Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

• Peer support groups (such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), etc.)
• Therapy and Psychiatry
• Inpatient detox/residential drug or alcohol treatment
• Medication-assisted treatments
• And more

You can visit the online SAMHSA treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The lists below are not all-encompassing, but they should help you get started with your goals. 

Substance Use Resources

Alcohol Resources

Opioid Resources

Smoking/Tobacco Resources

Mental Health Providers

To Learn More About Substance Use and Health 

Next Steps

Reducing or eliminating substances is not always easy! It can certainly be a challenge, but with the proper support, you can be on your way towards achieving your goals.   

The first step is connecting with a resource that is right for you. You can also speak with your primary care provider to discuss any concerns you may have. Your insurance company should be able to provide you with guidance on inpatient and outpatient treatment when needed.  

There is hope.  Reach out and allow yourself to receive support because you deserve to be healthy and happy! 

Reviewed by the Ovia Health Clinical Team

As you probably know, not all sleep is created equal. There’s a big difference between a good night’s rest, getting just enough shut-eye to function during the day, and more serious sleep issues that affect your quality of life.

In-app sleep tracking during menopause

Menopause can last several years. During this time, you might notice various physical changes and mental health symptoms — and sleep falls somewhere in the middle.

You can log all these symptoms and changes through the Ovia app. This will give you a clear picture of whether things are getting worse or improving and help you and your healthcare provider find the best possible solution.

Here’s a breakdown of what you might log in the app.

Difficulty falling asleep

Lots of folks have trouble falling asleep at some point or another. Whether you’re in your menopausal years or at a different life stage, it’s helpful to know if this is an every-night occurrence related to other health issues, or just something that happens when you’re busier at work or home.

Insomnia is common among middle-aged and older adults, and it goes beyond having trouble dozing off. People with this sleep disorder struggle to fall asleep and stay asleep, and they may not be able to get any shut-eye at all.

It can come and go or be a more brief occurrence. In any case, tracking your insomnia will help your provider know if it’s a serious concern that requires treatment.

Hot flashes and night sweats

Hot flashes and night sweats are common physical symptoms of menopause. Not surprisingly, they can make it harder to sleep comfortably and get a good night’s rest.

Urinary symptoms

Urinary symptoms affect menopausal women at all hours of the day, but they can be especially irksome at night. Incontinence (loss of bladder control) and a stronger or more frequent urge to urinate might make it harder to fall asleep and stay asleep.

Lifestyle habits and before-bed routine

If you’re facing sleep issues, it’s good to take note of your lifestyle habits and what you do before turning in for the night. While menopause could be the primary culprit, there might be other factors at play.

You can log:

• When you drink alcohol
• How often you exercise
• Your caffeine intake
• Whether you’re eating a well-rounded diet
• How much water you’re drinking throughout the day
• The days you read a book, watched TV, or scrolled on your phone before bed

Sleep issues aren’t always a result of menopause. People in their forties and fifties might be simultaneously supporting their children and aging parents, working full-time jobs, figuring out when they can retire, or potentially facing a serious illness.

Whatever the cause, elevated stress levels can affect your sleep. Tracking your moods, physical symptoms, and lifestyle habits with Ovia can help you stay on top of your health and ultimately improve your well-being.

Get started today.

Sources

• Mayo Clinic Staff. “Menopause.” Mayo Clinic. Mayo Clinic. October 14, 2020. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397. 
• “Menopause.” Cleveland Clinic. Cleveland Clinic. October 5, 2021. https://my.clevelandclinic.org/health/diseases/21841-menopause. 
• “What Is Menopause?” National Institute on Aging. National Institutes of Health (NIH). September 30, 2021. https://www.nia.nih.gov/health/what-menopause. 
• Infantino M. “The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women.” J Am Acad Nurse Pract. 2008. 20(5):266-72. doi: 10.1111/j.1745-7599.2008.00316.x. PMID: 18460167. https://pubmed.ncbi.nlm.nih.gov/18460167/. 
• “Menopause and mental health.” Harvard Health Publishing. Harvard Medical School. 2020. https://www.health.harvard.edu/womens-health/menopause-and-mental-health. 
• “Can Menopause Cause Anxiety, Depression or Panic Attacks?” Cleveland Clinic. Cleveland Clinic. November 25, 2019. https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/. 
• ​​Bilodeau. “Sleep, stress, or hormones? Brain fog during perimenopause.” Harvard Health Publishing. Harvard Medical School. 2021. https://www.health.harvard.edu/blog/sleep-stress-or-hormones-brain-fog-during-perimenopause-202104092429. 
• “Sleep Problems and Menopause: What Can I Do?” National Institute on Aging. National Institutes of Health (NIH). September 30, 2021. https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do. “A Good Night’s Sleep.” National Institute on Aging. National Institutes of Health (NIH). November 03, 2020. https://www.nia.nih.gov/health/good-nights-sleep#insomnia.

Though menopause isn’t always the culprit (mental and emotional struggles can happen at any age), logging your moods will provide a clearer picture of what’s going on. You can get a more accurate diagnosis from your healthcare provider and explore potential treatment options.

And if you’re ever struggling to feel like yourself, it’s time to speak with your provider. 

In-app mental function tracking

Ovia makes it easy to track your moods, emotional changes, and mental function. Here’s a breakdown of what you might log in the app.

