Menopause and anxiety: why it happens and how movement helps

Why menopause causes anxiety

Perimenopause can last anywhere from two to 10 years before you reach menopause, which is marked by 12 consecutive months without a period. During this transition, estrogen and progesterone can ping-pong up and down, sometimes erratically. These hormonal fluctuations can affect multiple systems in your body, including brain chemicals called neurotransmitters that help to regulate mood, sleep, and your stress response. As a result, some people may become more susceptible to anxiety.

But hormones aren’t the only factor. Hot flashes and night sweats can disrupt sleep, and poor sleep can contribute to feelings of anxiety. Joint pain or other physical symptoms can add another source of stress, too.

“When you’re in pain or tired, you’re more susceptible to feelings of stress and anxiety,” says Dr. Barker.

Life circumstances matter as well. The menopause transition often coincides with other sources of stress, from work and relationships to caregiving responsibilities and other health changes. People with a history of anxiety, depression, or other mood symptoms may also be more vulnerable to mental health changes during this stage of life.

Symptoms of menopause and anxiety

Anxiety affects everyone differently. Some people experience a persistent sense of worry or uneasiness, while others notice more physical symptoms. Common signs and symptoms can include:

• Feeling nervous, worried, or on edge

• Irritability

• Trouble concentrating

• Difficulty sleeping

• A racing or pounding heart

• Feeling restless or unable to relax

• Muscle tension or muscle spasms

• Panic attacks

Some physical menopause symptoms, such as hot flashes and heart palpitations, can also feel similar to symptoms of anxiety. Tracking when your symptoms occur and discussing them with a menopause-informed healthcare provider can help you sort out what may be contributing.

How movement helps menopause and anxiety

Movement can be a valuable part of managing anxiety during menopause, and it doesn’t have to mean an intense workout.

Regular physical activity can support mood, sleep, stress management, strength, and overall well-being. It can also help you manage musculoskeletal symptoms that may be adding to how you feel physically and emotionally. 

“Exercise triggers the release of endorphins, or ‘feel good’ chemicals in your brain that boost your mood,” explains Dr. Barker. “It also helps to lower stress hormones like cortisol, which contribute to anxiety.” 

Walking, strength training, stretching, yoga, swimming, or another activity you enjoy can all count. But exercise isn’t a replacement for mental health treatment when you need it. Think of movement as one tool in a larger toolbox for supporting your physical and emotional health during the menopausal transition.

Treatments for menopause and anxiety

The right treatment depends on how anxiety is affecting you and what else may be contributing to it. Lifestyle strategies and movement may be enough for some people with mild symptoms, while others may benefit from more targeted approaches, such as psychotherapy, medication, treatment of other menopause symptoms, or a combination of approaches. Consider these treatments:

• Stay active. Movement can support mood, sleep, stress management, and physical health. Walking, stretching, swimming, strength training, and other forms of exercise can all help, so focus on activities that feel manageable and enjoyable to you.

• Try physical therapy and targeted exercises. Targeted exercises help to address other menopause symptoms that may lead to anxiety, such as pelvic floor pain or urinary incontinence. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to both the physical and emotional symptoms of menopause. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. 

• Prioritize quality sleep. Sleep disruption can make it harder to cope with stress and anxiety. Developing consistent sleep hygiene habits, such as following a sleep routine, cooling your bedroom before sleep, and practicing relaxation techniques and mindfulness exercises, can all help you fall asleep. 

• Consider cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that can help you recognize and change thought and behavior patterns that contribute to anxiety. A mental health professional can also help you develop strategies for managing symptoms when they arise so you’re prepared at any time.

• Talk to your provider about menopause hormone therapy. MHT is an effective treatment for menopause symptoms such as hot flashes and night sweats. Its effect on anxiety is less clear, and it isn’t considered a stand-alone treatment for an anxiety disorder. If anxiety is occurring alongside other menopause symptoms, your provider can help you determine whether MHT may be appropriate based on your symptoms, health history, and individual risks and benefits.

• Ask about medication for anxiety. If anxiety is persistent or interfering with your daily life, a healthcare provider may recommend medication, psychotherapy, or both. Treatment is individualized based on your symptoms and medical history.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for anxiety relief, such as massage, acupuncture, or chiropractic care.

Tips to manage menopause anxiety

You don’t have to overhaul your routine to support your mental health. Small, consistent changes — like timing your workouts strategically, tracking symptom patterns, and adjusting your sleep environment — can make a meaningful difference in managing menopause-related anxiety day to day.

• Track your patterns. Sleep, hot flashes, pain, stressful events, and other factors may influence how you feel. “I recommend keeping a little diary on your phone’s notes app to help track if there are times of day, or certain triggers, that make anxiety worse,” says Dr. Barker. Look for patterns rather than trying to identify or eliminate every possible trigger.

• Move when it works for you. You don’t need to exercise at a particular time of day to benefit. Choose a time that fits your schedule and makes it easier to stay consistent. A morning walk may feel great for one person, while an evening strength session works better for someone else. 

• Adjust movement to how you feel. On days when anxiety or other menopause symptoms are more noticeable, you can still move without sticking rigidly to your usual workout. A walk, gentle stretching, breathing exercises, or a shorter workout can help you stay connected to movement while respecting how you feel. “Try to get in some light movement to help keep endorphin levels high and calm your nervous system without overloading it,” says Dr. Barker. 

• Pay attention to physical symptoms without assuming anxiety is the cause. Tingling and other unusual sensations can occur for many reasons. If you experience new, persistent, worsening, or one-sided tingling or numbness, talk to a healthcare provider rather than assuming it’s related to menopause or anxiety.

When to see a doctor

Anxiety during the menopause transition is common, but you don’t have to wait for it to become severe before asking for help. Talk to a healthcare provider if your anxiety is persistent, distressing, interfering with sleep or everyday activities, or simply feels difficult to manage on your own. It’s especially important to get medical care if you experience:

• Frequent or disabling panic attacks

• New or concerning heart palpitations, chest pain, or significant shortness of breath

• Anxiety that is interfering with work, relationships, sleep, or everyday activities

• Symptoms of depression or another mental health condition

• New, persistent, worsening, or one-sided numbness or tingling

PT tip: Focus on what you can do

Menopause symptoms can change over time, and the same is true for anxiety. Rather than waiting to feel completely symptom-free before doing the things that matter to you, focus on small actions that help you feel supported now, whether that’s taking a walk, getting some restorative sleep, or reaching out for professional support when you need it.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.