Depression, anxiety & mood
Anxiety in women — causes, symptoms and natural relief
by Marcelle Pick, OB/GYN NP
Many women operate in an ever-present state of generalized anxiety that may erupt into episodes of full-blown panic attacks, phobias, or anxiety disorders during times of psychological stress or biological changes — like menopause. Often, women who are chronically anxious think it is “normal.” Most of my patients with chronic anxiety are so accustomed to living with it, that they don’t mention it until I ask or until they begin perimenopause and their anxiety symptoms worsen.
Psychologists once viewed anxiety as a purely emotional problem. But over 30 years of research shows that anxiety has physiological causes, which must also be treated. This is especially true with anxiety related to hormonal imbalance.
This means you don’t have to just live with your anxiety or simply medicate your symptoms. Once you understand the physiological causes of your anxiety, you’ll see there’s a lot you can do to solve the problem.
What is anxiety?
Everyone experiences anxiety from time to time. Our natural ability to feel fear is a built-in alarm system that taps into our mental and physical powers when we encounter danger — the “fight or flight” response. But it’s not natural to be on perpetual high alert emotionally and physically without any tangible reason.
Severe panic and anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social phobias, and stress disorders affect only a small minority of anxiety sufferers. These conditions are highly treatable after medical diagnosis. If you think you may be experiencing a serious anxiety disorder, contact your healthcare practitioner right away. Drug and cognitive-behavioral therapies (such as exposure therapy) are very effective.
Mild to moderate anxiety or generalized anxiety disorder (GAD) is far more common but harder to identify than severe anxiety disorders. GAD is characterized by compulsive worrying and physical symptoms of anxiety which persist for more than six months. It may stem from childhood trauma or from growing up in an anxiety-filled household.
While anxiety can be debilitating, mild to moderate symptoms may not obviously affect a woman’s ability to function. In fact, it is often the high-achieving, “together” woman who has chronic anxiety, though it may be difficult for her to admit it. Even women who rarely felt anxious during their youth may develop anxiety and panic attacks as they enter perimenopause.
Symptoms of generalized anxiety and panic attacks include:
- Irrational fear or dread, elevated heart rate, palpitations
- Muscle tension, headache, chest pain
- Insomnia
- Diarrhea, GI distress, IBS, nausea
- Chest pressure, shortness of breath, tearfulness
- Jumpiness, irritability, shakiness, sudden changes in body temperature, hot flashes
- Depression (20–30% of people with anxiety disorders also suffer from depression)
When anxious, you usually don’t feel tired or hungry — until you eventually crash and crave sugar to restore your mood.
How does a normal anxious feeling become chronic anxiety?
The feeling of anxiety always begins with a trigger that initiates a survival response from the limbic system. At the first whiff of apparent danger, your brain chemistry, blood hormones, and cellular metabolism all kick into action.
With chronic anxiety however, this response may lessen but it never turns off, even if there’s no real threat. Over time, symptoms may be generated by even minor events because your brain’s limbic system has been sensitized to react to them as emergencies.
For example, if you were constantly yelled at as a child, you may feel anxious later in life whenever there is potential for confrontation — and you may go to extremes to avoid conflict even in benign situations.
Anxiety can easily become a “normal” state which is maintained by your neurotransmitters, hormones, and metabolism. That’s why anxiety relief is about resetting the physical and emotional roots of your anxiety, and creating a new, healthier equilibrium.
Anxiety and emotional experience
Adverse emotional experiences early in life, such as the death of a parent, divorce, emotional, physical or sexual abuse, or emotional modeling by an overly anxious or alcoholic parent can set up a pattern of chronic anxiety. When terrible things happen to us as children, we can’t process them. Adverse childhood experiences are trapped inside us, surfacing as anxiety symptoms when we’re adults.
It may be difficult to connect your anxiety to its source, but there is always a link. One of my patients was charming and gregarious (the way her parents wanted her to be) — and exceedingly anxious all the time. She didn’t know what was wrong, but she felt she was a fraud. She married a very controlling man and developed a compulsive eating disorder. Tests showed that her adrenals were exhausted, with low levels of serotonin, and the foods she ate disrupted her digestive and limbic systems. She began to support her neurotransmitters with diet and nutritional supplements and started “talk” therapy. She was able to find her own power within the balance of her family, her anxiety and compulsive eating lessened, her physical health improved and she found new mental strength — all without medication.
In my experience, multiple approaches are required to treat anxiety symptoms. Conventional doctors often prescribe antidepressants or anxiolytics to calm physical symptoms. But for real anxiety relief, you must deal with the emotional piece. (To learn more, read our article about the effects of emotional experience on health.)
That being said, let’s look at the physiological factors that perpetuate the anxiety response, and how you can support yourself, naturally, to reduce or eliminate your symptoms.
The physical factors behind anxiety
Anxiety affects your mind, but also your brain, pituitary gland, adrenals, GI system, heart, and ovaries, which are all interrelated.
Hormones, menopause, and anxiety. Sex hormones like estrogen and progesterone play critical roles in anxiety. Women are more than twice as likely as men to feel anxiety, especially during PMS, perimenopause, and menopause. Anxiety is often the first sign of perimenopause. Many women also experience rampant anxiety symptoms when transitioning off HRT.
Estrogen is tied to serotonin, which regulates mood. Progesterone has a soothing effect on your system similar to, and interdependent with, serotonin — when levels change, so do our moods and energy levels. As women approach menopause, estrogen and progesterone levels often fluctuate widely, amplifying any existing anxiety symptoms. In my experience, relief from menopausal anxiety and panic attacks is found only after hormonal balance is restored.