Mood changes

Hormone shifts can lead to mood changes at nearly any life stage, and menopause is no exception. Physical health issues during this time could also affect your mood, like an overactive thyroid gland, eating a poor diet, or not getting enough exercise. You can log all these lifestyle habits and more with Ovia.

Crying spells

You might also feel more emotional than usual during menopause. This could cause you to become readily upset, tear up easily, or cry more than you normally do.

Anxiety and panic attacks

Some people feel more stressed or anxious in their menopausal years. In some cases, it may lead to panic attacks. A panic attack is a sudden and unexpected spell of extreme anxiousness, usually accompanied by physical symptoms like excessive sweating, shaking, a racing heart, or shortness of breath.

Low motivation and depressive symptoms

There are also higher rates of depression among menopausal women. The symptoms could be relatively mild, like low motivation and loss of interest in things you typically enjoy.

But if it goes on for longer than two weeks or you’re experiencing suicidal thoughts, it’s best to talk to a healthcare provider right away. Help is available and you do not need to feel like this. 

Brain fog, difficulty concentrating, and memory problems

Hormonal changes, sleep issues, and elevated stress levels could lead to brain fog, difficulty concentrating, or even memory problems. If you’re having trouble focusing, making decisions, or remembering things, check in with your provider.

While these can be normal symptoms of menopause, a mental health professional can offer reassurance and work with you on possible solutions.

Sleep issues

Sleep issues fall somewhere in between mental and physical health — and they’re common during menopause. You might experience insomnia or trouble drifting off. Hot flashes, night sweats, or a frequent urge to urinate could also be keeping you up.

Start logging your mental health symptoms with Ovia today.

Sources

• Mayo Clinic Staff. “Menopause.” Mayo Clinic. Mayo Clinic. October 14, 2020. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397. 
• “Menopause.” Cleveland Clinic. Cleveland Clinic. October 5, 2021. https://my.clevelandclinic.org/health/diseases/21841-menopause. 
• “What Is Menopause?” National Institute on Aging. National Institutes of Health (NIH). September 30, 2021. https://www.nia.nih.gov/health/what-menopause. 
• Infantino M. “The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women.” J Am Acad Nurse Pract. 2008. 20(5):266-72. doi: 10.1111/j.1745-7599.2008.00316.x. PMID: 18460167. https://pubmed.ncbi.nlm.nih.gov/18460167/. 
• “Menopause and mental health.” Harvard Health Publishing. Harvard Medical School. 2020. https://www.health.harvard.edu/womens-health/menopause-and-mental-health. 
• “Can Menopause Cause Anxiety, Depression or Panic Attacks?” Cleveland Clinic. Cleveland Clinic. November 25, 2019. https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/. 
• ​​Bilodeau. “Sleep, stress, or hormones? Brain fog during perimenopause.” Harvard Health Publishing. Harvard Medical School. 2021. https://www.health.harvard.edu/blog/sleep-stress-or-hormones-brain-fog-during-perimenopause-202104092429. 
• “Sleep Problems and Menopause: What Can I Do?” National Institute on Aging. National Institutes of Health (NIH). September 30, 2021. https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do. “A Good Night’s Sleep.” National Institute on Aging. National Institutes of Health (NIH). November 03, 2020. https://www.nia.nih.gov/health/good-nights-sleep#insomnia.

No matter what stage you’re at, tracking your menopause symptoms can help you and your healthcare provider make sense of any changes you’re noticing and explore potential treatments.

The Ovia app makes it easy to log how you’re feeling physically and mentally, monitor changes, and keep track of new or ongoing symptoms. Here are some of the most important symptoms to track in Ovia! 

General menopause symptoms

Hot flashes and night sweats are among the most widely known menopause symptoms. But what many don’t realize is that the end of menstruation can also involve chills and cold sweats. If you find yourself constantly adjusting the thermostat to get comfortable, take note and let your provider know.

Hormonal fluctuations might also lead to weight gain. You absolutely don’t need to step on the scale regularly if that’s not your thing, but you might notice some changes to your body shape. During menopause, some people notice that their bodies shift from carrying more weight below the waist (in the hips and thighs) to carrying more weight above the waist. 

Hair and skin

You might notice your hair isn’t as thick as it once was or be alarmed by substantial fallout. Rushing to your hairstylist is an understandable response, but you’re also wise to keep track of when this started and how long it lasts.

Some people experience brittle nails and complexion issues, like dry skin, itchiness, or loss of collagen and elasticity (which usually shows up in the form of fine lines and wrinkles). This is just a natural part of aging, but there are some things you can do.

Head and neck

Symptoms surrounding the head and neck include dry or irritated eyes, dry mouth, or problems with the gums. And some will experience frequent headaches. 

Chest and back

Menopause might lead to stiff or achy muscles in the back or other areas of the body, and hot flashes can cause red splotches on your chest or back. Heart palpitations (a racing or fluttering heartbeat) could be a sign the ovaries are producing less estrogen. 

You might also notice sagging or loss of fullness in your breasts. It’s always good to let your medical provider know about any breast changes so they can recommend an exam if necessary.

Stomach and pelvic area

Hormonal shifts can lead to gastrointestinal issues, like acid reflux (heartburn) and indigestion (upset stomach). You could also experience vaginal dryness and issues with urinating, such as incontinence (loss of bladder control), a stronger urge to urinate, or pain when you do. You can log all these symptoms in Ovia. 

