The years leading up to menopause can bring many changes that may cause temporary mood fluctuations. About 50% of women may experience anxiety or stress symptoms during this time.(1) For some women, these mood changes may be more severe, including sudden bouts of intense fear that occur without any apparent danger; this is known as a panic attack. In one study, 9.8% of women in the menopausal transition reported experiencing a panic attack in the last six months.(2)
If left untreated, panic attacks may limit social functioning, as individuals may start avoiding people and places that could trigger a panic episode. While panic attacks are rarely life-threatening, they can be extremely uncomfortable and significantly impact quality of life. Many women might not seek help due to embarrassment or fear of judgment. However, it’s vital to understand that panic attacks are treatable, and consulting a physician can help make the transition through menopause easier, improving overall quality of life.
What happens during a panic attack?
The Diagnostic and Statistical Manual of Mental Health Disorders (DSM) defines panic attacks as “an abrupt surge of intense fear or discomfort reaching a peak within minutes.”(4) These panic episodes may occur suddenly, without any warning, and may trigger a fight-or-flight response that causes a range of symptoms, from palpitations to chest pain.
Panic attacks are a part of panic disorder that involves a complex interplay of various contributing factors. A 2023 review suggests that individuals susceptible to panic attacks have an altered response to fear due to an imbalance of brain chemicals, such as serotonin, dopamine, and gamma-aminobutyric acid (GABA).(3)
The Connection Between Menopause and Panic Attacks
Many factors may directly or indirectly increase the risk of panic attacks during menopause.(1)
Neurotransmitter Imbalance
Estrogen promotes the production and prevents the breakdown of serotonin — a brain chemical that supports a happy and balanced mood. The drop in serotonin that accompanies the declining estrogen levels during menopause may result in panic attacks and other mood changes.(5)
In contrast, progesterone has a calming effect on the brain and works similarly to benzodiazepines, a class of medications with anti-anxiety and sedative effects. Research suggests that low progesterone levels during menopause may also cause panic attacks.(5)
Stress Response
A study found that 40% of menopausal women experienced at least one stressful event in the past six months, including a severe illness, the death of a loved one, separation or divorce, or financial problems.(1)
Estrogen has an inhibitory effect on the stress hormone cortisol. As estrogen levels drop during menopause, this protective effect against stress also decreases, increasing the risk of panic episodes.(5)
Hot Flashes and Sleep Disruptions
Researchers have noticed a link between panic attacks and vasomotor symptoms (VMS) including hot flashes and night sweats. VMS affects the same brain area that can trigger panic attacks. Night sweats can also affect sleep quality, which may cause mood changes and even panic attacks in the long run.(1)
Other Factors
Additional factors that may increase the risk of panic attacks in women during menopause include the following:(1)
Entering perimenopause at a younger age
A history of medical conditions, including thyroid disorders and migraines
A family history of panic attacks
Symptoms of Panic Attacks During Menopause
Panic attacks can be frightening, with symptoms reaching a peak within just a few minutes. The episodes may last from a few minutes to several hours and can cause a range of physical and emotional symptoms:(6)
Fear of death or impending doom
Feeling out of control
Fear of places where previous panic attacks occurred
Racing heartbeat
Intense worry about the next panic attack
Sweating, chills, or trembling
Dizziness or weakness
Difficulty breathing
Chest pain
Nausea
Tingling in the hands
Important Considerations When Experiencing Panic Attacks During Menopause
Frequent or intense panic episodes may indicate a worsening of the condition. In such cases, women should consult a physician who can assess the problem and suggest the right treatment approach. Panic attacks are treatable, and seeking professional help can significantly improve the quality of life.
Calming Strategies for Managing Panic Attacks During Menopause
The following strategies can help manage or prevent panic attacks during menopause:
Relaxation Techniques
Therapeutic approaches can help manage panic attacks by promoting calmness. Studies have shown that long-term practice of relaxation techniques can reduce cortisol levels, lessening the impact of stress on the brain.(7)
Yoga, meditation, and deep breathing exercises are some of the most effective techniques for managing panic attacks. These relaxation exercises work best when combined with other treatment approaches like CBT or medications.
Cognitive Behavioral Therapy (CBT)
Some women may feel embarrassed to talk about their experiences with panic attacks during menopause with their friends or partners. They may fear that sharing this experience could change how their loved ones perceive them. Some also believe that having catastrophic thoughts or forgetting things is their own fault.
CBT can help identify and modify these negative self-beliefs, thoughts, and expectations to set more realistic goals. It can also help women adjust their attitudes towards menopause, reduce stress, and positively affect their perception of symptoms during this period of life.(1)
Lifestyle Changes
The following lifestyle changes can help manage panic attacks during menopause:
Eating a healthy, balanced diet consisting of vegetables, fruits, fatty fish, lean meats, legumes, pulses, eggs, nuts, seeds, and dairy products can support overall health. Caffeine and alcohol consumption should also be limited.
Staying active promotes the release of endorphins, which are mood-regulating hormones. Experts recommend getting 30 minutes of moderate-intensity exercise a day for at least five days a week. Some helpful exercises include brisk walking, swimming, jogging, or cycling.
Maintaining a regular sleep schedule and getting at least eight hours of sleep each night supports a balanced mood and improves overall health.
Medications
A physician might recommend medications if the above approaches don’t help or if the frequency or intensity of panic attacks increases. Some common medications that are considered effective in managing panic attacks during menopause include the following:
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): These medicines are antidepressants that may also help manage anxiety and panic attacks.
Beta-blockers: They can help manage some of the physical symptoms of a panic attack, including sweating, a racing heartbeat, and tremors. While doctors don’t usually prescribe these medicines for panic attacks, they may be useful in managing specific symptoms that precede a panic attack, like a racing heartbeat or trembling.
Benzodiazepines: These are anti-anxiety medicines that promote calmness and sedation, which can be effective in soothing panic attack symptoms. As it’s easy to build a tolerance to this medication, it’s best to consult a physician, who may prescribe them for a short period if deemed appropriate.
Hormone Replacement Therapy (HRT)
As changes in estrogen and progesterone levels influence brain chemicals responsible for a balanced mood, replacing these hormones through HRT may be effective in managing or preventing panic attacks. HRT can also help reduce the occurrence of VMS during menopause, which is commonly associated with panic attacks.(1)
Additional Tips for Managing Panic Attacks During Menopause
Women might need to try various approaches to see what works for them. The following strategies might also help manage panic attacks during menopause:
Joining a Support Group
Connecting with other women who are experiencing similar issues can provide a sense of support and community. It also allows women to share their struggles without the fear of judgment.
Developing a "Panic Plan"
When panic attacks occur frequently, having a panic plan can help individuals stay calm and grounded. Here are some steps that might be helpful in managing panic attacks:
Knowing the common signs of a panic attack
Making a list of things that have helped in the past
Taking medications or seeking help from loved ones
Experiencing menopausal panic attacks? Discover if HRT is right for you.
If you’ve entered the menopause transition and are struggling with panic attacks, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.
