Depression, anxiety & mood
Anxiety in women — causes, symptoms and natural relief
by Marcelle Pick, OB/GYN NP
Many women operate in a state of low-grade anxiety that may erupt into episodes
of panic attacks, phobias, or anxiety disorders in the face of increased stress
or biological changes — like monthly periods, the birth of a child, or menopause.
Over time, women who are chronically anxious may come to regard constant anxiety
as “normal.” Most of my patients with generalized anxiety are so accustomed
to living with it, that they don’t mention it until I ask, or until they enter
perimenopause and their longstanding
anxiety symptoms worsen.
Psychologists once viewed anxiety as a purely emotional problem. But over 30 years
of research demonstrate that anxiety has real, physiological causes that must also
be addressed to gain lasting relief. This is especially the case with anxiety related
to hormonal imbalance — an amazingly common cause of anxiety in women of all
ages. Other physiological causes can include
adrenal imbalance, thyroid issues,
and digestive imbalance.
This means you don’t just have to live with ever-present anxiety or medicate
your symptoms when feeling overwhelmed by them. Once you understand both the physiological
and the emotional causes of your anxiety, you’ll see there’s a lot you
can do to resolve the problem.
What is anxiety?
Everyone experiences anxiety from time to time. Our ability to feel fear is like
a built-in alarm system that brings the full weight of our mental and physical prowess
to bear whenever we sense danger. This acute “fight or flight” response
triggers a complex interplay between mind and body to deal with a perceived threat
— whether real or imagined. What’s not natural (or healthy) is to remain
on perpetual high-alert emotionally and physically when our lives are not at stake.
Symptoms of generalized anxiety and panic attacks may include...
- Irrational fear or dread
- Muscle tension, headaches, jaw-clenching, teeth-grinding
- Insomnia, restlessness, nervousness, fatigue
- “Choked” sensation, nausea, diarrhea, heartburn, IBS
- Chest pain or pressure, shortness of breath, elevated heart rate, palpitations
- Jumpiness, irritability, twitchiness, shakiness
- Sweating, sudden changes in body temperature, hot flashes
- Tearfulness, depression (two-third of people with anxiety disorders also suffer
from depression at some point in their lives)*
This is by no means a comprehensive list — anxiety manifests in women in so
many different ways. What you usually don’t feel, when anxious, is
tired or hungry — until you eventually crash, and crave sugar, alcohol, or other
comfort measures to soothe your jangled nerves.
(NOTE: Sometimes these symptoms can also indicate hyperthyroidism, so be sure to
ask your healthcare provider to rule this problem out if you have the above symptoms.)
Chronic anxiety symptoms can run the gamut in intensity and impact, from vague “background
noise” to severely incapacitating.
Severe anxiety disorders include obsessive-compulsive disorder
(OCD), post-traumatic stress disorder (PTSD), panic attacks, and
social phobias. These conditions afflict only a small minority of anxiety
sufferers, and fortunately, they are highly treatable after medical diagnosis. If
you think you might have a serious anxiety disorder, please contact your healthcare
practitioner right away. Approaches that include or combine treatments such as cognitive-behavioral
therapies (for example, exposure therapy), medication, or targeted supplements are
proving very effective.
Mild to moderate anxiety, or generalized anxiety disorder (GAD) is far
more widespread but harder to diagnose than severe anxiety disorders. This is the
ubiquitous tension that is more common than ever among women today. GAD is characterized
by compulsive worrying and physical symptoms of anxiety that persist for more than
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 and experience hormonal changes. This is a wake-up call
to change one’s life!
How does an “ordinary” anxious feeling become chronic anxiety?
Like a tangled-up knot of emotions and physiology, the origins of anxiety are often
found rooted in both. But the feeling of anxiety always begins with stress: a trigger
that initiates fear in 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, the intensity of this response may less dramatic but it never
shuts off, even if there’s no persistent threat. Over time, symptoms may be
generated by seemingly minor, “everyday” events because your limbic
and nervous systems have been sensitized to react to them as emergencies. The biochemical
state associated with anxiety can then come to seem “normal” to you,
a state that is maintained by your neurotransmitters, hormones, and metabolism at
the expense of your health and happiness.
As far as temperament goes, recent studies suggest that a propensity toward worry,
anxiety, and even panic can involve interactions between several genes. The genetic
links seem to be most associated with social anxiety disorder, which is
fairly common. But these genetic associations are not a destiny that you cannot
overcome. That’s because natural anxiety relief is about resetting both
the physical and emotional roots of your anxiety, and creating a new, healthier
Anxiety and emotional experience
Leading psychologists believe the emotion of each of our memories is chemically
encoded in the brain’s amygdala — the “nut” of
worry — and that every time we retrieve a memory, for better or for worse,
that memory is changed — actually chemically altered. A history of adverse
experiences in childhood can set us up for a lifelong pattern of chronic anxiety:
from the overt trauma of emotional, physical or sexual abuse, to a parent’s
death, divorce, or emotional modeling by an overly anxious, controlling or alcoholic
parent, when dreadful things happen to us as children, we may lack the skills to
process them. It’s as though the adverse events are trapped inside us, resurfacing
as anxiety symptoms when we’re adults.
