We explore why this time in a woman's life can be a trigger for anxiety. By Kirsten Braun.
Menopause - the last menstrual period – typically occurs between the late 40s and early 50s. "It's a transitional time in a woman's life, in the same way that puberty is," says Bronwyn Buckley, the health promotion officer at Women's Health Queensland Wide Inc. "Menopause has also been identified as a time when women can be vulnerable to developing emotional and mental health issues such as depression and anxiety." A 2012 study published in Climacteric found that women with psychological and social stressors and severe hot flushes were more at risk of developing anxiety during the menopause transition.
Stressors that may affect women at this time include:
When women are approaching menopause it is common for their menstrual cycle to change. Many women experience irregular periods that stop and start with no apparent pattern. Other women experience heavy bleeding at this time. All of these changes in a woman's periods can make her feel less confident about having adequate sanitary protection when it is required. Women in certain workplaces may find it difficult to make frequent toilet visits to change sanitary protection frequently.
Menopause is also a time when women can experience urinary incontinence issues. The drop in the level of oestrogen that occurs at this time can aggravate existing pelvic floor weakness resulting in stress incontinence - passing urine when coughing, sneezing, laughing or during physical exertion. Like irregular or heavy periods, urinary incontinence can also cause women to worry about the location and availability of toilets and what they will do if they have an 'accident'. "Women experiencing urinary incontinence can become very self-conscious and start to disengage from social events," explains Bronwyn. "The less we engage in social activities the more detrimental it is to our overall health and wellbeing."
The symptoms of hot flushes (flushed skin, sweating and heart palpitations) can be extremely troublesome for women. As many of these symptoms are highly visible it is often difficult for women to hide or disguise them. Consequently, women may find hot flushes very embarrassing, particularly if they occur in a work or social situation. It may be hard to explain what is occurring to younger female or male colleagues/guests. Women can start to feel anxious about their next hot flush and what they will do if it is during an important meeting, an appointment or intimate encounter. They may even start to avoid situations where they are more likely to experience a hot flush.
Night sweats (hot flushes that occur at night) can play havoc with a woman's sleep patterns. "Often women will be woken from their sleep by a night sweat and have to change their sheets and their night clothes," explains Bronwyn. "After being woken they may experience difficulty in getting back to sleep, which leads to sleep deprivation." Sleep deprivation can affect many aspects of a woman's health including her immune system, memory and importantly her ability to cope with other stressors.
Poor memory and concentration
Women at menopause often report that their memory and concentration suffers. They may forget things more easily or find it difficult to concentrate on the task at hand. Misplacing items like the house keys, mixing up appointment times, putting things away in the wrong place and forgetting common words are all incidents that women report. For working women experiencing poor memory and concentration can undermine their confidence in their ability to do their job professionally. They may feel they are disorganised or not working as effectively or efficiently as they could be.
As women are now older when they have their first child, many will have teenage children at the time they go through menopause. Teenagers are looking to express their individuality and find their independence at this stage in their life. This can bring with it many challenging behaviours such as experimenting with alcohol, drugs and/or sex, absences from home or school or a breakdown in normal communication. All of these behaviours can cause mothers a great deal of stress and anxiety.
In addition to having teenagers, many women experiencing menopause also have ageing parents or parents-in law who require care. "These women are often caught between generations, raising their own family and providing care to elderly parents," explains Bronwyn. For some women having to take on this caretaker role comes at a time when they thought they would have less responsibility. "Their children are older and they have a little bit of free time but suddenly this long awaited free time is taken away again with having to care for elderly parents," explains Bronwyn.
The global financial crisis has left some women less financially secure. Women who had planned an early retirement might now be faced with working for many more years. For other women separation or divorce might mean a poorer financial position, even having to rebuild their financial future.
How women can help themselves
It is quite common for women to use alcohol as a way of coping with the stressors of the menopausal transition. "While alcohol does help women de-stress, women need to explore healthier strategies besides having a glass of wine every night, "explains Bronwyn. Healthier strategies include:
Women suffering from fatigue as a result of disturbed sleep or experiencing brain fog, often look to caffeine as a stimulant. While a small amount of caffeine is okay and can help women feel alert, too much caffeine can in fact be detrimental. Caffeine is a stimulant and increases the amount of the hormone adrenalin in the body. As a result too much caffeine can cause anxiety-like symptoms such as heart palpitations and flushing of the skin. Therefore, limiting the amount of caffeine can improve anxiety symptoms. Caffeine is found in coffee, tea, chocolate, cola and some energy drinks.
Regular exercise is a great way for women to manage stress and anxiety. When we exercise our body releases endorphins, chemicals that make us feel happier and calmer. In addition, participating in regular exercise also helps women maintain a healthy weight and keeps their bones strong, both important factors for menopausal women. Taking up regular exercise can also be a way for women to get out and about again if they have not been participating in activities or events due to issues with anxiety. "Participating in a group sport can be particularly beneficial," explains Bronwyn. "It gives people a sense of belonging and they are more likely to commit to it longer term."
Managing underlying health conditions
If women are experiencing health problems such as hot flushes or night sweats, urinary incontinence or heavy bleeding they can see their GP. Managing night sweats, for example, can contribute to a better night's sleep which can help women cope with other menopausal symptoms. Similarly, not worrying about incontinence or bleeding issues can be a weight off a woman's mind.
There are many different forms of relaxation that women can participate in including yoga, meditation, tai chi, progressive muscle relaxation and visualisation. Practised regularly they can help reduce anxiety levels, lower blood pressure and improve concentration.
Keep the mind active
Women who feel their memory has declined can participate in activities that keep the brain active. "Doing crosswords, Sudoku, learning a new language, learning new skills all stimulate the brain," explains Bronwyn.
By recognising the stressors that can contribute to anxiety at this stage in a woman's life, women can hopefully experience a smoother menopausal transition.
Last Updated: December 2013
©Women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey 2013 Issue 4.