This post is an excerpt from "Get A Grip On Your Hormones!"

You pull up to the grocery store, locate a parking space, but just as you put your car in "Park" and shut the ignition, you're overcome with a wave of heat. A lump in your throat, your heart begins to race and you can't seem to open the door to exit your car. Your lungs feel crushed and you wonder if you're going to die, right there in the grocery store parking lot. Are you having a heart attack? Should you go to the emergency room?

You may be having a heart attack, but if you're a woman in her mid thirties-to-late-forties, you're more likely having anxiety.

Hormonal Transitions Can Span Four (or more) Years

The hormonal transition to menopause begins, on average, four years before you actually stop menstruating. One of the first signs of these hormone transitions can be anxiety and panic attacks.

The average age a woman ceases menstruating is 52 but some women experience the worst of their symptoms beginning in the mid-thirties and extending into the forties.

A great deal of attention has been paid to menopause but you can experience symptomatic hormonal transitions at any time in life: adolescence, pregnancy, post-partum, and breast-feeding.

Erratic Fluctuations in Hormone Levels During Transition

During the "pre-menopausal transition" your levels of estrogen and progesterone (the ovarian hormones) decline with each cycle, as the ovaries are expending the last of their eggs.

But they don't decline in a nice, smooth, orderly fashion. Instead, it's a herky-jerky ride down the hill. You can actually have dramatic hormone surges (especially high levels of estrogen) while your ovaries are transitioning to menopause--think of these as "sun flares”, surges of hormones followed by "crashes". It's the ride from the surges to the crashes can precipitate irritability, dysphoria, anxiety, and even panic.

“I Want My Hormones Tested”

Many women instinctively feel they’re having “problems with [their] hormones” and they come into my office wanting “hormone levels tested”. I can order “hormone tests”, however, in evaluating people in hormonal transitions I find it much more helpful to listen and pay attention to their symptoms, rather than reaching for a lab test. Hormone blood levels can be completely normal in someone who is very symptomatic.

Blood hormone levels drawn at any one time usually tell you what you already know just from listening to your symptoms: your estrogen can be very high if you’re having a “surge” or very low if you’re in the nadir of the “crash”. However, labs done at a specific time only give you a snapshot of what’s happening at that instant—they usually confirm your suspicions you’re having a hormonal transition. It’s the dynamic nature of hormones that determine symptoms—not any blood or salivary level done.

Hormones and Their Pre-Molecules Can Relieve Anxiety

Ovarian hormones and their precursors (estrogen, progesterone, and their building-block molecules) are natural "anxiolytics". This means they naturally interact with the "anxiety-control" receptors in your brain (gaba-receptors) to keep your mood even, cope with stress, and prevent panic. Fluctuations of one molecule in particular, allopregnenalone, have been found to be crucial in triggering peri-menopausal mood swings, anxiety, and premenstrual syndrome.

External Factors ("Life") Can Exacerbate Symptoms of Hormone Change

Anxiety in the peri-menopausal transition is often confounded by job factors and family changes. You may find you're having more conflicts with your boss or employees--perhaps you are older or a different gender than them and this creates tension. Children may be growing up and leaving (or not) home. Your relationship with your spouse may be changing as your sexual and other interests evolve.

Sometimes anxiety causes "dysphoria", an emotional state like a "funk"--this can be mis-diagnosed as "depression".

You Can Manage Anxiety

So what can you do about peri-menopausal anxiety?

Self care is essential to the management of anxiety, irritability, and other symptoms of hormonal transitions. A good method of self-care is yoga or some other gentle exercise. Yoga can be strenuous, get your heart rate up, and build strength but it is easy on the joints because it widens the joint spaces. Many peri-menopausal women are also having joint problems or other aches and pains. An excellent beginner yoga routine is Shiva Rae’s Flow Yoga for Beginners.

Talk to your health care provider because sometimes anxiety is severe enough it needs to be treated—it can even be disabling. There are many good treatments for anxiety. Untreated anxiety can lead to heart disease, depression, and a host of other health problems. So anxiety needs to be identified and taken seriously by both you and your health care provider.

Medications and Nutrition Support

Although hormonal changes can precipitate anxiety, hormones may or may not be the best thing to treat your anxiety, depending on the character and timing of your symptoms. There are cognitive (mental) techniques for managing anxiety as well as medications such as benzodiazepines and anti-depressants that work well for anxiety.

Exercise, Vitamin D, and a B-Complex (plus a multi-vitamin) can support your body physically and mentally as you're going "through the change". Many women's anxiety responds well to the cognitive techniques and paying attention to physical and mental health.

Peri-Menopause--More Than A Flash

So while hot flashes have received a lot of "press" as the harbingers of "menopause", many women experience anxiety long before hot flashes set in. This anxiety can be the first sign of peri-menopausal hormone transitions.

This post is an excerpt from "Get A Grip On Your Hormones!" To pre-order the book, to be published in October 2009, click here.

What was/is your experience with phases of hormone transitions?

Did you use hormones or other meds for transition symptoms?

Did your hormone levels tested? If so, have they been helpful to you in guiding therapy?

Don’t Panic: It May Be Hormones!