Weighing 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 may be required, but
we don’t recommend it for generalized anxiety.
Why not? First off, anti-anxiety medications are highly addictive; and second, 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. Third,
in some cases, particularly in older women, drugs like Xanax and Ativan can actually
make symptoms worse.*
If you think hormonal imbalance might be at the root of your anxiety, try our Personal Program
and balance your hormones naturally.
From initiating helpful lifestyle and dietary measures, to entering therapy and
learning new relaxation techniques, there are many safe, effective, natural anxiety
treatments that provide lasting relief.
Both mild and serious forms of anxiety may stem from childhood trauma or from growing
up in an anxiety-ridden household. For example, if you were constantly yelled at
as a child, you may feel anxious later on in life whenever the potential for conflict
arises — and you may go to extremes to avoid confrontation, even in relatively
While it may be difficult to connect your anxiety to its source, there is always
a link to be found. One of my patients was charming and gregarious (as her parents
had wanted her to be), but exceedingly anxious all the time. She couldn’t
pinpoint what was wrong, but said she felt like a fraud. Continuing the pattern
of her childhood, she’d married a very controlling man and developed a compulsive
eating disorder. Through testing, we learned that her adrenals were exhausted, her
serotonin levels were extremely low, and her erratic eating habits had disrupted
her digestive and nervous systems. She began supporting her neurotransmitters with
diet and nutritional supplements and started “talk therapy.” In time
she was able to tap newfound emotional strength and shift the power balance in her
relationships. Her anxiety resolved, her compulsive eating diminished, and her overall
physical health improved — all without medication.
In my experience, such a layered approach is often required to treat anxiety in
women. Conventional doctors so often prescribe antidepressants or anxiolytics to
“take the edge off.” But for lasting anxiety relief, we must be willing
to untangle the emotional piece. (See also our article on the
effects of emotional experience on health.)
That being said, let’s look at the physiological factors that perpetuate the
anxiety response, and learn how you can support yourself, naturally, to reduce or
eliminate your symptoms.
The physical factors behind anxiety
Women have long been told that anxiety is all in their heads: if only we could just
“think right,” we’d overcome the problem! But we now know that
anxiety is a body-wide phenomenon; its origins can be traced to not only your brain,
but your adrenals, thyroid, GI system, heart, ovaries, even your bones! And of course,
they’re all interrelated, but given that neurotransmitters and hormones are
the messengers of anxiety, we’ll begin there.
Neurotransmitters and anxiety. A neurotransmitter imbalance
can “sensitize” your brain, making you more prone to a fear response.
Consistently high levels of excitatory neurotransmitters (e.g., adrenaline/epinephrine
and noradrenaline/norepinephrine) and correspondingly low levels of the
calming, inhibitory neurotransmitters (e.g., serotonin and gamma-aminobutyric
acid [GABA]) can actually alter the brain’s circuitry.
As noted above, this alteration can develop over time as the result of acute or
repeated trauma or simply a life of low-grade chronic stress, particularly when
coupled with a genetic predisposition. At Women to Women, we run a neurotransmitter
test on many patients with symptoms of anxiety, to gauge how we can best support
Popular anti-anxiety medications
like BuSpar, Ativan, Valium, and Xanax work on these neurotransmitters and their
receptors, as do caffeine and alcohol. Caffeine raises adrenaline and dopamine levels,
whereas alcohol raises dopamine levels and binds to GABA and serotonin receptors,
among others. 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.
The HPA axis, adrenal health, and anxiety. As explained
above, when you feel anxious (an emotion), your sympathetic nervous system jolts
you into action (a physical response). This stress response is mediated along the
HPA axis. Your hypothalamus (H) releases a hormone called corticotropin–releasing
factor (CRF), which flows to your pituitary gland (P), where it
stimulates adrenocorticotropic hormone (ACTH), which in turn tells your
(A) to release epinephrine (adrenaline) and cortisol. Together these hormones
(some of which have dual roles as neurotransmitters, by the way) elevate your blood
pressure and blood sugar to give your brain, heart, muscles, and skeleton the edge
they need to respond to crisis.
