Most women are prepared for the physical symptoms of menopause. Although experiences such as hot flushes or vaginal dryness and painful sex vary from woman to woman, in general, they are an expected part of the process. Yet many women aren't prepared for the emotional changes, particularly the increase in anxiety. Women may find it hard to talk about anxiety if they feel that it's not a normal part of menopause, and so may not get the help they need. If you're approaching menopause - or if you know someone who is - then learning what to expect can make a huge difference.
Women attending menopause clinics are often told that a lack of libido is related to changes in oestrogen levels. These hormonal changes will cause vaginal dryness and can make sex more painful. Women are advised that using additional lubricants will make sex easier and less painful, and it's assumed that loss of libido is mainly a hormonal issue. Yet a study in the 1980s in the Journal of Psychology and Psychotherapy concluded that anxiety, not physical discomfort or hormonal changes, was the main reason for decreased sexual activity.
More recent studies have confirmed this link, finding that rates of anxiety and depression are higher in women who also experience painful intercourse, and also that poor sleep quality - a common symptom of anxiety - is reported by women who are most affected by hormonal changes. The Journal of the North American Menopause Society reported in 2008 that menopausal status was the single biggest factor in whether the women in the study experienced a good night's sleep.
Anxiety isn't only associated with poor sleep and painful sex. It's also closely linked with hot flushes. There's a clear link between the frequency and severity of hot flashes and the likelihood of feeling anxious. This is most common in "somatic" anxiety - where you feel the physical symptoms of anxiety such as increased heart rate, dry mouth or upset tummy - but is also associated with "affective" anxiety, where you experience the emotion without necessarily having the physical symptoms. Women risk being unprepared and overwhelmed by the experience if they have never been told that a hot flush, while uncomfortable in itself, can also feel like having a mild panic attack. And many women who have experienced anxiety when they were premenopausal aren't told that being anxious is likely to make hot flashes worse.
There are plenty of treatments for anxiety, from medication to Cognitive Behaviour Therapy or self-help, but too many women don't seek help because they don't expect that the menopause will affect their mood in this way. If you're menopausal and find yourself becoming more anxious, you're not alone. And if you have a friend or relative who's going through menopause, don't only sympathise with them about hot flashes. Ask about their mood too; you might be the person who can help them share their feelings and take a step towards dealing with their anxiety.
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