How to Manage Menopause Anxiety and Irritability

The years leading up to menopause are full of physical and life changes. While hot flashes, night sweats, and vaginal dryness are better-known, the mental health challenges can be just as impactful. 

Almost 25% of people going through menopause may experience anxiety and irritability.  

These symptoms can be worrisome, especially if you’ve never dealt with mental health challenges before. In this article, we’ll explore the potential causes of anxiety and irritability during menopause and what you can do about them. 

Understanding menopause anxiety and irritability  

Anxiety and irritability are two of the most common — yet often overlooked — mental health symptoms experienced during the menopause transition. The changes in estrogen levels are a major contributor. People with a history of premenstrual dysphoric disorder (PMDD) may be more likely to develop anxiety and irritability during perimenopause and menopause.  

Is irritability a symptom of anxiety? 

Yes, irritability is a common symptom linked to anxiety during menopause. Hormonal changes can affect both your physical and mental health, leading to mood swings and increased stress. These changes can make you feel more irritable and tense more often than usual.  

Physical and emotional symptoms 

Anxiety refers to the physical and emotional changes that happen when your body prepares to respond to a perceived threat. During menopause, a decline in estrogen levels impacts the production of serotonin and endorphins within the brain. Lower levels of serotonin and endorphins are both linked with increased anxiety, which explains the greater risk during perimenopause and menopause. Some emotional symptoms of anxiety you might experience include: 

• Excessive fear and worry. 
• Feeling easily agitated. 
• Difficulty focusing. 
• Irritability. 
• Difficulty sleeping. 
• Unwanted and intrusive thoughts. 

In some cases, anxiety may lead to panic attacks, which are sudden, intense episodes of fear and panic that may occur without a clear reason. 

While anxiety causes intense feelings of fear and worry, it also presents itself through various physical symptoms. Physical symptoms of anxiety during menopause may include: 

• Increased heart rate. 
• Sweating. 
• Feeling nauseous. 
• Heart palpitations. 
• Dry mouth. 
• Chest pain. 
• Headaches. 

Anxiety and irritability can affect various aspects of your life, including work, relationships, and sleep. You may also have life changes that add to your stress and anxiety. 

Perimenopause, menopause, and anxiety can also impact your sleep quality. Because worrying makes it hard to fall asleep, you may not get enough rest at night. Night sweats, a common symptom of menopause, can also interfere with sleep.  

Not getting enough sleep can worsen anxiety the next morning. Additionally, insufficient sleep may worsen symptoms of irritability. This can be a challenging cycle to overcome.  

Medical treatments for menopause anxiety and irritability 

If you’re struggling with menopause anxiety and irritability, it’s important to talk to your doctor. They can recommend several medications that may help: 

• Selective serotonin reuptake inhibitors (SSRIs). These antidepressants are often prescribed for anxiety symptoms. One SSRI, paroxetine, can be used for hot flashes and night sweats. Other common SSRIs include citalopram, fluoxetine, and sertraline.  
• Serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants are also often prescribed for anxiety.  
• Benzodiazepines. These medications can help calm the nervous system, offering temporary relief from anxiety. However, there’s the potential for dependence and they’re not considered a first-line treatment.  
• Buspirone. This anti-anxiety medication treats the symptoms of generalized (chronic) anxiety. 
• Menopause hormone therapy (MHT). MHT isn’t officially approved by the FDA for mood symptoms, but many people find that it does help. Plus, it can help reduce hot flashes and night sweats, which can make for better sleep and less irritability overall.  

Each treatment has its benefits and drawbacks, so it’s crucial to discuss your options with your doctor. 

Alternative and complimentary options 

There are many other ways besides medication or hormone replacement therapy that can help you manage mental health symptoms during menopause:    

• Cognitive-behavioral therapy (CBT). CBT is effective for managing anxiety and irritability. Research shows it can help with other menopause symptoms, too. CBT helps you identify and change unhelpful thought patterns and behaviors, providing a healthy way that makes it easier to cope with menopause symptoms. 
• Meditation. Regular meditation can help lower stress levels, which can reduce stress and anxiety. It can also help you let go of negative or anxious thoughts and focus on the present moment. 
• Yoga. Yoga combines gentle movements with controlled breathing, promoting a sense of calm. 
• Hypnotherapy. Studies suggest that hypnosis can be helpful for treating anxiety, especially when combined with other treatments. Hypnotherapy reduces sympathetic activation. This lessens common anxiety-related physical symptoms like elevated heart rate, sweating, and breathing.  

Other supportive options that have been found useful include aromatherapy (especially with lavender essential oil), or herbal supplements such as Ashwagandha and valerian root. In preliminary studies, aromatherapy with essential oils may significantly lower anxiety levels. Valerian root works with your body to help regulate sleep and relaxation. 

Always talk to your doctor before starting any new supplements to ensure they’re right for you, including that they don’t interfere with other medications.  

Lifestyle changes to manage your symptoms 

Small lifestyle changes can have a big impact on how you feel. Some helpful lifestyle changes include: 

• Eating a healthier diet. 
• Daily exercise. 
• Reducing alcohol, caffeine, and sugary foods.  
• Prioritizing sleep. 
• Practicing self-care. 
• Volunteering in your community. 
• Connecting with loved ones. 

These changes may take time to get used to. However, you're sure to find the right activities that resonate with you. As you make these changes, you may begin to notice a gradual decrease in your anxiety and irritability symptoms. 

What can you do next? 

Remember that menopause is a normal part of life, but it doesn’t mean you have to suffer with anxiety and irritability for years. There are many effective ways to manage these symptoms. If you're finding it difficult to cope, reach out to a trusted friend or family member. If you need more support, a mental health professional or healthcare provider can provide guidance and additional treatment options.