Arms and legs

You may notice tingling or numbness in your hands, feet, or other body parts. Restless leg syndrome can be a symptom of menopause too — adding to the list of things that make it hard to get a good night’s sleep.

Sleep and lifestyle

Speaking of sleep, the Ovia app is a great place to track sleep changes and concerns. This might include insomnia, trouble falling asleep, or frequent wake-ups. You can also log your eating habits, medications, supplements, and exercise.

Mental function

Changes to your mood or mental function can occur during menopause as well. While it might be par for the course, it’s good to keep track of things like crying spells, panic attacks, memory problems, brain fog, or difficulty concentrating.

Many of these symptoms might feel overwhelming (especially when you’re experiencing a few of them at once), but keep in mind that there are treatment options and that many of these symptoms will fade at the end of menopause. The first step you can take is to note how you’re feeling physically and emotionally so you can find the best treatment plan for you. 

Start logging your symptoms with Ovia today.

Sources

• Mayo Clinic Staff. “Menopause.” Mayo Clinic. Mayo Clinic. October 14, 2020. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397. 
• “Menopause.” Cleveland Clinic. Cleveland Clinic. October 5, 2021. https://my.clevelandclinic.org/health/diseases/21841-menopause. 
• “What Is Menopause?” National Institute on Aging. National Institutes of Health (NIH). September 30, 2021. https://www.nia.nih.gov/health/what-menopause. 
• Infantino M. “The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women.” J Am Acad Nurse Pract. 2008. 20(5):266-72. doi: 10.1111/j.1745-7599.2008.00316.x. PMID: 18460167. https://pubmed.ncbi.nlm.nih.gov/18460167/. 
• “Menopause and mental health.” Harvard Health Publishing. Harvard Medical School. 2020. https://www.health.harvard.edu/womens-health/menopause-and-mental-health. 
• “Can Menopause Cause Anxiety, Depression or Panic Attacks?” Cleveland Clinic. Cleveland Clinic. November 25, 2019. https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/. 
• ​​Bilodeau. “Sleep, stress, or hormones? Brain fog during perimenopause.” Harvard Health Publishing. Harvard Medical School. 2021. https://www.health.harvard.edu/blog/sleep-stress-or-hormones-brain-fog-during-perimenopause-202104092429. 
• “Sleep Problems and Menopause: What Can I Do?” National Institute on Aging. National Institutes of Health (NIH). September 30, 2021. https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do. 
• “A Good Night’s Sleep.” National Institute on Aging. National Institutes of Health (NIH). November 03, 2020. https://www.nia.nih.gov/health/good-nights-sleep#insomnia. 

Menopause can be a tough transition that impacts many aspects of your life. Many people find this stage of life difficult to cope with — so if you’re noticing that your mood has changed lately, you aren’t alone.

Mood swings and feelings of anxiety and sadness are common during perimenopause. Like most other symptoms, they can be associated with fluctuating hormone levels, specifically estrogen, progesterone, and serotonin. However depression during this time of life can also occur for reasons other than menopause. Here’s what you need to know about the link between depression and menopause. 

How your hormones play a role 

Estrogen and serotonin

The production of estrogen is correlated with serotonin, a neurotransmitter that acts as a “happy hormone” by reducing anxiety and fostering feelings of wellbeing. So as estrogen levels fluctuate during the menopausal transition, this can disrupt serotonin pathways, which can affect mood.

Progesterone and GABA

Progesterone is the “calming hormone” that may also influence Gamma-Aminobutyric acid or GABA for short. GABA is a neurotransmitter that produces a calming effect when it binds to its receptors. Progesterone increases the effects of GABA, so lower progesterone levels during perimenopause may result in less GABA-like activity, which then increases the chances of mood swings, anxiety, and sleeplessness.

Women between the ages of 40 and 55 are more likely to report depressive symptoms than premenopausal or postmenopausal women, suggesting that the highest risk for new-onset depression is during the transition into menopause, not during postmenopause.

In addition to depressive symptoms, menopause also presents physical symptoms like hot flashes/night sweats and sleep disturbances which can overlap and complicate depression, leading some researchers to believe that there is a correlation (not causation) between the two.

Those suffering from depression also report other menopausal symptoms like:

• Brain fog and difficulty concentrating
• Decreased energy
• Increased appetite
• Decreased libido (attributed to depression and/or vaginal dryness)
• Urinary incontinence (The science behind this potential association isn’t 100% understood but it may be due to decreased serotonin levels in the central nervous system, which is correlated with symptoms of depression as well as increased urinary frequency/bladder contractions. Of course, urinary incontinence can be linked to multiple factors, including its well-established link to declining estrogen levels and physical changes of menopause.)

Keep in mind that there are so many factors at play here that are difficult to discern: socioeconomic considerations, psychological, social, and health status, among others. Plus, let’s not forget that we’re dealing with our fair share of life stressors during this transition. Maybe we’re caring for children or aging parents, navigating career shifts, or struggling with our changing bodies. All of the above can adversely impact mood and should not be discounted as “par for the course.”

If you are experiencing severe symptoms that impact your everyday life or if you have suicidal thoughts, reach out to your healthcare provider right away. There is nothing shameful about getting the help you deserve.

