Mood Changes in Menopausal Women: A Focus on Anxiety

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Menopausal status should be considered when assessing women with anxiety.
Menopausal status should be considered when assessing women with anxiety.

Psychosocial Factors that Contribute to Anxiety

“Life stage issues are extremely important contributors to anxiety in women at midlife,” Dr Mathews noted. “Stressors related to aging begin at perimenopause and tend to intensify with increasing age.”

During this time, “there are many changes in how women regard their roles within the family unit and within society,” she said. For example, “many women experience changes in the family, as children grow up, go off to school, get married, or get jobs.” Some women return to work, while at the other end of the menopausal spectrum, some women are getting ready to retire.  Other “life transition changes” involve becoming the “sandwich generation, caring for aging parents as well as growing children.”

Additional factors that contribute to late-life anxiety are poor coping skills, childlessness, financial strain, fair or poor perceived health, and history of anxiety or trauma.2,6

Treating Menopausal Anxiety

Anxiety disorders during menopause can be treated with psychotherapy, pharmacotherapy, or a combination of modalities based on patient preference and symptom severity.2

Pharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are first-line treatment in anxiety disorders and have been found to be effective in treating symptoms of geriatric depression as well as anxiety.2 

Prescribing medication for older patients can be “complex,” since patients often have other medical conditions and take other medications, leading to potential drug-drug interactions. Additionally, reduction in libido and sexual dysfunction may be particularly concerning, as patients may already struggle with these issues due to the aging process.2

Hormone therapy is often prescribed to alleviate vasomotor symptoms and has shown to be effective in alleviating symptoms of depression as well, Dr Mathews said. In the case of mild depression or clinically significant vasomotor symptoms, hormone therapy may be sufficient.11 Women with surgically induced menopause are at particular risk of depression and may benefit from hormone therapy for this indication.12 However, it is unclear whether the impact of this treatment is direct or attributable to its effect on vasomotor symptoms.2

“Some women find hormone therapy preferable to psychiatric medication,” Dr Mathews noted, adding that she recommends hormone therapy for the shortest period possible. However, “since menopausal symptoms can continue for even a few years following the final menstrual period, if a woman is experiencing no ill effects, I tend to wait before discontinuing.”

Many women turn to complementary/alternative approaches to alleviate menopausal symptoms.13 Dr Mathews hesitates to support herbal supplements “that have not been rigorously studied in terms of safety and efficacy.” However, “if a patient is using these products, experiencing improvement, and there is no risk, she can continue their use. But I monitor closely for side effects, worsening mood, or medical complaints.”

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