Early in my marriage, I struggled with an unfounded fear that my husband was going to die. Not long term, because, duh, everyone dies, but like, every minute of every day.
When he left the house to get bagels, if it took him longer than usual to return, I immediately assumed the worst — that he was DEAD. On my walk home from the train, if I saw the lights of emergency vehicles, I just knew they were on their way to my house because my husband was DEAD.
Ridiculous, I know!
Logically, I understood that this was crazy. While it's true that we can lose our loved ones unexpectedly, I knew it wasn't likely. Despite this understanding, I couldn't control my fear. These unsettling thoughts felt like worms; once they penetrated my mind, they burrowed so deep that I felt paralyzed by dread.
The Uninvited Guest: Menopausal Anxiety
I started my perimenopausal journey around 40. I struggled primarily with sleep issues, fatigue, and a shift in body composition. I also had an extremely stressful corporate job that wasn't doing me any favors. At the time, I had no idea what perimenopause was, but as symptoms worsened (I basically stopped sleeping) and anxiety entered the party, I was like, "Who invited this a**hole?"
That was when I knew it was time to get some help.
Addressing these crazy death thoughts about my husband felt like the most urgent, so I went looking for a shrink.
Finding the Right Support and Connecting The Dots
Finding a good therapist is a lot like dating. Not everyone is a match. Luckily, I found someone quickly who also took insurance, AND I happened to really, really like her! If you've ever been in therapy, you know these things are RARE.
We began exploring the source of my anxiety, and it quickly became apparent in my first few therapy sessions that it was a cocktail of past trauma and, you guessed it, a drop in estrogen. This led to what I call "background anxiety," which would often spiral into catastrophic thinking about various situations, most significantly an overwhelming fear of my husband dying unexpectedly.
The prevalence of anxiety symptoms in midlife women is substantial, with estimates as high as 51% of women 40-55 years old. During the menopause transition, hormonal fluctuations affect neurotransmitters in the brain. This decline in hormones can lead to increased anxiety and mood swings.
There is also a correlation with ADHD. But. That's another story.
Understanding this connection was crucial for me.
Finding Treatment
First, my shrink had me do some thought reframing - a technique I would come to use often in my coaching practice. I needed to come up with a sentence or mantra to repeat to myself when I began to catastrophize. I settled on saying, "I can't control it, but I know I can survive it." Meaning, I knew I couldn't control the world around me, but I knew I was resilient enough to get through tragedy.
This professional guidance proved to be vital. Working with a therapist who understood menopause-related anxiety gave me clarity and tools to manage my feelings. However, I recognized that this was only one part of the solution, and there were other steps I needed to take.
Putting it All Together
I had really let some things fall to the wayside, and I hadn't even noticed until I started therapy.
Exercise: I refocused my exercise program, hired a personal trainer, started lifting weights regularly, and recommitted to a regular Pilates practice that I had fallen out of.
Nutrition: This was a mess. I spent many days eating whatever I could get my hands on because time felt limited with my job, and we were eating out and ordering in a lot. I started meal-prepping more, and I cut back on my sugar intake (under 35 grams a day) and limited my alcohol consumption.
Meditation: I had fallen out of my twice-a-day Transcendental Meditation (TM) practice; no wonder I was stressed! I picked that back up.
Medication: I sought the help of a menopause practitioner and started Hormone Replacement Therapy (HRT).
Sleep: Finally, I practiced better sleep hygiene by limiting my screen time and getting to bed early, AND with the addition of micronized progesterone, I began to sleep like a normal human again!
Let me be clear and say that this did NOT happen overnight. It took literal years to figure out the right combination of lifestyle, nutrition, and pharmaceutical intervention.
Even now, as I write this, I'm still figuring this sh*t out because the annoying thing about perimenopause is that until you are post-menopausal, hormones continue to drop until the ovaries are entirely out of gas. Once they're out of fuel, it's a bit easier to manage hormone levels because they no longer change.
Until then, it's a roller coaster you have to manage because you can't get off. Your hormones will fluctuate until they're gone, and you must keep reassessing your treatment approach as things change.
While there is no one-size-fits-all solution for treating anxiety related to perimenopause and menopause, there are so many things you can do! It will likely be therapy, lifestyle changes, medication, or some combination of those, but you have to start somewhere.
First and foremost, if you're struggling, acknowledging the fact that something is going on is paramount. Next, please don't keep it to yourself. Ask for help. That might be finding a menopause practitioner here, making an appointment with a therapist, or even working with someone like me. 😉
Whatever choice you make, don't let it take you years to get help like it did me.
You deserve to feel your best at every age! I'm rooting for you!!
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