How to Deal With Panic Attacks and Anxiety During Menopause

By: Marygrace Taylor

Deep breath…this too shall pass. File under unpleasant but true: Menopause and anxiety can sometimes go hand in hand, and in some cases, this transitional stage can even bring a heightened risk for panic attacks or a panic disorder.

Negative mood changes can be stressful, disheartening, or even downright exhausting. But there's good news. You're not doomed to months (or years) of riding an emotional rollercoaster. Here's the straight talk on how menopause symptoms relate to anxiety and panic attacks, and what you can do to start feeling more like yourself.

Does Perimenopause or Menopause Cause Anxiety and Panic Attacks?

Not every woman going through perimenopause experiences anxiety. (Phew.) That said, it's more common than you might think. Findings estimate that around 17 percent of perimenopausal women — nearly one in five — have mild anxiety symptoms, while 4 percent have anxiety symptoms that are moderate or severe.

These mood shifts are partly due to fluctuating hormones. Changes in estrogen and progesterone levels can impact neurotransmitters in the brain, leading to feelings of anxiety as well as depression. Other menopause symptoms can have an indirect impact on mood too: You're more prone to feeling anxious or depressed, for instance, if your sleep is regularly disrupted because of hot flashes.

Hormones aside, menopause is also a time when normal but challenging life shifts can put a damper on your mood. It's normal to notice an uptick in anxiety or stress as you navigate children leaving home or manage feelings surrounding not having children (or wondering whether you should have had more), caring for aging parents, relationship changes, or even changes to your body as it ages.

Panic attacks can also develop during perimenopause, though these are less common. Marked by a sudden feeling of intense fear or impending doom (and intense physiological symptoms like shortness of breath and a rapid heart rate), panic attacks can come on out of nowhere and diminish almost as suddenly. People that experience panic attacks frequently may be diagnosed with a panic disorder.

Panic attacks and panic disorders may be more likely among menopausal women who have experienced anxiety or postpartum depression in the past. Panic attacks may also be linked to hot flashes, research suggests. But they can ultimately affect anyone — and they're certainly nothing to be ashamed about. While experts don't fully understand why panic attacks happen, it's thought that they could be related to genetics, intense stress, changes in brain function, or simply having a temperament that's more sensitive to negative feelings.

How to Know If You're Having a Panic Attack

Panic attacks are like massive fear tornadoes. They sweep in quickly, shake you to your core, and dissipate almost as fast. In the end, you're looking around and wondering what just happened — and worried about how you'll cope if another one strikes.

During perimenopause or at other times of life, panic attacks are often marked by symptoms like:

A sense of impending doom
Feeling like you're losing control or even dying
Pounding heart
Sweating
Shaking or trembling
Shortness of breath or throat tightness
Chills or hot flashes
Nausea or stomach cramps
Chest pain
Headache
Dizziness
Feeling numb or tingly
Feeling like you're detached from reality

When Can Panic Attacks Happen?

Unfortunately, panic attacks can strike at any time — even first thing in the morning — and their unpredictable nature is part of what makes them so scary. Once you've had one hit you out of the blue, you might be on edge about if and when you might have another. This, of course, only adds fuel to the fire if you're already dealing with anxiety.

It's even possible to experience nocturnal panic attacks that wake up you from sleep. Like with panic attacks that happen during the day, these nighttime episodes are usually marked by sweating, heart palpitations, trembling, shortness of breath, chills, flushing, and that stomach-churning sense of doom. It might seem like you're waking up from the world's worst nightmare.

Even though panic attacks can be random, it's normal to wonder whether there's anything you can possibly do to predict when one might be coming. While the episodes sometimes can come on without warning, if you pay attention, you might notice that you feel a little off or unsettled shortly before a panic attack. Many perimenopausal women describe the feeling as similar to those that precede a hot flash. It's worth being on the lookout for other possible triggers too. (More on those in a minute.)