Lifestyle

If you’ve been having a hard time lately and think you may be struggling with depression, you aren’t alone. You’re going through so many big physical and emotional changes that impact many menopausal people. Many lifestyle interventions have been studied to assess their effect on mood disorders, including depression. Please don’t struggle through these feelings on your own — everyone deserves support. Speak to your provider about getting the proper care, and if you are interested in exploring additional methods of support, here are some recommendations from Elektra’s founding physician, Dr. Anna Barbieri, MD. 

Nutrition and diet

Focus on eating more nutrient-dense foods like fruits and veggies and try to cut back on overly sugary snacks. Lean proteins (like fish and chicken) and whole foods (like veggies and beans) are good for our brain health, mood, and overall health!

Spend time in nature

Frequent exposure has been shown to reduce anxiety and depression while improving an overall sense of well-being. Taking a walk through the park or spending an afternoon by a lazy river can help you feel better.  

Practice gratitude

Practicing gratitude has been shown to improve our mood, help reduce symptoms of depression, and even lower blood pressure! 

Prioritize high-quality sleep

A lack of sleep can impact your stress hormone levels which, in turn, impair thinking and emotional regulation. Prioritize your sleep by limiting screen time before bed, drinking a soothing cup of chamomile tea, and curbing your caffeine intake before bedtime. 

Psychotherapy 

There are two types of psychotherapy recommended for menopause-related depression: interpersonal therapy and cognitive behavioral therapy (CBT) — both of which are often used in conjunction with medication. If you are interested in seeing a therapist, be sure to ask about their particular approach and practice.

Exercise

Studies show a clear link between regular movement and an elevated mood, improved sleep, and higher self-esteem. The effect of exercise specifically on depression proves to help prevent the development of depression in adults and is a useful strategy to help manage and treat existing symptoms. And don’t worry about pushing yourself too hard —- even a brisk walk around the block is a wonderful way to get your blood pumping. 

Hormonal prescriptions

Hormone therapy is a viable treatment option for women with elevated depressive symptoms who have been screened for common risk factors. Oral contraceptive pills are typically prescribed for early-late perimenopause, while hormone replacement therapy (HRT) is prescribed for late perimenopause-menopause.

Estrogen therapy alone is not approved to treat perimenopausal depression; however, there is evidence that it has antidepressant effects, particularly for those suffering from vasomotor symptoms (e.g., hot flashes & night sweats). 

Non-hormonal prescriptions 

Antidepressants such as SSRIs and SNRIs are a helpful option for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors. These antidepressants work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (which plays a vital role in the body’s “fight-or-flight” response to stress). Like therapy, there is still a stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up. 

Sources

• Yoon, H. “As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too”. NPR. NPR. January 16, 2020. https://www.npr.org/sections/health-shots/2020/01/16/796682276/for-some-women-nearing-menopause-depression-and-anxiety-can-spike 
• Freeman, E. W. “Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population”. Women’s Midlife Health. 11;1:2. Web. August 2015. 
• Soares, C.N. Almeida O.P. “Depression During the Perimenopause”. Archives of General Psychiatry. 58(3), 306. Web. March 2001.
• “Perimenopause: Rocky road to menopause”. Harvard Health Publishing. Harvard Health Publishing. April 14, 2020. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause 
• “Depression, Mood Swings, Anxiety, Sexual Side Effects of Menopause” The North American Menopause Society. The North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/depression-mood-swings-anxiety 
• Ventriglio, A., Sancassiani, F., Contu, M. P., Latorre, M., Di Slavatore, M., Fornaro, M., & Bhugra, D. (2020). Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clinical Practice & Epidemiology in Mental Health, 16(1), 156–164.
• Li, Y., Lv, M.-R., Wei, Y.-J., Sun, L., Zhang, J.-X., Zhang, H.-G., & Li, B. “Dietary patterns and depression risk: A meta-analysis”. Psychiatry Research. 253, 373–382. Web. July 2017.
• “Spend Time in Nature to Reduce Stress and Anxiety”. American Heart Association. American Heart Association. August 1, 2019. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/spend-time-in-nature-to-reduce-stress-and-anxiety  
• “Giving thanks can make you happier”. Harvard Health Publishing. Harvard Health Publishing November 2011.https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier 
• Cohut, M. “What are the health benefits of being social?”. Medical News Today. Medical News Today. February 23, 2018. https://www.medicalnewstoday.com/articles/321019  
• Ackerman, C. M. E. “83 Benefits of Journaling for Depression, Anxiety, and Stress”. PositivePsychology.Com. PositivePsychology.Com.October 12, 2020. https://positivepsychology.com/benefits-of-journaling/ 
• Chowdhury, R. B. M. A. “The Neuroscience of Gratitude and How It Affects Anxiety & Grief”. PositivePsychology.Com. PositivePsychology.Com. September 1, 2020. https://positivepsychology.com/neuroscience-of-gratitude/ 
• “Exercise for Stress and Anxiety”. Anxiety and Depression Association of America.Anxiety And Depression Association Of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety 
• Siefken, K., Junge, A., & Laemmle, L. “How does sport affect mental health? An investigation into the relationship of leisure-time physical activity with depression and anxiety”. Human Movement. 20(1), 62–74. Web. March 2019.
• Frühauf, A., Niedermeier, M., Elliott, L. R., Ledochowski, L., Marksteiner, J., & Kopp, M. (2016). Acute effects of outdoor physical activity on affect and psychological well-being in depressed patients – A preliminary study. Mental Health and Physical Activity, 10, 4–9.
• Villines, Z. “What are the differences between SSRIs and SNRIs?” Medical News Today. Medical News Today.October 23, 2020.  https://www.medicalnewstoday.com/articles/ssri-vs-snri 
• Rocca, W. A., Grossardt, B. R., Geda, Y. E., Gostout, B. S., Bower, J. H., Maraganore, D. M., de Andrade, M., & Melton, L. J. “Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy”. Menopause. 15(6), 1050–1059. Web. November 2008. 
• Stewart, J., Garrido, S., Hense, C., & McFerran, K. “Music Use for Mood Regulation: Self-Awareness and Conscious Listening Choices in Young People With Tendencies to Depression”. Frontiers in Psychology. 10. Web. May 24, 2019.
• Freeman, E. W. “Associations of depression with the transition to menopause”. Menopause. 17(4), 823–827. Web. July 2010.
• Schuch, F. B., & Stubbs, B. “The Role of Exercise in Preventing and Treating Depression”. Current Sports Medicine Reports. 18(8), 299–304. Web. August 2019.

