Depression, anxiety & mood

Anxiety in women — causes, symptoms and natural relief

by Marcelle Pick, OB/GYN NP

• What is generalized anxiety?
• How emotional experience contributes to anxiety
• Physical causes of anxiety
• Risk and benefits of anti-anxiety medications
• Natural anxiety relief

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.

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 six months.

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 equilibrium.

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.

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 benign situations.

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 neurotransmitter balance.

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 adrenal glands (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:

• 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!)
• 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.
• Eliminate potential food allergens. Gluten, for example, is notoriously associated with anxiety. If you are experiencing anxiety-related gastrointestinal problems, an elimination diet may help you identify any sensitivities at play.
• 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.
• 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.
• About your emotional work... Just as you developed coping skills as a child, so too can you unlearn old patterns that no longer serve you. Don’t be discouraged by the knowledge that our brains aren’t quite as plastic as in adulthood as in childhood; it may take commitment and perseverance, but you can learn new skills to free yourself of the emotional and physical trappings of anxiety. These include methodologies that quiet the nervous system, raise awareness of your personal emotional triggers, and provide coping strategies you can draw on when nerve-wracking situations arise. Our patients troubled by anxiety have done well with the Hoffman Quadrinity Process, Emotional Freedom Techniques, and integrative manual therapy. Other methods proven helpful include cognitive behavioral therapy (CBT), qi gong, and transcendental meditation (TM).
• Targeted neurotransmitter support. If you’ve tried the above measures and your anxiety problem continues to seem entrenched, you may want to talk to a functional healthcare practitioner about neurotransmitter testing and support. At Women to Women we use these test results to select neurotransmitter precursors, modulators, and enzymatic cofactors that support neurotransmitter and receptor balance, communication, and responsiveness. (This process should be supervised by a qualified medical provider.)

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

 

Original Publication Date: 08/17/2005
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP