The Relationship Between Menopause and Stress

illustration of a woman with a cloud of stress around her


And how to manage hot flash-induced anxiety.

You might think that the longer we live and the more we experience in life, the less stress we’d suffer from. When we’re young, we’re stressed about our careers and our futures. When we have young families, we’re worried about the kids. When they start growing up, we’re stressed about their futures. By the time we’re empty nesters or retiring, we’ve certainly earned a break. But, new stressors might take the place of those old ones — especially for people experiencing menopause

Menopause is a major transition defined as the cessation of menstrual periods for 12 consistent months. When we go through menopause, our bodies cease producing estrogen and progesterone so we are no longer able to become pregnant.

The decline in hormones can cause a series of conditions and symptoms including hot flashes, night sweats, hair loss, weight gain, insomnia, bone loss, depression, anxiety, loss of libido, and vaginal dryness. Sounds stressful, doesn’t it?

While most people think of menopause as an inconvenience, for some, it’s much more than that. 

The connection between stress and menopause

Simply put, menopause can cause stress, and stress can impact menopause.

Chemically speaking, during perimenopause, stress hormones such as cortisol are affected by fluctuating estrogen and progesterone levels. Low estrogen can affect cortisol levels, and menopause symptoms can echo cortisol imbalances.

The characteristic “vasomotor symptoms” — you know them as hot flashes — are not just the cause of immense discomfort, both physically and mentally. Research discussed at a recent meeting of the North American Menopause Society (NAMS) showed that they aren’t just a momentary nuisance, but they’re also associated with one’s physical and emotional health. 

It makes sense: Having several hot flashes per day can be stressful. Making plans when you know you might break out in a sweat a few times throughout the activity can be tricky. And how do you dress for a hot flash when it’s cold out? Hot flashes often interrupt sleep, too. Sleep fragmentations have been shown to significantly affect your mood, which you probably already knew.

The only FDA-approved treatment for vasomotor symptoms is hormone therapy. Some women use low-dose Paroxetine, which in higher doses is used as an antidepressant. Non-medication therapies for hot flashes, such as cognitive behavioral therapy, have shown how thoughts and emotions can affect hot flashes and cause stress.

In addition to menopause causing stress in women, stress can also affect menopausal symptoms. Worry and anxiety can affect sleep and contribute to insomnia in perimenopausal women. Stress increases cortisol, and increased cortisol can cause a decrease in memory. 

Add to that the other menopause symptoms you might experience, including hair loss, weight gain, depression, loss of libido, and vaginal dryness, and it’s safe to stay menopause isn’t a walk in the park. 

Menopause symptoms aren’t the only cause of mid-life stress — there are aging parents, troubled teenagers, work demands, and intimate relationship issues, not to mention global issues like climate change, political conflict, and war. If you thought it wasn’t easy being a teen, try being a woman in her 50s. This layering of stressors creates a major burden that can significantly impact a menopausal person’s health and well-being.

How we deal with the symptoms of menopause and other everyday stressors can determine our ability to thrive during this stage of our lives.

What can you do to build your resilience to stress?

While it’s ideal to build your resilience before menopause, it’s never too late to start optimizing your health to counter the increased stress that can accompany “the change.

Organize your daily routines

Try to organize your schedule to eliminate last-minute madness that causes you to rush. Plan ahead to slow things down. 

Ask yourself, What are things that can make my life easier and gentler? Write down the answers and start making adjustments. Start with small lifestyle changes, such as going to bed a half hour earlier to get more sleep — the more rested you are, the more equipped you will be to deal with stressful situations. Continue to add changes as you go. 

Use the DMWS plan

In my book Don’t Mess With Stress: A Simple Guide to Managing Stress, Optimizing Health, and Making the World a Better Place, I outline a strategy to deal with menopause stress head-on. Here are the basic elements:

D: Diet

Limit or avoid inflammatory foods like sugar, white flour, candy, cookies, pastries, processed and deep-fried foods, and caffeine. These foods gunk up our brains and bodies and increase our risk of heart disease, stroke, diabetes, memory loss, and other conditions that can start to show up in mid-life. In addition, sugar and caffeine can make us feel hyper and anxious, and caffeine can cause palpitations. If it’s hard to go cold turkey, begin by swapping in one vegetable per day to your diet. Aim for five to nine servings of veggies and fruits per day.   

M: Meditate

Meditation helps to decrease stress and can even lower blood pressure. There are many types of meditation, and you can find the right one for you through books and apps. I’ve found personal instruction to be very helpful and recommend Transcendental Meditation and the breathing meditation taught by Art of Living. When you’re feeling stressed, closing your eyes for one minute and focusing your awareness on your inhalation and exhalation allows you to “pause” briefly and calm yourself down. It interrupts the stress response.

W: Walk, Move, Exercise, Dance

Naturally, people start to slow down at the time of menopause. But physical activity has so many benefits for your memory, cardiovascular system, mood, well-being, and weight. Start by walking a bit each day and increase the time or distance every week.

S: Sleep  

Stress can affect your sleep during menopause. Hot flashes and night sweats disrupt sleep and can lead to irritability. Sleep deprivation also affects work performance and social interactions and increases the risk of injury and accidents. Hormone therapy — estrogen and progesterone for women who have a uterus and estrogen alone for women without a uterus — is only indicated to treat hot flashes. A promising non-drug approach to dealing with insomnia in menopausal women is called Cognitive Behavioral Therapy for Insomnia (CBT-I). You can try it out with apps like CBT-I Coach or Caria

Remember, menopause is a new phase in a woman’s life and can be a very stressful time. Some women experience very few symptoms while others experience many. Either way, it’s important to live a healthy and active life to decrease the risks of mid- to later-life diseases like diabetes, heart disease, arthritis, memory loss, and mood disorders. The first step to combatting stress is to have a plan, so simply reading this article has set you on the right path.

Jill Baron, MD, is a Board-Certified Family Physician (FAAFP), North American Menopause Society Certified Menopause Practitioner (NCMP), Certified Functional Medicine Practitioner (IFMCP), and author of Don’t Mess With Stress: A Simple Guide to Managing Stress, Optimizing Health, and Making the World a Better Place. Sign up to receive her health and well-being newsletter and a free guide for Stress Management.