Menopause and perimenopause often bring up intense feelings of anxiety, worry, and stress. While anxiety is a normal symptom of menopause, it’s still tough to deal with — especially when you’re already going through so many other changes. Whether you’re familiar with anxiety or this is the first time you’ve experienced it to this degree, it’s overwhelming when these feelings negatively impact your daily life.

Although it’s normal to experience heightened anxiety during menopause, if you have prolonged, intense feelings of worry and/or stress that make it hard to go about life normally, speak with your healthcare provider right away. There are a range of treatment options available, including lifestyle changes, new practices (like therapy), and medication. Your provider can work with you to find the best treatment plan. You can feel like yourself again.  

If you’re thinking about what you can do on your own, there are some ways to cope with anxiety. Lifestyle and mood disorders are related, and it’s possible to make positive changes that help curb your symptoms. Here are some lifestyle changes you may want to consider if you are battling anxiety during menopause. 

Consider your diet

Try to limit processed foods and added sugars and instead focus on maintaining a well-balanced diet with a wide range of whole foods, especially veggies and healthy fats (e.g., olive oil, avocados, nuts like almonds and walnuts, and fatty fish). Eating a healthy diet leads to improved brain health and mood. 

Spend time in nature

Routine, frequent exposure to the great outdoors has been shown to reduce anxiety and depression while improving an overall sense of wellbeing. Never underestimate the power of Mother Nature (aka vitamin N) to boost your mood!

Reduce stress

We know it’s easier said than done when everything and everyone seems to be competing for your attention. Here are some ways to manage stress. 

Try meditation

Many people enjoy taking the time to sit with their thoughts each day. If you are a beginner, try meditation with an app or a guided class.

Cultivate a gratitude and/or journaling practice

Studies have linked both practices to decreased anxiety, and they can also help improve general feelings of wellbeing and facilitate mindfulness. 

Get high-quality sleep

Sleep disruptions affect our stress hormone levels which, in turn, impair thinking and emotional regulation. That’s why it’s so important to prioritize those Zzzzs. 

Prioritize downtime with family and friends

While we may be conditioned with a “go-go-go” mentality, it’s important to step back and prioritize rest and downtime with loved ones (pencil it into your calendar!). After all, human beings are social creatures, and we gain a great deal of comfort from connection.

Don’t forget about “me” time

Call it what you want — self-care, alone time, R&R — but you deserve it. There’s nothing selfish about taking time for yourself, especially when it supports your mental health and overall wellness.

Cognitive Behavioral Therapy (CBT)

CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and mindset. It’s ideal for those looking to address underlying causes of anxiety while working toward long-term management.

Exercise

Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes your mood, improves sleep, and boosts self-esteem. According to the World Health Organization, 150 minutes per week of moderate-intensity movement (a brisk walk counts!) can help reduce the risk of developing symptoms of anxiety and depression.

Supplements and over-the-counter solutions

According to some studies, certain supplements and over-the-counter solutions may help reduce symptoms of anxiety. Talk to your healthcare provider about which solution may be best for you.

Medication

SSRIs and SNRIs remain the first line of pharmacologic defense for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors — total tongue twisters! These neurotransmitters are antidepressants that work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (which plays a key role in the body’s “fight-or-flight” response to stress). 

A note about antidepressants: there is still a stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up. Talk to your provider if you have questions or are wondering if an antidepressant might be a good fit for you.

