Stress and anxiety – a doctor ’s overview

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Some of the most challenging menopause related symptoms are the ones you can’t see. Dr Shilpa McQuillan discusses the psychological side of menopause, and the symptoms many women visit her for help with: stress and anxiety, low mood and feeling tearful, irritability and mood swings.

Many people think of hot flashes and night sweats as the main symptoms women experience as they approach their menopause. But in fact there are also many psychological symptoms that occur. These are the symptoms that people don’t physically see – so can be more difficult to deal with.

During menopause, psychological symptoms can be overbearing, impacting on your physical health as well as affecting relationships at home and in the workplace. Some of the symptoms many women describe include:

    • low mood
    • anxiety
    • irritability
    • panic attacks
    • feeling tearful
    • low self- esteem
    • mood swings

Why do we get more stressed and anxious at menopause?

There are many reasons that you can experience mood changes around the menopause. Changes in the balance of your hormones is one of them.

Normally, your body produces a hormone called cortisol. One of the roles of cortisol is to deal with stress. It is important that you have the right balance of cortisol in your body, otherwise we can become quite unwell.

The hormone estrogen helps maintain the level of cortisol in the body.

As you go through menopause, the levels of estrogen begin to drop. This means you can’t regulate your cortisol levels as effectively as before, causing you to experience mood changes and stress more readily.

Testosterone also plays an important role on our mood and concentration (as well as libido and energy). Many people think of testosterone as the ‘male hormone’, but it is actually produced by the ovaries in high quantities. Like estrogen, these levels drop around menopause and result in low mood and brain fog.

Stress – and the vicious circle it can trigger

Stress can be a challenging symptom to manage. The more you are stressed, the more you can experience symptoms such as sleep problems; headaches; difficulty concentrating (‘brain fog’); sweating; and palpitations. Furthermore, the more menopause symptoms you experience i.e. sleep problems, flashes, sweating and headaches can in turn cause you to experience more stress and have low mood and anxiety. This can feel like a ‘vicious circle’, but thankfully there are ways to break free.

How can you help manage stress and anxiety?

Two people can go through the same stressful experience but cope in very different ways.

There are many factors that determine this such as your own personal health, and what kind of relationships and support you have. There are also many lifestyle factors that can help you cope with stress. These factors are a good place to start if you’re struggling with mood changes, anger, stress and anxiety – and there’s lots of help on this website to support you in making positive changes.

Positive steps to make today are…

Healthy diet

It is important to have a balanced diet and maintain a healthy weight. This means eating a diet that includes plenty of fruit and vegetables. Try and opt for foods low in fat, sugar, and salt (no more than 6 grams per day). This in turn can help boost your energy, improve your sleep, as well as prevent conditions including diabetes and heart disease, which themselves are associated with depression and anxiety. There’s lots of help here on Health & Her, including: Menopause nutrition advice.

Regular aerobic exercise

When you exercise your body releases endorphins. These are known as the ‘happy hormones’. These help keep your mood stable, and give you more energy to do the things you enjoy. In turn it can help improve sleep quality. If you’re not yet including exercise in your routine, there are some videos on Health & Her that may help including menopause routines for you to try at home created by personal trainer and some of the best exercises to try in menopause.

Limiting alcohol intake

Our brains rely on a careful balance of chemical and hormones that control our thoughts, feelings, and actions. Alcohol disrupts this balance. Initially, you may have a feeling of being relaxed and confident. This is because the part of the brain causing ‘inhibition’ is affected. As more of the brain is affected, there is more hormonal imbalance resulting in feelings of anger, aggression, and anxiety. Therefore alcohol is known as a natural ‘depressant’. It is important to keep health risks from drinking alcohol to a low level. This is best achieved by drinking no more than the recommended 14 units per week.

It is ok to have the odd glass of wine, but may be tempting to drink more if you are feeling low, and this is likely to make you feel worse. It may be helpful to try some social activities that can help boost your mood, like meeting a friend for a walk, indulging in a relaxing massage, or just taking time out for a yoga class. There are some free classes – designed for menopause – you can try here on Health & Her.

Pharmacy medications

You can get some calming tablets from your pharmacy. It is important you check with your doctor or pharmacist if it is safe for you to take these.

Cognitive Behavioral Therapy (CBT)

CBT is a well-recognized treatment for stress and anxiety. Generally, the techniques used include improving mental health, relaxation techniques, mindfulness, and sleep hygiene.

You can find more information in our ‘CBT for menopause’ advice by Professor Myra Hunter.

Hormone Therapy (HT)

Taking HT replaces the low levels of estrogen. By restoring the balance, many women find their mood more ‘stable’ and uplifted, with improved energy levels and motivation.

Some women may also need to replace testosterone levels to improve their energy and stress levels.


Some antidepressant medications such as Selective Serotonin Re-uptake Inhibitors (SSRIs) and Selective Noradrenaline Re-uptake Inhibitors (SSNRIs) are known for their treatment in depression and anxiety. Women who already suffer from these mood disorders, and who develop worsening symptoms around menopause, may benefit from starting these medications.

However, it’s really important to get the right treatment for you. If you think your symptoms are related to menopause then it’s actually very unlikely antidepressants will work – and you should talk through your options with your doctor.

If you would like to know more about how menopause can affect you psychologically, Clinical Psychologist Deborah Lancastle has written an overview of coping with emotions during menopause. There is also help from Relate to explore how to manage menopause stress and anxiety in relationships. You might also be interested in using exercise and complementary therapies – there’s advice from different practitioners in the Expert Advice section.

About Dr Shilpa McQuillan MRCGP MRCOG DFSRH

Dr Shilpa McQuillan is a doctor with a difference; she brings a wealth of specialist knowledge when it comes to women’s health. Previously a Hospital Registrar in Obstetrics and Gynaecology, Shilpa now works in general practice, providing patients with resident expertise and knowledge on women’s health concerns.

Read Shilpa’s full biography here

Dr Shilpa McQuillan

Dr Shilpa McQuillan

General Practitioner

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