Adrenal health and anxiety. As part of the fight-or-flight response, your hypothalamus releases a hormone called corticotropin–releasing factor (CRF), which jolts you into action. CRF flows through your pituitary gland, where it stimulates adrenocorticotropic hormone (ACTH), which in turn tells your adrenal glands to release cortisol. Cortisol generates a rush of glucose, fat, and protein to give your cells the energy and alertness they need.
In a healthy system, the hormonal flood recedes once the threat is disabled. But if the gates stay open, the adrenals get exhausted, resulting in anxiety, weight gain, accelerated aging, and metabolic imbalances. Adults with high anxiety generally have elevated levels of CRF — which indicates that this response is always on.
Neurotransmitters and anxiety. A neurotransmitter imbalance can sensitize your brain to a fear response. Consistently high levels of excitatory neurotransmitters (for example, norepinephrine and epinephrine) and correspondingly low levels of the calming, inhibitory neurotransmitters (such as serotonin and gamma-aminobutyric acid, or GABA) actually modify brain chemistry. At Women to Women, we run a neurotransmitter test on every patient with symptoms of anxiety to determine how to support her neurotransmitters effectively.
Popular anti-anxiety medications like BuSpar, Ativan, Valium, and Xanax work on these neurotransmitters, as do caffeine and alcohol. Caffeine raises dopamine levels, whereas alcohol raises levels of GABA, which explains its relaxing effect.
Anti-anxiety medications (particularly benzodiazepines), caffeine, and alcohol are all highly addictive. People who inherit or develop anxiety-sensitive brains also have greater risk for addiction.
Nutrition, digestion, and anxiety. Most of the chronically anxious patients I see have GI problems, whether it’s nervous stomach, IBS, diarrhea, nausea, bloating, or bleeding — all of which can add to the vicious cycle of anxiety!
The digestive system is intricately tied into hormonal balance, brain chemistry, and moods — the gut is even a source of serotonin, the major neurotransmitter regulator of mood. In some people, food allergies and food sensitivities trigger anxiety symptoms, much like dust triggers an asthma attack.
Your nutrition heavily influences your mood. For example, research shows that essential fatty acids (EFA’s) help reduce inflammation in the brain and gut, which otherwise contributes to anxiety disorders. We recommend that everyone take EFA’s daily, especially those with symptoms of anxiety.
The risks and benefits of anti-anxiety medications (anxiolytics)
Medication for anxiety is being prescribed with abandon. Scared of flying? Take a Xanax. Can’t sleep? Take an Ambien. Shy at parties? Try a BuSpar. For severe physical symptoms of anxiety, a limited course of medication is fine, but we don’t recommend it for generalized anxiety.
Anti-anxiety medications are particularly habit-forming and they do nothing to reboot the neural and hormonal pathways for long-term mental health — they simply disrupt the pathway and mask symptoms so you can function. Anxiolytics are not a smart long-term solution, and in cases of menopause-related anxiety, drugs like Xanax and Ativan can actually make symptoms worse.
The vast majority of women with anxiety symptoms do not need medication. I only prescribe anti-anxiety medicine for patients with severe generalized anxiety who feel paralyzed by their symptoms. This helps calm the neurotransmitters, enabling people to start making better lifestyle and diet choices and begin therapy.
Anxiety relief: natural treatments for anxiety
Relief from chronic anxiety comes from restoring your body’s natural equilibrium by learning to process your emotional history while making changes to lifestyle, nutrition, allergy management, exercise habits, and hormonal balance. Here’s what we recommend:
- Dietary changes. If you are serotonin-deficient, you will crave sugar and simple carbohydrates, but those foods cause insulin levels to spike and destabilize your mood. Eat whole, organic foods to maintain stable blood sugar levels. Avoid processed foods, trans fats, artificial additives, simple sugars, and carbohydrates. Add fiber-rich vegetables or fruit to every meal, and drink plenty of filtered water. Also, examine your diet for potential food allergies or sensitivities. If you are experiencing anxiety-related gastrointestinal problems, an elimination diet may help.
- Nutritional support. Take medical-grade multivitamin/mineral and essential fatty acid supplements to fill in any nutritional gaps. Getting out in the sun a little every day will help your body produce vitamin D, a key nutrient for mood. If you live in a northern climate or don’t get much sunlight, supplemental vitamin D may help.
- Support your adrenals. Practice stress relief every day to give your adrenals a break. Aim for about 30 minutes of exercise a day, and try to get at least 7-8 hours of sleep every night.
- Balance your hormones. When anxiety is related to perimenopause or menopause, gentle endocrine support is often key to relief. We recommend phytotherapy or bioidentical HRT.
- Do your emotional work. Find a counselor to talk with about your emotional experience. Many of our patients have had great success with the Hoffman Quadrinity Process. We also recommend the Emotional Freedom Technique and integrative manual therapy to support your healing process.
You may also talk to your health care provider about taking a neurotransmitter test. At Women to Women we use these results to select supplements with specific amino acids and other nutrients that are important precursors to neurotransmitters. This process should be supervised by a qualified medical provider.
Bringing it all together
Getting a handle on anxiety before it manifests into health concerns is an important goal. If you already have chronic anxiety, you’ll find help by supporting your body, examining your past, and rebalancing your body and mind.
Just imagine how powerful you could feel if all the energy that has been fueling your anxiety and fear was instead unleashed in a life-affirming, positive way! As my friend’s mother once said, “Life demands a warrior, not a worrier.” I know that may be easier said than done, but it’s true, and today is a perfect time to get started.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at 1-800-808-0849. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.
Related to this article:
References & further reading on anxiety
Original Publication Date: 08/17/2005
Last Modified: 08/17/2009
Principal Author: Marcelle Pick, OB/GYN NP