Sources

• “8 principles of low-glycemic eating”. Harvard Health Publishing. Harvard Health Publishing. February 15,  2014. https://www.health.harvard.edu/healthbeat/8-principles-of-low-glycemic-eating 
• “Spend Time in Nature to Reduce Stress and Anxiety”. American Heart Association. American Heart Association. August 1, 2019. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/spend-time-in-nature-to-reduce-stress-and-anxiety 
• “Giving thanks can make you happier”. Harvard Health Publishing. Harvard Health Publishing November 2011.https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier 
• Cohut, M. “What are the health benefits of being social?”. Medical News Today. Medical News Today. February 23, 2018. https://www.medicalnewstoday.com/articles/321019 
• “Exercise for Stress and Anxiety”. Anxiety and Depression Association of America.Anxiety And Depression Association Of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety 
• Siefken, K., Junge, A., & Laemmle, L. “How does sport affect mental health? An investigation into the relationship of leisure-time physical activity with depression and anxiety”. Human Movement. 20(1), 62–74. Web. March 2019.
• Nobre AC, Rao A, Owen GN. “L-theanine, a natural constituent in tea, and its effect on mental state”. Asia Pac J Clin Nutr. 17 Suppl 1:167-8. Web. 2008. 
• Villines, Z. “What are the differences between SSRIs and SNRIs?” Medical News Today. Medical News Today.October 23, 2020.  https://www.medicalnewstoday.com/articles/ssri-vs-snri 
• Ackerman, C. M. E. “83 Benefits of Journaling for Depression, Anxiety, and Stress”. PositivePsychology.Com. PositivePsychology.Com.October 12, 2020. https://positivepsychology.com/benefits-of-journaling/ 
• Chowdhury, R. B. M. A. “The Neuroscience of Gratitude and How It Affects Anxiety & Grief”. PositivePsychology.Com. PositivePsychology.Com. September 1, 2020. https://positivepsychology.com/neuroscience-of-gratitude/ 
• Ortmann, O., et al. “Peri- and postmenopause—diagnosis and interventions interdisciplinary S3 guideline of the association of the scientific medical societies in Germany”. Archives of Gynecology and Obstetrics. 302(3), 763–777. Web. July 13, 2020. 

As you approach perimenopause and menopause, you’re likely juggling a lot! You may be caring for kids or aging parents, busy at work in peak career years, or all of the above. So it’s natural to feel overwhelmed sometimes, but it’s important to recognize that there are physiological factors at play here as well.

Anxiety, which may (but doesn’t always) go hand-in-hand with depression, is thought to be influenced by changing hormone levels.

Hormones that can impact anxiety

• Serotonin: the “happy hormone” that stabilizes mood and fluctuates with age and decreasing estrogen levels.
• Estrogen: results in increased serotonin levels and increased serotonin receptors. More serotonin = less anxiety and depression. The relationship between these two hormones is complex though and we are just starting to scratch the surface!
• Progesterone: the “calming hormone” that may also influence GABA.
• Gamma-Aminobutyric acid (GABA): a neurotransmitter that produces a calming effect when it binds to its receptors, which may support a reduction in stress, anxiety, and sleeplessness. With lower progesterone levels, GABA’s receptors don’t bind as well, thereby prolonging the stress response and increasing anxiety.

The most common anxiety symptoms are tension, nervousness, panic, and worry. Some may feel physical signs too, like an upset stomach, headaches, racing heart, or sweating. Others may experience panic attacks, which is an extreme episode of anxiety that is accompanied by physical symptoms such as heart palpitations, shortness of breath, and even chest pain.

Hot flashes and anxiety

There is one interesting connection between hot flashes and anxiety. Research has shown that women who experience anxiety are 3-5x more likely to have hot flashes. Another study found that women who experienced anxiety with physical symptoms (upset stomach, racing heart, etc.) had a strong tendency to have hot flashes.

Can the cause of anxiety, mood swings, and depression be independent of menopause? Of course. Either way, it’s important to talk to your healthcare provider, especially if you’re experiencing intensive, excessive, and persistent worry or fear about everyday situations that are difficult to control, interfere with your day-to-day life, and/or peak within minutes.

Read more to learn about treatments and options to help manage anxiety. 

Sources

• Bromberger, J. T. et al.  “Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation”. Menopause: The Journal of The North American Menopause Society. 20(5):488-495. Web. May 1, 2014. 
• Beck, T. “Estrogen and female anxiety”. Harvard Gazette. Harvard Gazette. August 9, 2012. https://news.harvard.edu/gazette/story/2012/08/estrogen-and-female-anxiety/ 
• Yasgur, B. S. “Mood Changes in Menopausal Women: A Focus on Anxiety”. Psychiatry Advisor. Psychiatry Advisor. December 17, 2018. https://www.psychiatryadvisor.com/home/topics/anxiety/mood-changes-in-menopausal-women-a-focus-on-anxiety/ 
• Mayo Clinic Staff “Anxiety disorders – Symptoms and causes”. Mayo Clinic. Mayo Clinic. May 4, 2018. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961 
• Young, L. M., Pipingas, A., White, D. J., Gauci, S., & Scholey, A. “A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals”. Nutrients. 11(9), 2232. Web.September 16, 2019.

Hot flashes (or night sweats, if they happen at night) are one of the most infamous menopause symptoms. Everyone will experience them differently and the frequency, intensity, and overall duration can vary. This hormone-related temperature instability is often referred to as “vasomotor symptoms” (VMS).

Hot flashes feel like episodes of perceived heat and/or sweating and typically last less than two minutes. You might feel a sudden sensation of warmth that spreads through the upper body and face. A flushed appearance, red or blotchy skin, rapid heartbeat, perspiration, and (ironically) chills are also common symptoms. 

Why do hot flashes happen?

