Why do some women suddenly experience anxiety symptoms after menopause?

Anxiety symptoms after menopause are not uncommon, and there is a clear biological reason for them. The female hormone oestrogen influences substances in the brain that regulate mood and calm, including serotonin and GABA. When oestrogen levels fluctuate sharply during menopause and eventually fall, that balance is disrupted. This mechanism has not yet been definitively proven, but is considered a plausible explanation.

Hot flushes and night sweats are also likely to play a role. Sleep deprivation caused by night sweats exhausts the nervous system, and women with more anxiety symptoms in turn appear to have more intense hot flushes that also last longer. The two therefore reinforce each other. The risk rises most sharply in the later stages of menopause, when periods have been absent for months.

Not every woman is equally vulnerable. Women who have previously experienced depression, or who are naturally more sensitive to negative emotions, have a greater chance of developing anxiety symptoms. In addition, the age at which menopause occurs often coincides with other stressful periods: children leaving home, caring for ageing parents. All those factors at once make it difficult to point to menopause itself as the sole culprit.

For those affected by anxiety symptoms, there are a few options with reasonable supporting evidence. Low-to-moderate intensity exercise demonstrably helps, and the effect is clearest in women who have already passed menopause. Mind-body practices such as yoga and tai chi also show a positive effect, although the studies on this point varied considerably from one another. Hormone therapy is an option for women with broader menopausal complaints that is safe for most women in the short term, but requires consultation with a doctor because of possible risks with long-term use. Nutritional supplements still show too inconsistent results in research to be regarded as a proven approach.