Stress is a major cause of medical issues in both men and women, with 70% of primary care visits being related to stress and lifestyle. Interestingly, we have a normal biological process that has kept us safe since the beginning of time – our fight, flight or freeze response to an external event. We call it our stress response.

An external “stressor” triggers the sympathetic drive of our autonomic nervous system, we produce hormones such as adrenaline (epinephrine) and cortisol from our adrenal glands, causing our heart rate, blood pressure and respiratory rate to rise and blood sugar to increase for energy. The result is that historically if there is danger, we can run away or fight. In nature, it happens all the time and is usually a short-term event. For example, an animal will either get away and will resume what it was doing before or will be caught, as referred to in Robert Sapolsky’s book “Why zebras don’t get ulcers”.

Our stress response is very useful in situations of danger or for increasing focus and alertness short term. However, our modern busy lives are filled with overstimulation of our sympathetic nervous system because of how we process external events happening daily.

The autonomic nervous system also has a parasympathetic nervous system, which is involved in most of our normal daily functions and is known as the “rest and digest” or “feed and breed” system. This is when the body performs many of its vital functions such as production of our sex hormones and digestion of our food.

Stress And Menopause

When menopause starts, it is usually at a time in our life when there can be multiple life changing events happening as well. Women in their 40s and 50s are potentially caring not just for their own children but often parents too. It can be a time when a child is leaving home or family bereavement occurs due to losing parents. It is also a common time for relationship difficulties and divorce. At the same time, women are having fluctuating hormone levels, which leads to symptoms that mimic those when under stress – such as palpitations, hot flashes (hot flushes in UK), mood swings, heightened anxiety, anger/irritability, fatigue, poor sleep and depression.

In other words, during perimenopause and menopause, women are already experiencing symptoms due to fluctuating hormone levels. If we are also experiencing chronic stress, our sympathetic nervous system is being activated more than normal. In this case, instead of producing sex hormones, we are producing (the hormones) adrenaline and cortisol. This further disruption of our sex hormones means that stress exacerbates the symptoms of menopause. Pre-menopause, the body has more sex hormones, as these hormones decrease coming into perimenopause and menopause, stress starts to have a greater effect.

We can put our bodies under stress in many ways, not just from relationship issues, work stress, time pressures, etc. For example, a bad diet can cause inflammation in the body and is a form of stress. The consequence of prolonged exposure to stress is fatigue, weight gain, burnout and exhaustion.

How Can We Deal With Stress During Menopause?

There are multiple lifestyle changes that you can adopt to help deal with both stress and menopausal symptoms. Do not get overwhelmed; try a small change first and see how it helps, then add more changes.

    1. Diet
    A bad diet is a stressor for the body. It will not only make menopausal symptoms and the long-term consequences worse but also causes the body to adopt a “stressed” state. Processed foods high in carbohydrates and sugars cause an increase in inflammation and cortisol in the body. Please see my related blog for more on diet during the menopause.

    2. Exercise
    Exercise does wonders for stress control. It does not have to be gruelling or an activity that does not appeal to you. Find an exercise that is right for you. For example, it can be a form of dance or movement, a brisk walk out in nature, swimming, yoga or Pilates. Exercise deepens breathing and relieves muscle tension. Aim for 150 minutes of physical activity per week, doing something intense enough that you would not be able to sing but can still talk during the activity.

    3. Sleep
    Prioritise sleep like you would diet. Giving ourselves the opportunity for adequate rest helps us deal with stressful situations better. There are different stages of sleep that help us process traumatic events and stress more naturally. For more on sleep see my related blog - Why Sleep Is Important During The Menopause

    4. Stress reduction techniques

    • Meditation and deep breathing exercises – Meditation decreases the negative impact of stress and help shift your body back into the parasympathetic drive. Guided meditation can be a helpful start; there are multiple apps and online videos to help. There are also many types of mediation from breathing and relaxing exercises to body scans to loving kindness mediations. It is worth looking at each to see which is most helpful for you.

      There are numerous types of breathing exercises such as box breathing. Box breathing involves the following steps:

      • Breathe in through your nose deeply and slowly for 4 seconds, and feel your lungs expand
      • Hold your breath there for 4 seconds
      • Slowly exhale for 4 seconds
      • Hold for 4 seconds and then repeat

      There are many deep breathing exercises to try, breathing into your belly and feeling it expand can be useful. Lengthening your outbreath can help calm anxiety and activate the parasympathetic nervous system.

    • Mindfulness- Mindfulness can be grouped with meditation. It is something most people can do easily, even if they do not like to meditate. If breathing exercises are not for you, find some calming music, close your eyes and just concentrate on that music, the notes, the words, the tones, etc. Try a mindful walk. Leave your phone at home. Go out into nature, feel the ground beneath you, listen to the sounds. Are there planes overhead? Can you hear birds singing?

      If there are trees or bushes, look at the patterns on the leaves. The repeating patterns of nature are known as A. Think about branching trees, ferns and acorns. Looking at fractals can decrease stress by as much as 60% according to studies. Take pleasure in some small routine you have such as savouring a morning coffee – look at how it looks, see the steam coming off, notice the smell and taste, and be in the moment.

    • Journaling/gratitude– Physically writing things down can be helpful to “offload” stressful thoughts. Also, starting to make a regular habit of writing down three things you are grateful for on a daily basis causes a shift in health behaviours. The more gratitude is practiced the more a shift in thinking happens.

    5. Social connection, i.e., talk/share/cultivate friendships
    An important predictor of happiness and longevity is social connectedness. Make sure to make time to see friends and family. Good levels of social support decreases anxiety and can activate the parasympathetic nervous system to help with calming stress.

    6. Plan your own time
    In addition to socializing, ensure you have time in the week for relaxation. A bath in the evening or a book, hobby or a fun class will help make life more enjoyable and the stressful times easier to handle. As they say, remember to fit your own oxygen mask before attending to others.

In summary, menopause can be a stressful time. It can cause symptoms of stress such as palpitations, sweats, fatigue and depression. External stress can make these symptoms worse. If you feel you have a lot of stress in your life, then perimenopause and menopause are perfect times to start looking at your lifestyle to see what you can do to minimize stress and how you can best cope with stress. Doing so will help your overall wellbeing and will make a positive difference to your menopausal symptoms.

Dr. Sherina Fernandes, MBBS, BSc, DCH, nMRCGP, IBLM, BSLM, is a lifestyle physician working as a clinical lead for a telehealth company in the UK. Her main interests are preventative medicine using a lifestyle approach, women's health and preventing burnout.

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