Although the causes aren’t yet fully understood, evidence points to hormone changes. When estrogen levels drop (which happens during menopause), the hypothalamus — our body’s internal thermostat — becomes more sensitive to slight changes in body temperature. Thinking it’s overheated, the hypothalamus starts working to cool the body by pulling blood away from the core to the skin. This kick-starts a chain of events that causes flushing, sweating, and an internal sensation of heat despite the fact that body temperature isn’t actually rising.

There are four primary types of hot “flashers:”

• None (or relatively few) flashes: a rare and lucky bunch!
• Early onset: flashes begin in perimenopause and decline soon after menopause
• Late onset: flashes begin during menopause and persist into postmenopause
• Super flashers: flashes begin in perimenopause and persist well after menopause

What else can I expect from hot flashes?

Most people experience symptoms for six months to two years. Although more people report daytime hot flashes, night sweats are often more bothersome. Which makes sense — when you’re sleeping, you can’t anticipate a hot flash like you can during the day, and take the necessary steps to mitigate it (e.g., shed layers, move to a cooler room, or crank up the A/C). So where does that leave you? Often, waking up drenched in sweat. What’s particularly frustrating is that a common trigger for hot flashes and night sweats is stress. So stress leads to night sweats which leads to poor sleep, which is stressful and that makes it difficult to manage said stress…you get the picture.

Night sweats can bring on a lot of anxiety for people — especially when they start to impede your life. If you’re suffering from night sweats that routinely disrupt your sleep — and especially if you qualify as a “super flasher” — talk to your healthcare provider to create a plan for managing your symptoms.

Read more about hot flashes and symptom management here. 

Sources 

• Leon-Ferre, R. A. et al. “Oxybutynin vs Placebo for Hot Flashes in Women With or Without Breast Cancer: A Randomized, Double-Blind Clinical Trial “ JNCI cancer spectrum. 4(1) pkz088. Web. October 21, 2019.
• El Khoudary, S. R. et al. (2019). “The menopause transition and women’s health at midlife”. Menopause. (10):1213-1227. Web. October 26, 2019.
• “Why Do Women Have Hot Flashes?” University of Utah Health. University of Utah Health. November 12, 2020. https://healthcare.utah.edu/the-scope/shows.php?shows=0_ypv7dl6i#:~:text=All%20women%20who%20live%20long,off%20will%20experience%20hot%20flashes. 
• Deecher, D. C., & Dorries, K. (2007). “Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages”. Archives of Women’s Mental Health. 10(6), 247–257. Web. December 12, 2007.
• Mayo Clinic Staff. “Hot flashes – Symptoms and causes”. Mayo Clinic. Mayo Clinic. April 24, 2020. https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790#:~:text=Although%20other%20medical%20conditions%20can,treatments%20for%20bothersome%20hot%20flashes. 
• Freeman, E. W., & Sammel, M. D. “Anxiety as a risk factor for menopausal hot flashes”. Menopause. 23(9) 942–949. Web. September 23, 2016. 
• Ferrari, N. (2020, August 19). “Menopause-related hot flashes and night sweats can last for years”. Harvard Health Blog. Harvard Health Blog. August 19, 2020. https://www.health.harvard.edu/blog/menopause-related-hot-flashes-night-sweats-can-last-years-201502237745 
• Taku, K., Melby, M. K., Kronenberg, F., Kurzer, M. S., & Messina, M. “Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity”. Menopause: The Journal of The North American Menopause Society. 19(7), 776–790. July 1, 2012.

The background

For a good portion of our life, menopause is one of those “out of sight, out of mind” concepts.

Of course, we all know it’ll happen eventually, but it just seems so far off until it isn’t. 

It’s common for menopause to catch you by surprise and while we don’t talk menopause prep enough, knowing what you can expect is very helpful. Let’s break down all the need-to-knows when it comes to causes, timing, and symptom management. 

When, how, and why

During the menopausal transition, the body’s production of two key female hormones, estrogen and progesterone, begins to progressively decline. This happens until you hit menopause. You’ve officially reached menopause when you’ve gone 12 consecutive months without a period.

As you can see here, progesterone starts to decline first, and the decline is steep. Estrogen follows the same course but fluctuates a lot as it decreases. Testosterone also declines on a gradual slope. 

In Western societies, the average person hit menopause 51, but many start experiencing symptoms — like irregular periods and hot flashes — upwards of 8-10 years beforehand. This stage is known as perimenopause (aka “around menopause”). Once you’ve hit menopause, ovaries stop releasing eggs and stop producing estrogen.

Many of us assume menopause means we’re destined to feel tired, deflated, and, well, “meh” for years on end, which is simply not the case. As Oprah Winfrey once said, “So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time, and talent.” 

Perimenopause and menopause symptoms: what to expect

In an ideal world, we’d be able to package the symptoms of perimenopause, menopause, and postmenopause into neat, well-organized boxes and unpack them one at a time. Unfortunately, menopause isn’t one-size-fits-all, and every woman experiences the transition differently.

“The experience can vary from individual to individual as well as across ethnic and cultural groups and different countries and regions of the world,” says Dr. Barbieri.