Meanwhile, they also suppress less dire bodily functions like immunity, digestion,
and bone building, which is why chronic anxiety chips away at your health foundation
over time. In a healthy system, the stress-hormone flood recedes once the threat
is disabled. But if the gates stay open, the adrenals become tapped-out, resulting
in chronic anxiety, depression, weight gain, accelerated aging, osteoporosis, and
other metabolic imbalances. Many of my patients with high anxiety have elevated
levels of CRF, epinephrine, and cortisol — which indicate that this response
is always “on.”
Sex hormones, menopause, and 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 —
for example, women with moderate anxiety are three to five times more likely to
experience hot flashes. Many
women also experience rampant anxiety symptoms when
transitioning off HRT.
Progesterone has a particularly soothing effect on your system similar to, and interdependent
with, serotonin. When levels begin to drop as a woman approach menopause, this can
leave her susceptible to anxiety-related problems, including insomnia. 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 can only be gained once hormonal balance is restored.
Digestion and anxiety. As I ask a patient with GI problems
to share a little more about what’s going on in her life, she will almost
invariable identify some component of anxiety. But whether it’s nervous stomach,
heartburn, IBS, gluten intolerance, diarrhea, ulcers, nausea, bloating, or bleeding,
anxiety does not necessarily precede a digestive concern. Though anxiety was blamed
for generations as the cause of stomach ulcers, for instance, we now know now that
a bacterium (H. pylori) is the primary causal agent. Yet the very fact
that a patient has an ulcer — or any another GI problem — can precipitate
anxiety, which can then set up a vicious cycle of symptoms.
Our grasp of the weblike connections between our emotions and gut health is still
in its infancy, but we do now recognize the digestive system as an independent center
of nervous activity, intricately connected with brain chemistry, hormonal balance,
and moods. In essence, we have a “second brain” in our belly! Indeed,
the gut is even a major site of serotonin production and utilization, where it functions
as an enteric neurotransmitter. Genetic variations in receptors for cholecystokinin,
another hormone synthesized in our guts, have also been linked with the development
of panic disorder and anxiety.
So clearly, anxiety isn’t all in our heads! And in over 20 years
of practice, I have seen many women recover from this problem without resorting
to mind-numbing drugs.
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, exercise habits, and hormonal balance. Here’s what we recommend:
- Balance your sex hormones. When anxiety is related to perimenopause
or menopause, gentle endocrine support can often restore balance. We recommend phytotherapy
or bioidentical HRT. Botanical therapies such as passionflower, valerian, and chamomile
have been used for many generations to dissolve restlessness, nervousness, and anxiety.
- Consider nutritional supplements. We encourage all women with anxiety
symptoms to take a medical-grade multivitamin/mineral complex like the ones offered
in our Personal Programs. Some nutritionists regard the B-complex as the most important
nutritional factor for healthy nerve cells, but there is also evidence that omega-3
fatty acids can help reduce symptoms of anxiety. Likewise, vitamin D is a key nutrient
for mood, and deficiency is widespread. If you’re elderly, overweight, dark-skinned,
live in a northern climate, or don’t get much sun, vitamin D testing and appropriate
supplementation is strongly suggested.
- Deliberate dietary choices. Sound nutrition so heavily influences
our hormones and transmitters — it’s simply a must. Eat the majority
of your protein early in the day; choose whole, nutrient-rich foods with a low glycemic
index; and don’t let yourself get too full or too hungry — three simple
precepts to normalize your two major hormones, insulin and cortisol, which in turn
will help optimize your neurotransmitters and balance your sex hormones.
- Fresh air, sunshine, and exercise. A healthy measure of each will
not only to help you manage better when under pressure, but aid restorative sleep
at the end of the day. (No need to overdo it — you want to soothe your nerves,
not add stress!)
- Extra support. If you’ve tried the above measures and your
anxiety problem continues, you may want to talk to a functional healthcare practitioner
about neurotransmitter testing and support or explore emotional support through
the Hoffman Quadrinity Process,
Emotional Freedom Techniques,
integrative manual therapy, cognitive behavioral therapy (CBT), qi gong, or transcendental
Bringing it all together
In over 25 years of working with women in our clinic, the above approach has been
shown to be extremely helpful — but you don’t have to try everything
on the list at once! No one thing works for everyone, and your path to emotional
wellness is as unique as you are.
Getting a handle on anxiety before it manifests into full-blown health concerns
is an important goal. If you already have chronic anxiety, supporting your body,
examining your past, and rebalancing your body and mind will go a long way toward
relieving your symptoms.
And if you’ve tried to resolve your anxiety in the past and have yet to find
relief, we want to encourage you to try again and to keep going. 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!
Related to this article:
References & further reading on anxiety
Last Modified Date: 04/18/2011
Principal Author: Marcelle Pick, OB/GYN NP