QUESTION
Now that I’ve started having hot flashes, my anxiety levels are off the charts. Sometimes I can’t tell if I’m freaking out because I’m flashing or flashing because I’m freaking out about something else. Either way, how can I keep my cool?
ANSWER
During menopause, hot flashes and bouts of anxiety definitely can have a chicken-and-egg relationship. When you’re in the throes of both at once, it can be tough to tell which came first! The truth is, it can go either way—high anxiety states can cause hot flashes, and hot flashes can trigger anxiety. Why is something of a medical mystery. Dips in estrogen levels during the menopausal transition are associated with hot flashes. And estrogen affects brain neurotransmitters such as serotonin, dopamine, and gamma-aminobutyric acid (GABA) that help us maintain an emotionally steady state. That may be why you can get hit with a double-whammy hot flash and anxiety simultaneously—plummeting estrogen levels may cause both at the same time. This also may explain why, according to some research, drugs called selective serotonin reuptake inhibitors (SSRIs)—antidepressants that affect neurotransmitter levels—can have a positive impact not only on hot flashes but also on psychological states. For women who have frequent and intense anxiety and hot flashes, these drugs may be an effective solution. Before you go that route, though, you may want to explore the many nondrug ways to deal with bouts of hot flashes and the anxiety that they can bring on. Here are a few ways... Just cooling off from the hot flash itself can help calm you down. Here's what to do in the moment…
- Peel off. Remove a layer or two of clothing. This tactic will take some planning, of course. You’ll need to dress in layers in case you later want to remove one (or two).
- Freeze it out. Stand in front of an open fridge for a few minutes or, if you’re in the car, roll down your window in cool weather or blast the AC in warm weather.
- Make a move. Taking a short walk or getting up from your desk to stretch or stroll down the hall can discharge the “power surge” of a hot flash/anxiety attack.
To help prevent hot flashes that may bring on anxiety…- Hit the mat. Research has found yoga can help mitigate hot flashes. In one study, for example, women who had at least four hot flashes per week experienced a 66% reduction in frequency of hot flashes after taking a weekly 90-minute yoga class for 10 weeks.
- Vanquish them with valerian. This commonly used herbal supplement has phytoestrogen qualities that have been found to help mitigate hot flashes. In a 2017 study published in Women’s Health, women who took a 530 milligram capsule of valerian twice a day had a significant reduction in severity and frequency of hot flashes after two months. Valerian can also help when anxiety interferes with a good night's sleep. (Note: Check with your doctor before taking valerian and if it's ok, how long you should take it. That's especially important if you have a medical condition.)
To head off anxiety that may bring on hot flashes… Have your blood minerals checked. Too much copper along with relatively low levels of zinc can create an imbalance of dopamine and
norepinephrine (adrenaline) in the body that in turn may amp up anxiety. Your primary care physician can run a serum copper and serum zinc test. If your copper is high, discuss whether you should go on a low-copper diet. This means avoiding certain foods, including shellfish, liver, and chocolate! If your zinc is low, consider taking the supplement zinc picolinate, and eating pumpkin seeds to boost levels of this important mineral.
Bump up this B vitamin. Inositol (sometimes referred to as vitamin B-8) can be extraordinarily helpful in decreasing anxiety in perimenopausal and postmenopausal women. I typically prescribe taking 1,000 mg two or three times a day. Check with your health-care provider to see if this is a good idea for you. Side effects, which are rare, include nausea, fatigue, headache or dizziness. Pregnant and breastfeeding woman should avoid inositol as there isn’t enough research on this population to know if there are interactions—although admittedly this isn't relevant to menopause!
