Laura Barcella
When I hit my late 40s, I started noticing something strange. Things that used to seem like no big deal were, suddenly, major sources of anxiety. I couldn’t make a routine phone call without a wave of nerves washing over me. Even putting my name in at a restaurant’s host stand made me feel uneasy, somehow overexposed.
My anxiety was about anything and everything; issues both big and banal. Even though my mother is alive and in generally good health, I found myself fixating on her eventual — hopefully distant — death. I worried about my own mortality, too. I was anxious about making idle chitchat in the coffee line, and the idea of trying a new exercise class freaked me out. What was going on? Why did I suddenly feel so paralyzed by fear, and at times, overwhelmed by existential dread?
According to Milissa Aronson, LCSW, of Magnolia Psychotherapy, this type of midlife anxiety isn’t unusual. In fact, many women experience a noticeable increase in anxiety during perimenopause and menopause. Why? Because, in part, “estrogen and progesterone levels decline at this time,” Aronson explains. “These hormones interact with serotonin, dopamine, and GABA — the feel-good neurotransmitters. Serotonin helps to regulate our mood; lower serotonin levels mean less emotional regulation.”
Other physical changes associated with menopause can lead to heightened anxiety, too, according to Aronson, especially when symptoms like hot flashes and night sweats affect women’s sleep. “When our sleep is off, our mental health is always off,” Aronson says. Add on issues like aging parents, financial stress, and the demands of raising children, and it’s easy to see how this stage of life can feel like an anxiety pressure cooker.
Trina Read, 57, experienced this shift herself. Read, who’s about one year into menopause, is a sexologist who describes herself as a “high achiever with high anxiety,” noting that her anxiety ramped up in recent years — particularly during bouts of PMS in perimenopause. “The anxiety and PMS [together made me feel] like, ‘I can’t take this,’” she recalls. At one point, the stress manifested physically, showing up as a rash that persisted for years.
Read finds herself feeling more stressed out about work and the well-being of her teenage sons. But she also notices that small things that wouldn’t previously trigger her can cause her to spin out. “Some days I can roll with it and other days, someone charges me an extra five cents and I’m spiraling because of it. I’ve been working really hard to even out those emotions, but it’s a daily thing.”
Read describes herself as more “fragile and emotionally vulnerable” than she used to be. “Until I was maybe 40, I could bounce back from a really shitty day. I’m not bouncing back now. It takes me a couple days to recover,” she says.
PR professional Julia Sherwin, 52, says her menopause transition caused her to ponder deeper questions about identity and purpose. “The hormonal and biological changes, they’re all happening at the same time. It’s definitely a time when you start to question your identity and how you’re going to make a mark on this world,” she says. She too noticed an increase in anxiety, especially when it came to her kids. When her oldest was preparing to head off for college, she experienced an anxiety spike she couldn’t shake. “I didn’t really understand the word ‘anxiety’ before. I was 49 years old, and I finally was like, ‘Wow, I know what anxiety is now.’ You just can’t shake this feeling; you wake up with it and sometimes you go to sleep with it.”
Writer Nina Camp, 53, was 49 when she began experiencing a dramatic anxiety increase and a sense of being utterly overwhelmed. “The first time it happened, when it spun out of control, the trigger was an ailing pet. I couldn’t let go of the stress. I don’t remember ever having that level of just being totally swept away by some kind of trigger,” she says. Being in a relatively new romantic relationship, she notes that relationship-centered anxiety is an issue for her, too. “The anxiety has increased to the level where I can’t eat for a couple of days. That’s new … I just don’t remember it ever being that bad to where I’m losing three pounds and I can’t do any work.”
Camp has also found herself more sensitive to noise and environmental stressors. Living in New York City, she now wears earplugs to cope when she goes outside. “I’m more sensitive to noise and [general] human behavior in public … than when I was in my 30s and 40s,” she says.
Dr. Vesna Pirec, a Chicago-area psychiatrist, says increased anxiety is common among women in this age group. “Each woman must be individually evaluated and an adequate approach should be suggested,” she notes. She recommends hormone replacement therapy (HRT) for some of her perimenopausal patients, as it “can address both insomnia and other physical and psychological manifestations of perimenopause.” She prescribes other medications to some of these patients, too. “Antianxiety medications, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) are used as needed to treat anxiety symptoms and depression.”
There’s no single way to manage this kind of anxiety, and each of the women I spoke with has found her own strategies to help. When she’s struggling with anxiety or spiraling thoughts, Read tries addressing herself out loud, saying things like “stop,” “what’s going on?” or “why are you doing this?” She also makes a concerted effort to stay present, whether she’s meditating or just walking her dog.
Sherwin saw a doctor and began taking medication for her anxiety, but also prioritizes self-care. This includes exercising regularly and making frequent plans to see her girlfriends. Camp says she currently uses medication to help quiet the constant mental chatter, but also finds relief in small grounding practices. “Even a couple of minutes of yoga in my room — just something simple like child’s pose — can help,” she says.
As for me, at 49 and in perimenopause, I’m still figuring out how to navigate it all. But knowing there are legitimate reasons behind the anxiety spikes — and that I’m far from alone in experiencing them — has made it feel a little less overwhelming. Some days are rougher than others, but I’m learning how to meet my anxious moments with more patience and less fear.