That said, research does point toward certain patterns and trends. For example, we know that the symptoms typically associated with menopause (there are roughly 34) are actually experienced by most women during late perimenopause, peaking during the last two years due to an accelerated drop in estrogen levels. Below are the most common:

• Hot flashes/night sweats
• Irregular periods
• Vaginal dryness and discomfort during sex
• Urinary urgency and incontinence
• Difficulty sleeping
• Emotional changes (e.g., irritability, mood changes, anxiety/depression)
• Dry skin, eyes, or mouth

Postmenopause

After you hit the menopause mark (12 months without a period), you officially enter post-menopause. Many women will go 8-9-10 months and think they are in the clear and then they get a period, at which point the clock starts over.

Once you are post-menopausal, many symptoms tend to subside and some may persist, like vaginal and urinary symptoms. And, unfortunately, there are some longer-term health implications that come with being post-menopausal. Post-menopausal women have a higher risk of developing heart disease, diabetes, and osteoporosis.

The menopause transition is therefore the time to take action to help prevent those conditions by establishing healthy habits, caring for yourself, and being proactive about getting the healthcare you deserve.

Unless we go through “sudden” or premature menopause for medical reasons, we’ll spend a third or more of our lives in postmenopause. This is a long time, so it’s important to understand what treatments are out there. Sure, some symptoms may be unavoidable, but there are still ways to have agency and manage the impact they have on your life. It’s all about optimizing your health for the long term.

Lifestyle changes for menopause

Lifestyle changes are paramount to temper the symptoms of menopause and postmenopause, whether or not you’re considering additional treatments, like hormone replacement therapy. Fortunately, research shows they can be as effective as medication, sometimes even eliminating the need for it. And the good news is that it doesn’t matter if you’re just starting perimenopause, beginning full-fledged menopause, or enjoying what many regard as the period-free liberation of postmenopause.

Leaning into healthy lifestyle changes at any age can greatly improve your symptoms, energy levels, and overall health. In other news, it’s never too early and it’s never too late.

“Hormones are very much affected by your mood, stress levels, sleep, exercise, and nutrition,” says Dr. Eva Selhub, MD, a physician, author, and resiliency expert — so much so, in fact, that studies have shown that a diet high in whole foods, especially vegetables is inversely correlated with menopause symptoms.

Tapping into your community 

We also recommend building a “menopause support team.” Start by reviewing the list of symptoms, recording your experience with each on a scale of 1-10 (least disruptive to most disruptive), and prioritizing which to tackle first. You can track all of this information in your Ovia app. Bring the list to your next doctor’s appointment to discuss

It’s essential that you have provider who listens to you and is informed about the menopause journey. And it’s very possible that a provider you have loved isn’t the right fit for this new stage. Evaluate how comfortable you feel asking questions about your symptoms, how confident you feel in the answers, and how you feel leaving appointments. 

Do you leave feeling informed and confident about your next steps? If not, or if you don’t feel like your provider is listening to you, then find a new one! Having a provider on your team with deep menopause training and understanding is key to thriving during this period of life. 

Reach out to family and friends for support — the more conversations you have, the more you’re helping to break down the stigma around menopause that prevents so many people from sharing their experiences. 

At any given moment, 50 million or more women in the U.S. are experiencing menopause, and a whopping 16% never discuss it with anyone at all. That needs to change!

Lifestyle changes 

In addition to building a “menopause support team,” consider meditation and mindfulness for stress management and other psychological symptoms associated with menopause. “These techniques,” explains Dr. Selhub, “…allow one to manage them better without distress.”

Alongside nutrition, physical activity, sleep, and mind-body interventions, there are a number of botanical and supplement solutions that can help, including soy isoflavones, black cohosh, and vitamin B6. Like hormone replacement therapy, however, some come with risks, side effects, and medication interactions, so it’s important to carefully evaluate your options and consult your healthcare provider first.

Menopause treatments

One of the most effective therapies for menopause is hormone replacement therapy (HRT), which involves taking a supplemental form of either estrogen — or estrogen and progesterone — to balance out the two and replace what the body is no longer naturally producing.

As with all medications, there are benefits and risks. For HRT, the benefits can include improving hot flashes, night sweats, sleep, mood, sex drive, and bone density, among others. 

Despite the fact that today, the North American Menopause Society (NAMS) considers HRT to be safe and effective for most women in menopause (especially when started prior to age 60 or within 10 years of menopause), it is still a hotly debated and often misunderstood topic. When factors such as health history and medical conditions, as well as the type, dose, and duration of therapy are considered, benefits of HRT can outweigh the risks. Speak with your provider to find the right option for you. 

Remember that there are also non-hormonal prescription options, including certain antidepressants, that can be used for severe symptoms, especially for women who cannot or do not wish to try hormonal therapies.

The bottom line? Yes, menopause comes with symptoms. No, you’re not alone in what you’re experiencing. Medications and supplements can play an important role, but don’t underestimate the power of nutrition, exercise, quality sleep, and stress management.

Reframing how you think about menopause is also incredibly powerful. For example, you can turn this time into an opportunity to step back, renew your identity, and set future goals.

Many of us will be retired and/or empty nesters with more time on our hands — perfect for considering what pursuits we used to love that we’ve not had time for lately Or, what new interests do you want to dive into? Not only will challenging ourselves in new ways keep our brain healthy, but it’ll also help us combat stress, stay present, and pursue long-overdue passions.

No matter how you’re feeling about this transition, the first step is finding a knowledgeable who can help you navigate the journey ahead.