Part 1: A Conversation About Menopause and Anxiety

As part of Menopause Wellness Week, we reached out to an expert to learn more about how menopause can affect women’s mental health. It can be a very difficult time in a woman’s life, but our Real Woman, Real Feedback survey revealed that a shocking 92% of women felt uncomfortable going to see a professional to discuss the changes they were experiencing through menopause. Talking about our experiences openly is the only way to remove the stigma and make sure women get the support and understanding they need.

Tracey Patrick is an accredited Cognitive Behavioural Therapist. As a director of MoodWise, she has extensive experience treating people suffering from anxiety, depression, and other mood disorders.

Tracey joined us for a frank conversation about how to recognise the symptoms of anxiety, what the menopause has to do with it, and why it’s so important for women to be able to talk about their experiences.

Tracey, why is it that so many women suffer anxiety in the lead up to and during menopause? What makes you more susceptible to it during that time?

Well, apart from the fact that you’ve got all these hormonal changes happening, anxiety comes from our perception. So, if your skin is starting to age, and suddenly you start to notice that people are looking a little bit younger than you, you start having hot flushes, all of these things – we start judging ourselves based on what we’re feeling, and what we think other people are thinking about us.

Our place in the world can feel as though it’s changing a little bit. That’s a massive threat which will ramp up our threat system. And when our threat system is activated, we start to get ready for action. We go on guard and start thinking people are looking at us in an odd way – and they’re not, they’re probably looking at the person standing behind us, but we start misinterpreting all of these things. We think, “Is it because I’ve gone a bit red and I’m sitting here fanning myself?”

We’ll start to feel really uncomfortable when we feel those emotions because we get a surge of adrenaline – which is great when you’re being chased by a tiger; not so great when you’re sitting in a meeting opposite half a dozen people and you’re suddenly feeling not yourself.

Memory loss can also happen for lot of people with menopause and bring a lot of fear with it.

For me, brain fog was a massive issue. You feel like, “What the hell is wrong with me?” And that is a scary thought if you’ve been somebody who has gone through life with a really clear sense of who they are, feeling comfortable and confident. To lose words, your train of thought, concentration – you start to really doubt yourself, and with doubt comes uncertainty.

So you’re putting pressure on yourself, judging yourself based on previous standards even though things are changing. But then there’s also the other side, where women don’t want to admit what’s happening. Women’s “moodiness” is always blamed on your period when you’re younger, menopause when you’re older, so we learn to hide it. We internalise it so people don’t see it and judge us.

Exactly, and so when it starts to happen, it’s often not something that is talked about, even among friends. If one person could talk about it, that might open up other people and they can start having a conversation about it.

My mother’s generation never spoke about it. My generation talks about it a little bit (I’m 58 now), but probably people’s husbands would rather not hear them talk about it, thank you very much! And so it is massively misunderstood.

And I suppose that’s passed down through generations. I know my gran never talked to my mum about it. So actually, the older women in families haven’t said anything about it, even to their daughters.

What exactly is the effect that anxiety has on you? And what can happen if you just carry on without looking to change anything?

When we start to feel anxious, our body will start to respond to that very automatically. From an evolutionary point of view, we’re designed to respond to danger. Fear will kick in. Anxiety comes when there’s that perception of fear – it’s the thought of the tiger that will kick off that physical response. And our body will start prioritising and doing what it needs to do.

For instance, you might notice that your heart is beating faster, because it wants to quickly get the adrenaline that is starting to course through your body to your large muscle groups. We need a pump to do that. Sometimes you might be aware of that, and some people will really feel their heart going. Other times it might be smaller palpitations.

Another thing people might notice is that their breathing will change. That’s because the adrenaline wants well-oxygenated blood to get to those big muscle groups. And again, some people will really notice a big change, while for other people it’s a smaller reaction.

As soon as we notice our breathing is altered we can start to feel different because we’re not getting the right combination of oxygen and carbon dioxide. If that balance goes out, we can start to feel a bit woozy, a little bit dizzy. Then we might start to worry that we’re going to faint – and of course that is akin to another sabretooth tiger walking across our mind. So then we start responding to that.

And because we’re not making a conscious decision to do any of this, it’s all our sympathetic nervous system kicking in to “help” us, we start to feel out of control.

