Episode 20 - Hormonal Anxiety: Understanding and Managing It

The Anxiety That Arrived Without a Reason

When you’re anxious about nothing and everything simultaneously

In this episode:

You’re lying in bed. Nothing has happened. Nobody has said anything. And yet your chest is tight, your heart is racing, and your brain is scanning for threats that don’t exist. I explain why menopause anxiety is hormonal, not psychological — the progesterone-GABA deficit, the serotonin fluctuation, the lowered cortisol threshold — and give you practical tools: morning light, caffeine timing, extended exhale breathing, and the art of not fighting the anxiety, which paradoxically makes it worse.

Your One Thing this week:

Tomorrow morning, step outside within the first hour of waking. Stand in natural daylight for five minutes. No phone. Just light. Do it every morning this week and notice whether your afternoon anxiety is any different by Friday.

Links:

→ Grab the free 5 Riviera Standards Starter Guide: https://rivieramenopausemethod.kit.com/5-riviera-standards

→ Follow Riviera Menopause on Instagram: https://www.instagram.com/rivieramenopause/

If this helped you understand your anxiety, send it to the woman who cancels plans because the dread is too much. Tell her: it’s hormonal. It’s temporary. And there are things that help.

Transcript

SPEAKER_00 0:01

I need to describe a feeling, and I want you to tell me if you recognise it. You're lying in bed, or sitting at your desk, or driving, you're not doing anything stressful, nothing's happened, nobody said anything, there's no email to worry about, no crisis to manage, no deadline bearing down on you, and yet your chest feels tight, your heart's beating slightly too fast, your brain's scanning for threats like a security camera panning left, panning right, looking for danger, and there is no danger. But the feeling doesn't care about the absence of danger, the feeling's there anyway. Heavy, humming, relentless. And the worst part is that you can't explain it to anyone because when someone asks what are you anxious about, the honest answer is everything and nothing. Which sounds ridiculous, but it's the most accurate description for what's happening. If you recognise that feeling, this episode is going to give you an explanation that I hope will take some of its power away. We talked about confidence in episode 5 and touched on the neurochemistry. Today we're going deeper into anxiety specifically, because for a lot of women, this is the symptom that is most distressing and most misunderstood. And I want to make sure that you understand what's happening so you can stop thinking there's something psychologically wrong with you, because there almost certainly isn't. And this isn't necessarily an anxiety disorder, there is a hormonal explanation for it. So I want to be clear about that from the start because if you've developed anxiety in your 40s that you didn't have in your 30s and it arrived without any kind of triggering event, the most likely explanation is hormonal, not psychological hormonal. And here's what's happening. Progesterone, again, uh your calming hormone is declining. It enhances GABA, which is your brain's primary calming neurotransmitter. Less progesterone means less GABA activity, which means your brain's ability to self-soothe is reduced. You feel more on edge, more vigilant, more reactive to the stimuli that would previously have barely registered. Estrogen's also fluctuating, and in perimenopause, fluctuations can be extreme, high on one week or even one day, low the next, swinging unpredictably. Each fluctuation affects serotonin, which affects mood stability and emotional regulation. The inconsistency is part of what makes perimenopause anxiety so distressing. You can't predict when it will arrive because the hormonal fluctuations are themselves unpredictable. Combined with all this, your course result is elevated. So your baseline stress response has shifted upwards, which means your nervous system is interpreting neutral situations as mildly threatening. Not because you're irrational, but because the chemical threshold for threat detected has lowered. Your alarm system has become way more sensitive than it was, and the same stimuli that your brain used to file under not important is now being flagged as potentially dangerous. That's why the anxiety hasn't got an object to it necessarily. You're not anxious about something. You're anxious because your nervous system is in a heightened state. It's scanning for threats because the chemistry is telling it that there are threats, but there aren't threats. The system is miscalibrated, if you like, and the miscalibration is in fact fixable and it's not a permanent state, which is very good news. But this often gets misdiagnosed. And I need to tread really carefully here. Firstly, because I'm not a qualified medical professional, and secondly, because I'm not in any way anti-medication or antidepressants or anything like that. But I do think that something needs to be said because a significant number of women in perimenopause and menopause are being prescribed antidepressants for anxiety that's hormonally driven. They go to their GP, they describe anxiety, they receive a prescription for an SSRI, and SSRIs can be appropriate and helpful for some women. I'm not dismissing that. But if the anxiety is primarily driven by hormonal changes, an antidepressant is treating the symptom, not the cause. And it's worth having a conversation with your GP about whether hormonal factors should be explored before or alongside any medication. That's not anti-doctor at all, that's just pro-information. And you're entitled to have that conversation and you really should be having that conversation and gathering that information. I haven't got any authority to tell you what to take or not to take. That's between you and your doctor. But what I can tell you is that if your anxiety appeared in your 40s and has no clear psychological trigger and it's accompanied by other menopause symptoms, the hormonal explanation should be on the table for discussion. If your GP hasn't raised it, you can raise it. Episode 9 actually covers on how to do that with your doctor. And okay, so what can help? And we're not talking medical stuff here, that's for your for your doctor to decide, but um tools for an overactive nervous system, if you like. So the things that can help manage anxiety that's hormonally driven are often lifestyle tools. They're not generally clinical interventions, but they will work alongside whatever