Anxiety

Anxiety is the most common mental health condition in Australia with 1 in 8 females (13%) reporting an anxiety related condition in the 2014-15 period. Women are more likely to experience anxiety than men are, with the exact reason for this being unknown. Could hormonal changes be the reason for this increased prevalence in females?

Anxiety is more than just feeling stressed or worried.

Despite the high prevalence rates, anxiety disorders are often under-recognised and under-treated. Unfortunately, society has placed a certain stigma on anxiety and mental health conditions leading to a number of unreported, silent sufferers.

The sooner a person with anxiety seeks support, the more likely they are to recover.

What is anxiety?

Anxiety is defined as a feeling of worry, nervousness or unease about something with an uncertain outcome.

While stress and anxious feelings are a common survival response in certain situations, it usually passes once the situation has resolved or the ‘stressor’ has passed. An anxiety disorder can be identified when these anxious feeling don’t subside, or when these worried or stressed sensations persist without a particular reason or cause.

Prolonged, persistent or significant anxiety can affect your ability to concentrate, sleep and carry out ordinary tasks at work, home or school. The overactivity of the brain, through excessive worry, over thinking and often fear, can compel people to avoid stressful situations, and in extreme cases avoid social interaction.

If you have thoughts of worry, nervousness or unease and it is affecting your quality of life, or impacting on your daily activities, you may be experiencing an anxiety disorder. We recommend you ask for help. The sooner you seek support, the more likely you are to recover.

Who experiences anxiety?

Anybody and everybody is exposed to developing an anxiety disorder.

Short term anxiety is a survival response designed by the body to help you get through that stressful situation. Chronic exposure to these situations, or the inability to handle the situation can lead to excessive anxiety, even once the ‘stressor’ has passed.

Old, young, female, male, rich, poor, large or small – we all have the possibility of developing an anxiety disorder.

What are the causes of anxiety?

Whilst there is no single known cause of anxiety disorders, there are a number of risk factors or triggers that may contribute. In general, the following factors may play a role:

• Perimenopause: Perimenopause is a time of unpredictable hormone fluctuations. Women undergoing hormonal fluctuations have an increased risk for particular psychiatric disorders with women in peri-menopause being more likely to experience anxiety or panic attack than those who are the same age.
• Menopause: Menopause is a time of flat-lined ovarian hormones and a change in bodily function. During this time, in addition to the hormones, there are many other factors that contribute to the development of anxiety. For example, women who suffer more physical symptoms, experience negative life events or who are less functional, are more likely to develop an anxiety disorder during menopause, than women without these additional stressors.
• Hormone fluctuations: Peri-menopause, puberty and pregnancy are all times that women appear to be more vulnerable to psychiatric symptoms, particularly depression and anxiety.
• Genetics: Certain anxiety disorders appear to have a genetic component, with some anxiety disorders running in the family. Whilst genetics appear to play a role in prevalence, having a family member with an anxiety disorder does not mean that you’ll automatically develop anxiety. A number of other factors play a role in gene expression.
• Personality factors: Research suggests that people with certain personality traits are more likely to have anxiety. For example, children who are perfectionists, easily flustered, timid, inhibited, lack self-esteem or want to control everything sometimes develop anxiety during childhood, adolescence or as an adult.
• Thinking style: Patterns of thinking characterised by anticipating the worst, persistent negative self-talk, low self-esteem and unhelpful coping strategies are linked to problematic anxiety.
• Physical health: Poor health can increase a person’s vulnerability to developing symptoms of anxiety. Chronic physical illness can also contribute to anxiety conditions or impact on the treatment of either the anxiety or the physical illness itself.
• A stressful event, or chain of stressful events: Ongoing, significant or persistent stressful events such as a marriage breakdown, work or school deadlines, trauma, death of a loved one or financial hardship can act as a trigger for anxiety.
• Biochemical response: One theory of anxiety is that it is caused by an imbalance of the neurotransmitters, or chemicals, in the brain that regulate feelings and physical reactions. This can alter your thoughts, emotions or behaviour and can result in anxiety.

What are the symptoms of anxiety?

Symptoms of anxiety are sometimes not all that obvious as they can develop slowly over time, and given that we all experience a level of anxiety at various points in our lives, it can be hard to know how much is too much.

