
Hormonal changes
Scientists do not yet fully understand the link between hormonal changes and anxiety, but they do have some good theories.
Estrogen does far more than just regulate your periods. It works throughout the body including in the brain and affects the way neurotransmitters, such as the ‘happy’ hormone – serotonin – act. Neurotransmitters are chemical messengers that help your brain regulate mood, emotion, and behavior. It seems logical that a decrease in estrogen means these processes work less well, possibly leading to anxiety and the other mood changes commonly felt during menopause.
Physical symptoms
It is also normal to feel anxious about menopause symptoms themselves. Unpredictable hot flashes and irregular periods can understandably put you on edge and sleepless nights can really ramp up your anxiety levels.
Can HT help with anxiety?
HT can help with some menopause-related mood changes, including low mood. When it comes to how HT affects anxiety, we have less evidence that it helps. This means that your doctor might advise you to try a non-hormonal solution first if you don’t have any other menopause symptoms, as HT does come with some risks.
Your healthcare provider may suggest:
- Talking therapies, including cognitive behavioral therapy (CBT)
- Antidepressant medications
- Beta-blockers, for short-term use
- Exercise
- Improving your sleep routine
- Cutting down on alcohol, caffeine, and nicotine
You should still consider HT if you have other menopause symptoms, as it is the most effective treatment for many of them, such as hot flashes, night sweats, and disrupted sleep. HT could be especially helpful if your other symptoms are contributing to your anxiety.
Speak to your healthcare provider to find out if HT might work for you.
Can HT cause anxiety?
Mood symptoms including anxiety are potential side effects of HT, although they are likely to calm down once your body adjusts to the hormones. They can be caused by either estrogen or progesterone HT.
You are likely to notice these side effects most when you first start HT or increase your dose. Side effects generally wear off and often disappear altogether after about three months. Your healthcare provider will usually arrange a follow-up appointment at this point, so let them know if anxiety is still causing you problems.
Sometimes simply waiting it out is the best option. Initial side effects of HT tend to wear off within the first three months of use for most people.
Which is the best HT for anxiety?
There are many different kinds of HT including pills, patches, sprays, gels, and vaginal preparations. None of them is currently thought to be better or worse for treating menopause anxiety.
Your healthcare provider will recommend the safest option for you. For most people, this is transdermal estrogen, which means the hormone is absorbed through the skin in the form of a patch, gel, or spray. If you still have a uterus you will also need to take progesterone as a pill, patch, or hormonal IUD.
Read our guide to different types of HT.
When to see your healthcare provider
Anxiety can be extremely distressing and difficult to handle. If you are struggling with anxiety, get help – there are lots of options available and most people can find a treatment option to suit them.
When to get urgent help
You should seek urgent help if you are struggling to cope. If you feel that you might harm yourself or you can’t keep yourself or others safe, call 911 or go to the ER for emergency help.
While panic attacks are common if you have anxiety, don’t assume mental health is to blame for any physical symptoms. Seek urgent medical advice if you have:
- Chest pain
- Breathing problems
- An irregular or fast heartbeat
- Fainting or feeling faint
- Unexplained dizziness
- Pins and needles, numbness, or losing control of any part of your body
- Any other serious or worrying new symptoms
Talk to your healthcare provider if you have been previously diagnosed with panic attacks and your symptoms change, last longer, or come on unexpectedly. It may mean something else could be happening.
Final word
HT isn’t a miracle cure for anxiety during menopause, though it can help in some cases.
Whether you use HT or not, the best approach to anxiety is to consider your wider health alongside your lifestyle choices. Speak to your healthcare provider for advice on medicines, talking therapies, and lifestyle change.
Find out more about menopause on our blog or in our symptoms library.
- Alblooshi S, Taylor M, Gill N 2023, ‘Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review’, Australasian Psychiatry, vol. 31, no. 2, pp. 165–173
- Bromberger JT, Kravitz HM, Chang Y, Randolph JF, Avis NE, Gold EB, & Matthews KA 2013, ‘Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation’, Menopause, vol. 20, no. 5, pp. 488–495
- Herson M, Kulkarni J 2022, ‘Hormonal agents for the treatment of depression associated with the menopause’, Drugs & Aging, vol. 39, no. 8, pp. 607–618
- Sharma A, Davies R, Kapoor A, Islam H, Webber L, Jayasena CN 2022, The effect of hormone replacement therapy on cognition and mood’, Clinical Endocrinology, vol. 98, no. 3, pp. 285–295
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