When Sara Stamey was 53, she was worried about her finances, her position as a non-tenured college professor, and feeling old and unattractive. Having considered herself carefree when she was younger, she found herself struggling with these newfound anxieties. She needed to sort things out. So, one day, she began her diary entry with “Dear Diary, I’m tired of being tragic.” It was a turning point for her.
“I didn’t worry when I was younger,” Stamey said, who is now 68 and lives in Bellingham, Wash. “I’d always been a very adventurous person. I taught scuba in the Caribbean, backpacked all through South America and Greece. I was never considered as a fearful person, but suddenly I was afraid of a lot of things.”
Now, Stamey believes that these changes were caused by perimenopause and the increased anxiety that can come with it. Perimenopause, the stage where women transition from their childbearing years to menopause, brings symptoms many women have heard of: hot flashes, vaginal dryness, weight gain. But anxiety is also a symptom, and according to Barb Dehn, a nurse practitioner and a member of the HealthyWomen Women’s Health Advisory Council, it gets little attention.
“A lot of things are not understood by women as hormonal changes,” Dehn said. “Many women come in to see me and say, ‘I am not the same person.’”
These sudden changes are caused by the declining levels of estrogen during perimenopause. Because that hormone feeds serotonin, the “happy chemical,” the drop in estrogen can trigger anxiety.
“There’s a clear correlation between perimenopause and the drop of estrogen,” said Alicia Jackson, founder and chief executive of Evernow, a women’s telemedicine start-up that conducted a study on 40,000 women going through menopause that found that nearly 60 percent reported severe anxiety or depression. “It’s not all in their head; it’s in their bodies and not some made-up thing.”
Such was the case for Patricia Brown. The mother of three and breast cancer survivor from New York experienced perimenopause earlier than most, in her late 30s, because of cancer and a hysterectomy within a couple of years of each other. While she was going through it, she felt like she was having a nervous breakdown, she said.
“It was overwhelming to the point where I literally had to call my doctor,” Brown added. “I thought I was losing it. Just really nervous. It came to the point where driving was a little uncomfortable, like if I was driving over bridges, and I never had that.”
For New Jersey resident Yolanda Colon, the anxiety hit as soon as her ovaries were removed because of fibroid tumors when she was in her late 30s.
Colon said she had always been a “Nervous Nelly” but that perimenopause heightened that anxiety. “I didn’t feel safe. I felt like I had to be constantly looking over my shoulder when I would walk the dogs,” she said. “When I went back to work, I would cry over anything.”
Other perimenopausal symptoms can additionally trigger anxiety, as happened for Angela Gala Gonzalez of Houston. She began perimenopause when she was 47 and had just emigrated from Cuba. She said she experienced not just anxiety but also painful menstrual cramps for the first time.
“I felt miserable,” Gonzalez said. “I noticed that I was very anxious around the days of the month. Probably the fact that I knew that I’d be in pain was a trigger for anxiety and stress.”
All the women said they were unaware that hormonal changes were behind their overwhelming anxiety. Some said their mothers and female relatives never told them what to expect during perimenopause. Others noted that society does not discuss perimenopause openly enough, so they didn’t feel they had anyone to talk to.
For Colon and her husband, it was an added difficulty that she was younger than most people are when they go through perimenopause. She said that her husband told her that while he may not have fully understood what she is going through, he did try. He told her it was easy to forget, “because you don’t look like someone going through menopause.”
Colon also envisioned perimenopausal women as looking older. But through her own experiences, she has developed a new viewpoint: “Menopause strips you of so much, so much” no matter the age, she said.
Some of the women interviewed for this article reported that their doctors were not much help in explaining what they were going through and how to manage it, either. Stamey said her gynecologist at the time was dismissive about her concerns.
Joy, who is 49 and lives in North Carolina and asked to be identified by her first name out of privacy concerns about her job, said she had the same problem.
“My mother never told me about it,” she said, adding she did not understand what was going on until she was almost through perimenopause. “When I went to talk to my gynecologist, who was a woman, [she said] the answer for you is just to start taking birth control pills for 28 days. And that was it. There was no discussion of [how] it could be a hormone regulation issue, [that] this could be something you can deal with through diet, exercise and supplements.”
Joy said she found a health coach who gave her the support and information she felt medical doctors were not giving her.
Dehn said the tepid support from some physicians might be related to a lack of training in how to treat perimenopause. “If you talk to some,” she said, “many have had only one hour of education in women’s health in midlife.”
Despite a general lack of information and education, women are finding ways to treat their perimenopausal-driven anxiety. Hormone replacement therapy (HRT) — which is medication that contains female hormones to replace the ones your body is no longer making — is a common treatment.
Stamey said HRT did wonders for her: “Within a week to 10 days, I was my old self again.”
But HRT isn’t advised for some people, including those who have had or have the genes for breast or ovarian cancer, or those with heart and blood vessel disease. According to the Mayo Clinic, HRT risks depend on those family histories, the type of hormone therapy, and the duration and dose of the medication.
Gonzalez, Brown and Colon found other ways to cope with the anxiety associated with perimenopause.
“I started to see a therapist,” Colon said. “I’ve learned to work with it, learned to manage it. If I’m going to get emotional, I’m going to get emotional, I’m sorry. That’s how it is.”
Brown also took that route. “I had to really just tough it out,” she said. “Basically, I just pushed through it. Being the fact that I have a background as an athlete, I started working out. I cut a lot of sweets out, drank my water. Just got into a routine, and I noticed a lot of the anxiety subsided.”
For Gonzalez, the experience led to a career change. She is now a health coach and helps guide other women through perimenopause.
“Perimenopause is unavoidable, inevitable,” she said. “It is important to see menopause as it is, a natural process that all women have to go through. Understand what it means and how it affects your body. Stay ahead of any risk factor that would impact your transition.”
Jackson agrees that it is time society recognizes perimenopause as a natural stage in a woman’s life.
“We need to de-link it from getting older,” she said. “Of course this is the end of their reproductive years. But it is not about being an old lady.”
Stamey, whose experience inspired her to write a novel called “Pause,” said she tells younger women not to anticipate disaster. “Life really can adjust in a good way,” she said. “But also, be aware that there’s these obstacles coming up, and be informed about your options.”
For Dehn, it’s important for women to know that symptoms won’t last forever — but that their hormones will not go back to pre-perimenopausal levels.
“As providers, we don’t want women to just try to get by and survive as best they can,” she said. “We want to help women find evidence-based solutions, understand the benefits and the risks so that they can be optimistic and hopeful that things will get better. I believe in enjoying your life at every age and stage.”