Normal anxiety tends to be limited in duration and connected with a stressful situation or event, such as a job interview. The type of anxiety experienced by people with an anxiety condition is more frequent or persistent, not always connected to an obvious challenge, and impacts on their quality of life and daily functions. While each anxiety condition (there are a few) has its own unique features, there are some common symptoms.

• Physical: Panic attaches, hot and cold flushes, racing heart, tightening of the chest, nausea/upset stomach, light headedness, quick breathing, difficulty concentrating, irritable, restlessness or feeling tense, wound up and edgy.
• Psychological: Excessive fear, worry, catastrophising or obsessive thinking.
• Behavioural: Avoidance of situations that make you feel anxious, which can impact on study, work or social life.

Does menopause affect anxiety?

Yes. Menopause and Peri-menopause are times of hormonal fluctuations and both instances are times of increased vulnerability and uncertainty.

Further to these direct hormonal changes, the actual stress of menopause can significantly add to the anxiety picture.

Perimenopause:

As previously mentioned, peri-menopause is a time of unpredictable hormone fluctuations resulting in sudden hormone changes, hormone excesses and hormone deficiencies. Going through this transition can often lead to periods of oestrogen excess and progesterone deficiency. Not only does this typically lead to significant PMS (anxiety, breast tenderness, irritability, abdominal cramps, over-heating) via oestrogen dominance, but it is also a time where progesterone presence is questionable, and less likely over time (progesterone is only present with ovulation).

High levels of oestrogen are believed to produce an imbalance in the system that aggravates or causes symptoms of tension and anxiety. It has been suggested, and we have seen, that a high level of oestrogen in addition to a low level of progesterone (classic peri-menopause) can result in women exhibiting extreme rage, resulting in a self-defeating demeanour. This experience has been explained as an out-of-body experience, where a woman watches herself respond erratically, and has no clue where the emotions and words have come from. This outburst can not only lead to anxiety, but can result in a confused, angry, sad period of time.

The other key player in a woman’s menstrual cycle is her progesterone. As mentioned previously, progesterone is only produced or present within the body if ovulation occurs; unfortunately, perimenopause is a time when ovulation is scattered, unpredictable and waning. A lack of progesterone not only can lead to an oestrogen dominance, but it also results in the absence of progesterone. Progesterone has direct access to the ‘emotion centre’ in the brain and it is believed to have a calming effect in this area. A lack of progesterone leads to increased vulnerability to erratic moods and anxiety as the calming benefits are not available.

Menopause:

Menopause is a time of stabilised oestrogen ‘deficiency’ and progesterone ‘deficiency’. Whilst menopause is not technically an illness, as it is a passage of life, there is often a period of time at the start of menopause that can result in significant symptoms of oestrogen and progesterone deficiency. Once the body adjusts to the hormonal changes, these deficiency symptoms should significantly reduce, or vanish.

During this ‘adjustment phase’, the lack of oestrogen and progesterone can be felt throughout the body, particularly in the brain. Oestrogen plays a significant and complex role in the stabilisation and expression of moods. It is believed to have a role in serotonin (happy neurotransmitter) production, utilisation and duration of benefits, it is believed to influence dopamine release (controls reward and pleasure), it can influence endorphin levels within the brain (influence feeling of euphoria), and it is believed to have a relationship with melatonin (sleepy hormone) and allopregnanolone (anti-anxiety hormone). The reach that oestrogen has within the brain, let alone the body, is quite significant, offering an explanation for why menopause can be the start of a ‘new chapter’ and the rise of a different woman.

Stress (HPA axis):

Peri-menopause and menopause can be quite a stressful period of time. Your stress may develop as a direct response to the hormone fluctuations, or it may develop as an indirect response to the hormone fluctuations. Whichever the reason, significant or repetitive stress can lead to an anxious mind and an anxiety disorder.

The stress response itself, is excellent. It was designed to help you survive another day and get through a stressful situation. Unfortunately, our body does not know the difference between a life-threatening stress, and a day-to-day stress. Our body will respond in the same way, demanding (and providing) an increase in energy, strength, clarity and motivation. If we are placed in this state long term, it wears and tears on the body, and eventually it will start to show some cracks. Mental health and energy are generally the first areas to dwindle.

If your peri-menopause or menopause symptoms (hot flushes, night sweats, mood changes, etc.) are adding to your stress load, do something about it. Speak to the Australian Menopause Centre.