Then it carries on. Our digestion can change. Your body will start to prioritise – what do you need to do to help you in this imminent danger? And what you probably aren’t going to do in the face of this danger is eat a sandwich! So it will say, we don’t need your digestive system to work as it normally does. You’ll get a dry mouth, for example, because your body is trying to conserve energy to get you away from the danger. Great! But when you’re sat having a meal with people, or you’re trying to talk, it’s not what you want. And then your stomach suddenly goes. When your body starts doing these things, it starts to feel a little less reliable.

Then, if we start to get tense, we’ll start to get shaky. And the shakiness is just our body saying, “Could you move a bit?” Because we’re not actually designed to be sitting very static and holding ourselves in all the time.

So the body does lots of things that are designed to help us, but we don’t know that, so we misinterpret it. We start to notice, but we don’t understand why it’s happening, and that just makes us more anxious: “There’s something wrong. Something ELSE that’s wrong with me. Bloody hell, I can’t even do this!”

And it’s so difficult to be comfortable in situations when you’re going to feel like that.

Yes, definitely and if you are feeling something emotionally, you are going to have a physical response to it. It’s how evolution has ‘designed’ us to help us survive.

So we sense these physical responses, and we don’t like it. But instead of addressing it, we just change our behaviour, and not in a positive way. Maybe you’ll just stop going to meetings. You’ll decide not to go out with your friends, because you don’t want to feel uncomfortable and like you’re being judged. You feel less confident in yourself.

Could it affect other things as well, like your sleep?

Sleep will definitely be impacted. One of the biggest problems with having trouble sleeping is that we then start to dread going to bed. So the thought that I might not sleep very well or I might wake up a few times because I’m going to be absolutely drenched through, that makes getting to sleep even more difficult. And again your body helpfully responds to all that by going, “Here! Have some adrenaline to fight the scary thing!” So it’s a real battle within ourselves the whole time.

And that just leads on to more and more things. Overthinking everything.

Totally overthinking. Catastrophising. And probably a lot of self-criticism. A lot of, “Well, everybody else is managing. What’s wrong with me? Why can’t I do this?”

And that is so important because in reality other people aren’t managing either. We just don’t know that because people aren’t talking about it.

No, they aren’t. Mariella Frostrup did a TV programme a few years ago on the menopause. I was quite surprised when it came on – it was the first time I’d really seen anything, you know at prime time, 8, 9 o’clock, where people were talking about the menopause. I thought it was great!

Do you see many women who come to you with anxiety with regard to menopause? Or is it normally they think it’s something else and then it turns out to be a factor?

I think it generally is a part of it. I don’t know that I’ve had somebody turn up, specifically, and said, “I’m struggling with menopause, can you help me with it?” So if I’m working with women of that age, I will ask them about periods, peri-menopause, menopause, just to see where they sit with it. And I would say it’s a fairly high percentage of women that are then surprised when I say, might this be anything to do with the menopause? Because we are taught to ignore it and just get on with things.

It’s such a huge change, it shouldn’t be a surprise that it’s a struggle.

And it’s also happening for women at a time of their life when they can be quite well-advanced, career-wise. They have more responsibility. You know, they might have had any family that they’re going to have. They might be a grandmother, or are about to be. But they then also have parents who are getting older.

So actually – you’re probably working full time, you’ve got older parents, you’ve got your own children, and you’ve got younger children. And you’re kind of like the filler between the sandwich, really – you’re holding everything together. You’re looking after everybody. And in amongst all of that, I think it’s probably quite easy to lose track of the fact that actually, before we can look after anybody else, we have to look after ourselves.

Make sure to check out part two of our interview, for tips from Tracey on how we can look after ourselves, and a simple but powerful exercise to help manage anxiety.

If you’re interested in learning more about cognitive behavioural therapy and the work Tracey does, visit her MoodWise clinic or find her on Twitter @MoodWiseCBT.

Encouraging conversations about menopause is a key focus for us at Emepelle. Our survey Real Woman, Real Feedback has given us insight into the experiences of lots of different women leading up to and post-menopause, and has given us a great steer on the topics that you want to talk about more. That’s why we’ve teamed up with experts like Tracey to bring relevant and interesting content about menopause and everything around it to our fantastic customers and online community.

Emepelle is a revolutionary skincare range designed to treat the root cause of menopausal skin ageing – oestrogen loss – for skin that’s hydrated, brighter and firmer. It features revolutionary MEP Technology, a non-hormonal oestrogen receptor stimulator, as well as numerous anti-ageing ingredients.

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