How to Deal With Anxiety and Panic Attacks During Menopause

You may not be able to know when a panic attack will strike, but being prepared with a few coping mechanisms handy can help you ride out the wave. Have a reassuring mantra or script handy (keep it in a note on your phone if you need to) and repeat it to yourself when your symptoms start to flare up. Something as simple as, "You will get through this. You can breathe," can be helpful. As you repeat your mantra, take slow, deep breaths and try to distract yourself. Pet your dog or cat, look at a favorite photo, or call someone who can help talk you through it. You'll start to feel calmer in just a few minutes.

After a panic attack happens, it can be helpful to think about whether there were any specific triggers that may have brought it on. Maybe the attack happened after a particularly stressful day, or you were exposed to something that reminded you of a past traumatic experience. In some cases, even alcohol can trigger panic attacks in people who are prone to them. If you can get a handle on the underlying cause, you may be able to reduce the chance for similar attacks in the future.

As for dealing with general feelings of anxiety? While there's no cure, there are ways to manage your negative emotions and keep them from taking over your life. These include:

Talk therapy. Cognitive behavioral therapy, or CBT, can teach you to manage your negative or anxious thoughts and even change how you react to panic attacks.
Lean on those you love. Turn to your partner, family members, friends, or others you trust for support. When people know what you're going through, they're better able to help.
Exercise. Regular physical activity is a natural mood booster that's been shown to be helpful for people with anxiety disorders.
Find outlets for stress. Do something to relax and unwind every day. Make time for meditation, take a walk after dinner, spend some time journaling, or try a creative hobby like painting.
Eat a healthy diet and limit caffeine. Fruits and vegetables, lean proteins, healthy fats, and whole grains can support your mental health by feeling your best overall. If you notice that caffeine makes you jittery or anxious, consider cutting back or ditching it altogether.
Review supplements with your doctor. Some supplements (like vitamin B6) can actually make anxiety worse or interact with medications you may be taking — so talk to your doctor about what’s in your routine to see if adjustments need to be made.
Medications. Antidepressants like SSRIs or SNRIs, beta blockers, or anti-anxiety medications like benzodiazepines can all be helpful, especially when combined with talk therapy.

What's the Difference Between Panic Attacks and a Panic Disorder?

Panic disorders are characterized by frequent, unexpected panic attacks. While both problems may become more common during menopause, having one or a few panic attacks doesn't necessarily mean you have a panic disorder. But if you experience frequent panic attacks and spend a lot of time worrying about them, it's worth speaking with a therapist. Panic disorders should be diagnosed by a mental-health professional and require treatment — usually talk therapy, medication, or both — in order for a person to improve.

Outlook

Skyrocketing anxiety isn't unusual during menopause. But it doesn't have to be your norm — and there are ways to cope. Even more reassuring: Most women find that these mood changes aren't permanent. As your hormones stabilize, you may notice that your emotions follow suit. In the meantime? Share your feelings with your doctor or a mental-health expert. Together, you can decide on the best way to manage your anxiety and feel your best right now.

SOURCES

Cleveland Clinic, Can Menopause Cause Anxiety, Depression, or Panic Attacks?, November 2019.

Cleveland Clinic, How to Stop a Panic Attack, October 2021.

Cleveland Clinic, Panic Disorder, August 2020.

Cleveland Clinic, Why Am I Panicking in My Sleep?, April 2021.

Mayo Clinic, Nocturnal Panic Attacks: What Causes Them?, January 2018.

Mayo Clinic, Panic Attacks and Panic Disorder, May 2018.

National Institutes of Health, National Institute of Mental Health, Panic Disorder: When Fear Overwhelms.

National Institutes of Health, National Library of Medicine, Anxiety Disorders Among Women: A Female Lifespan Approach, April 2017.

National Institutes of Health, National Library of Medicine, Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety, July 2018.

North American Menopause Society, Depression, Mood Swings, Anxiety, 2022.

North American Menopause Society, Going Mad in Perimenopause? Signs and Solutions, 2022.