Is anxiety connected to menopause? Here’s what you should know.

Have you ever felt restless, your heart racing for no reason, or a tightness in your body that just won’t go away? Maybe you’ve been constantly worrying, feeling irritable, or unable to focus. It’s easy to chalk it up to everyday stress or a busy life. But what if these symptoms are something more?

If this sounds familiar, you’re not alone. Anxiety is incredibly common, especially for women. In fact, about 30% of women will experience an anxiety disorder in their lifetime, compared to just 19% of men (Archives of General Psychiatry, 1994) (1).

Despite its prevalence, anxiety often takes a backseat to discussions about depression in women’s mental health, leaving many women unaware of how common it is—especially during the transition to menopause.

Anxiety during menopause can creep in unexpectedly, showing up in your body and mind in ways you might not recognize. It’s about more than just “feeling worried”—it’s deeply connected to the hormonal changes of midlife.

Understanding Anxiety: Two Types You Should Know

Anxiety doesn’t always look the same. Understanding the difference between somatic anxiety and affective anxiety can help you better understand what’s going on:

• Somatic Anxiety: This is anxiety you feel in your body. Symptoms include a racing heart, tight muscles, trouble sleeping, or even hot flashes. It’s that physical sense of being “on edge,” even when there’s no emotional reason for it.
• Affective Anxiety: This is more about your emotions. It shows up as worry, fear, or a persistent sense of dread. You might feel irritable, overwhelmed, or unable to stop negative thoughts.

Hormones, Hot Flashes, GSM and Anxiety: How They’re All Connected?

Hormonal changes during menopause — particularly the decline in estrogen — can affect how your brain regulates mood and how your body responds to stress. But that’s only part of the story.
Studies also found connections between vasomotor symptoms (VMS), like hot flashes and night sweats – genitourinary syndrome of menopause (GSM) and anxiety. For example:

• During menopause, somatic anxiety tends to take center stage. A long-term study (Menopause: The Journal of The North American Menopause Society, 2016) (2) found that physical symptoms like a racing heart and restlessness were three times more likely to occur alongside hot flashes than emotional symptoms like worry or fear.
• Women with genitourinary syndrome of menopause are more likely to experience anxiety and depression, particularly those aged 45-54 (Menopause: The Journal of The North American Menopause Society, 2020)(3).

While GSM doesn’t necessarily cause anxiety, untreated symptoms – like vaginal dryness or pain during sex – can significantly impact mental health.
By speaking openly with your doctor about symptoms like hot flashes, dryness, or painful sex, you can find treatments to address both the physical and emotional toll.

Why Anxiety Peaks During Menopause

If anxiety is new to you, you might notice it flaring up during menopause, particularly in late perimenopause — the stage just before your periods stop completely. A 2013 study (Menopause: The Journal of The North American Menopause Society, 2013) (4) found that anxiety often peaks during this time, creating what researchers call a “window of vulnerability.”

Here’s what the study revealed:

• Women without prior anxiety saw rates of anxiety jump from 4.6% in premenopause to 13.5% in late perimenopause. This increase is closely tied to the hormonal shifts happening during this stage.
• Women who already had high anxiety before menopause remained consistent, suggesting their anxiety was more influenced by long-term factors like life stress or health issues.

What This Means for You
Understanding the connection between anxiety and menopause is empowering. It gives you a clearer picture of what’s happening and how to manage your symptoms. Here’s what the evidence suggests:

1. If you’ve had anxiety before menopause, work with your healthcare provider to manage it during this transition. Hormonal changes may not be the root cause, but they can still make existing anxiety worse.
2. If anxiety feels new to you, it might be tied to the hormonal shifts of menopause. Recognizing this as part of the transition can help you find the right treatment and support.
3. Hot flashes and anxiety are closely linked: Managing one can help the other. Addressing hot flashes may ease anxiety, and reducing anxiety might make hot flashes less intense.
4. Vaginal dryness and painful sex matter too: These physical symptoms can take a toll on your mental health, so addressing them early is key.

How to Find Relief

Anxiety during menopause is real, but there are effective ways to feel better:

• Talk to Your Healthcare Provider: They can help you decide if hormone therapy (HRT), anxiety medications, or other treatments are right for you. HRT is especially effective for anxiety tied to hormonal shifts and VMS.
• Try Mind-Body Approaches: Mindfulness, mediation, yoga, and relaxation techniques can ease both physical and emotional symptoms.
• Exercise Regularly: Physical activity supports mental health, reduces stress, and promotes better sleep.
• Prioritize Balanced Nutrition: Research suggests a Mediterranean-style diet—rich in fruits, vegetables, whole grains, and healthy fats—can help reduce anxiety (Menopause: The Journal of The North American Menopause Society, 2022)(5)

- Avoid alcohol, high-fat and high-sugar food, which can worsen symptoms.

- Include iron-rich foods like leafy greens and lentils, especially if heavy periods are leaving you drained. Pair these with vitamin C (like oranges) for better absorption.

• Address Hot Flashes, Vaginal Dryness and Painful Sex: Treating these symptoms through lifestyle changes, HRT, or other options can ease their emotional impact.

You’re Not Alone
Anxiety during menopause is more common than you might think—and it’s nothing to be ashamed of. Whether it’s something you’ve faced for years or a new challenge, understanding how it connects to hormonal changes is the first step toward finding relief. With the right support and strategies, you can regain control, break the cycle of anxiety, and thrive through midlife and beyond.

Resources

1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 1994 Vol. 51, pp. 8-19.
2. Freeman EW, Sammel MD. Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort. Menopause: The Journal of The North America Menopause Society 2016 Vol. 23, pp. 942-949.
3. Moyneur E, Dea K, et al. Prevelance of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia. Menopause: The Journal of The North America Menopause Society 2020 Vol. 27, pp. 132-142
4. Bromberger J T, Kravitz H M, et al. Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation. Menopause: The Journal of The North America Menopause Society 2013 Vol. 20, No. 5 pp. 488-495
5. Grigolon R B, Ceolin G et al. Effects of nutritional interventions on the severity of depressive and anxiety symptoms of women in the menopausal transition and menopause: a systematic review, meta-analysis, and meta-regression. Menopause: The Journal of The North America Menopause Society 2022 Vol. 30, No. 1 pp. 95-107