else you're doing. So the first one is morning light, and I've mentioned this before, and I will keep mentioning it because it's one of the most effective, most free, and most underused interventions available. Five to ten minutes of natural daylight within the first hour of waking resets your entire cortisol rhythm. It tells your body the day has started, cortisol should peak now and then decline through the day. When cortisol follows a healthy rhythm, anxiety is lower in the afternoon and in the evening. When the rhythm's disrupted, which screens, irregular wake-up times, and indoor mornings all contribute to, cortisol stays elevated all day. Five minutes outside, every morning, rain or shine, doesn't matter, it's the it's the light quality that you're looking for. So it doesn't really matter if it's sunny or not, it's just daylight. The second thing is caffeine timing, and I know I covered this in an earlier episode, but it does bear repeating here because it's specifically relevant to anxiety. Coffee within the first hour of waking amplifies your cortisol peak. And for an anxious person in menopause, that amplified peak can set the tone for the entire day. Just wait 90 minutes if you can. Have your coffee after the natural cortisol peak has subsided. The anxiety reduction will be noticeable, I promise you. The third thing you can do is breath work, specifically an extended exhale breathing. So you breathe in for four counts, breathe out for six or eight counts, or you can do seven-eleven, which is breathe in for seven and breathe out for eleven. And the point is the extended exhale activates your parasympathetic nervous system through the vagus nerve. That's the fastest way to shift your body from fight or flight into rest and digest. Two minutes of this when you feel the anxiety building can interrupt the escalation. It's not a cure, it's a circuit breaker, and circuit breakers are invaluable. The fourth thing is reducing stimulation in the evening, and we covered this in last week's episode about your uh 10 pm phone scrolling, but it applies more broadly. Your nervous system needs a clear wind-down signal. So lower lights, a quiet environment, less input, less noise, less screens. Think of your evening as a runway for sleep. It's a gradual descent, not a crash landing onto your pillow. And finally, movement. Again, this keeps coming up, I know, and if you hate exercise, I'm sorry, but it really is the best medicine. Gentle, regular, preferably outdoors. Walking is consistently shown to reduce anxiety and menopausal women. Not running, because that can raise cortisol, but walking. The rhythm of walking, the bilateral movement, the sensory experience of being outside, all of it soothes the nervous system. 20 minutes, daily if possible, more effective for anxiety than most things you can buy. Okay, I want to say something here that might seem contradictory. One of the most helpful things you can do with menopausal anxiety is to stop fighting it. Not stop managing it, because that's important, and everything I just described is part of that management, but stop fighting the fact that it exists because fighting it adds a second layer. Anxiety about the anxiety. Why am I anxious? I shouldn't be anxious. What's wrong with me? Is this going to last forever? That layer is sometimes worse than the anxiety itself, because the original anxiety is hormonal. The second layer is psychological, and together they create a feedback loop that feels inescapable. What can help is saying, I'm experiencing anxiety, it's hormonal, it's temporary, it's uncomfortable, but it's not dangerous, and it will pass. That's not just some positive thinking woo-woo. That's accurate thinking. And saying it out loud is gonna really help put everything into perspective. And accurate thinking is the antidote to the catastrophizing that anxiety loves to generate. The anxiety won't last forever. The hormonal transition is exactly that, a transition. It has a beginning, it has a middle, and it has another side. And the intensity of the anxiety typically peaks around the most volatile hormonal phase and reduces as the body begins to find its new equilibrium. You're in the middle. The middle's the hardest part, but you're not stuck here forever. And I want to say one more thing about this. Talk about it. Not to everyone, but to someone, a friend, a partner, a therapist if that's available to you. The anxiety thrives in silence. It tells you that nobody would understand, that you should just cope, that talking about it is somehow self-indulgent. That's the anxiety talking. And anxiety is a bloody liar, and one of its favourite lies is that you should keep it to yourself. You should not. Sharing it doesn't make it disappear, but it does take it out of the dark, and anxiety is always worse in the dark. Okay, your one thing this week. Tomorrow morning, step outside within the first hour of waking. Stand in the natural daylight for five minutes. No phone, just light. If you can do a bit of 7-Eleven breathing while you do it, fab. Do this every morning for a week and notice whether your afternoon and evening anxiety is any different by Friday. Five minutes. It's free, doesn't have any equipment, doesn't require an app, it's just you and the sky. If you've been living with anxiety and wondering what's wrong with you, I hope this episode has offered you a different frame. Nothing's wrong with you, something's shifting in you, and shifting is not necessarily the same thing as breaking. You're going through a hormonal transition that has temporarily sensitized your nervous system. Every tool I've just described, the light, the breath, the walking, the reduction in stimulation, gives your nervous system evidence that you are safe. Enough evidence, consistently enough, and the system will begin to recalibrate. Next week we're going simple. We're talking about walking, not hiking, not power walking, not adding it to your fitness tracker, just walking. And why it's the most underrated, most accessible, most evidence-based thing that you can do for your menopausal body. And why, it might be the only episode where the one thing is also the whole thing. If this episode on anxiety helps you understand your anxiety, then send it to someone who's living with it. A woman who cancels plans because the dread is too much, the woman who lies awake at night with her heart racing for no reason, tell her it's hormonal, it's temporary, and here are things that can help. But for now, that's me signing off with love from Monaco. I'll see you next week.