Anxiety and Panic Attacks

By Paula Brown, Founder, Konenki Menopause Solutions

Why It Is Happening

During perimenopause, women often experience increased anxiety and panic attacks, primarily due to hormonal fluctuations, particularly involving estrogen and progesterone. These hormones significantly influence the central nervous system and mood regulation.

Estrogen modulates neurotransmitter systems, including serotonin and gamma-aminobutyric acid (GABA), which are crucial for maintaining mood stability and anxiety levels. Fluctuating estrogen levels during perimenopause can disrupt these neurotransmitter systems, leading to increased anxiety and susceptibility to panic attacks.

Progesterone has anxiolytic (anxiety-reducing) effects through its metabolites that enhance GABAergic activity. Declining progesterone levels during perimenopause can reduce this calming effect, contributing to heightened anxiety and the occurrence of panic attacks.

A study published in the Journal of Clinical Endocrinology & Metabolism in 2018 investigated the association between hormonal changes during perimenopause and the prevalence of anxiety disorders. The researchers found that women with significant fluctuations in estrogen and progesterone levels had higher rates of anxiety and panic attacks compared to those with more stable hormone levels.

Additionally, hormonal fluctuations can lead to physical symptoms such as palpitations, hot flashes, and sleep disturbances, which may exacerbate anxiety and trigger panic attacks. The interplay between physiological changes and psychological responses during perimenopause creates a complex environment that can heighten anxiety levels.

In summary, the hormonal fluctuations characteristic of perimenopause, particularly involving estrogen and progesterone, can disrupt neurotransmitter systems and reduce anxiolytic effects, leading to increased anxiety and panic attacks. Understanding these mechanisms is crucial for recognizing and managing these symptoms during this transitional phase.

What You Can Do About It

To alleviate these symptoms, consider the following strategies:

1. Cognitive Behavioral Therapy (CBT)

CBT is an effective treatment for anxiety disorders, focusing on identifying and modifying negative thought patterns. A study in Maturitas (2018) found that CBT significantly reduced anxiety symptoms in perimenopausal women.

2. Mindfulness-Based Stress Reduction (MBSR)

MBSR combines mindfulness meditation and yoga to enhance present-moment awareness. Research in the Journal of Clinical Psychology (2017) demonstrated that MBSR reduced anxiety and improved emotional regulation in women undergoing menopausal transition.

3. Physical Activity

Regular exercise, such as aerobic activities and yoga, can alleviate anxiety symptoms. A randomized controlled trial in Menopause (2016) showed that yoga reduced anxiety levels in perimenopausal women.

4. Hormone Replacement Therapy (HRT)

HRT may help alleviate mood disturbances associated with hormonal changes. A systematic review in Menopause (2017) indicated that HRT could reduce anxiety symptoms in perimenopausal women.

5. Pharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective in treating anxiety disorders. A study in The Journal of Clinical Endocrinology & Metabolism (2015) found that SSRIs reduced anxiety symptoms in perimenopausal women.

6. Lifestyle Modifications

• Stress Management: Engaging in relaxation techniques such as deep breathing exercises and progressive muscle relaxation can reduce anxiety.
• Sleep Hygiene: Maintaining a regular sleep schedule and creating a restful environment can improve sleep quality, thereby reducing anxiety.
• Balanced Diet: Consuming a diet rich in fruits, vegetables, and whole grains supports overall mental health.

Implementing these strategies can help alleviate anxiety and panic attacks during perimenopause, enhancing overall well-being.

Ready to Take the Next Step?

Find Support Near You: Visit our Find a Provider page to connect with a vetted menopause expert who understands what you’re going through.

Not Sure Where to Start? Schedule a free 20-minute call with our Wingwoman Concierge for personalized guidance—because you shouldn’t have to figure this out alone.

References

Carmody, J. F., et al. (2017). Mindfulness-based stress reduction for menopausal symptoms: A randomized controlled trial. Journal of Clinical Psychology, 73(7), 927-936.

Chattha, R., et al. (2016). Effect of yoga on anxiety symptoms in perimenopausal women: A randomized controlled trial. Menopause, 23(2), 130-135.

Gordon, J. L., et al. (2015). Efficacy of sertraline for treatment of perimenopausal anxiety: A randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism, 100(11), 4214-4221.

Gordon, J. L., et al. (2018). Perimenopause-Related Mood Disorders: Epidemiology and Biological Basis. Journal of Clinical Endocrinology & Metabolism, 103(10), 3821–3830.

Hunter, M. S., & Chilcot, J. (2018). Cognitive-behavioral interventions for menopausal symptoms: A review. Maturitas, 109, 28-34.