Maybe it's heartburn... (or not!)

Several months ago (not for the first time but the first in a long time) I woke with a violent start and pounced on my husband (not for any of the reasons he would have preferred) - I couldn’t breathe, I felt lightheaded, and it felt like my heart was beating out of my chest. 

I was 300% certain I was having a heart attack.

I paced our bathroom floor, seconds away from calling an ambulance while my husband suggested it might be “something I’d eaten” (this was a familiar dance). 

I didn’t want to make the decision to call an ambulance myself (God forbid I wake the EMTs); I wanted my husband to call but he was far less concerned about my impending doom (“Maybe it's heartburn?”) and seemed even less willing to be the one to wake the EMTs. 

I thought perhaps he could drive me to the hospital but our children were sleeping and I didn’t want to wake them up or leave them without an adult. 

(Somewhere in the back of my messed up mind, I must have known I was having a panic attack and not a heart attack because, in retrospect, my thought process seemed (barely!) rational.)

Except…  

I made the unquestionably poor decision to drive myself to the emergency room. Apparently, I was certain enough I was having a heart attack to need to go to the hospital, but not certain enough to be afraid my heart would stop on the way (yes, I’d say barely rational).

I made it safely, checked myself in, and began to pace the waiting room, very concerned that the receptionist wasn’t more concerned. I told her I was having a heart attack! I should have been on a gurney… at the very least in a wheelchair.  

It turns out she’d seen this more than a few times before. Ninety minutes later, I was discharged after my blood tests and EKG suggested that my heart was in perfect working order.

Oozing sympathy, the doctor on call wished me farewell with a “That was one hell of an expensive panic attack”.

Ah, bless.

I began to experience this physically and emotionally debilitating anxiety when I was about 38 years old (coincidentally, around the same time my ovaries gave their notice but I didn’t know that at the time). 

I suddenly found myself living at a consistently elevated level of fear and stress. I carried a pit in my stomach, I couldn’t sleep, I was overwhelmed by everything. My boys were 3 and 5 and I worried constantly that something terrible was about to happen to them. My mind became adept at creating and then carefully walking me through terrifying (albeit unlikely) scenarios.

I know now that my runaway anxiety was very likely the result of a frightening combination of declining estrogen levels, elevated cortisol levels, a disruption in brain chemicals critical for emotional regulation, and all the other stressors that might plague a 30/40-something-year-old mom, daughter, wife, employee, people-pleaser. 

And I know now that anxiety can be a very real and common symptom of perimenopause. Depending on the study, anywhere from 20–58% of women experience anxiety during perimenopause. And a recent study in BMC Women’s Health suggested these rates will continue to increase.

Why?

Estrogen has neuroprotective and antidepressant effects. So during perimenopause, when estrogen levels fluctuate and then fall, women can experience a broad range of symptoms related to the nervous system (e.g., nervous system dysregulation) and mood, including increased feelings of stress, anxiety, and depression (the subject of a future email). 

And - all joking aside, the emergence of anxiety around perimenopause can have a significant impact on a woman’s quality of life.

What perimenopausal anxiety might look like:

• Racing thoughts, especially at night

• Increased worry 

• Feeling overwhelmed by tasks that used to be manageable

• New or heightened social anxiety

• Irritability or a shorter fuse than usual

• Insomnia

• Physical symptoms like heart palpitations, shortness of breath, or tightness in your chest

Some key management strategies to consider:

• Regular movement: Even gentle exercise like walking or yoga can significantly reduce anxiety by boosting endorphins and improving sleep quality.

• Nutrition support: While research is ongoing, reducing caffeine, alcohol, and refined sugars can help stabilize mood swings and anxiety. Some women find omega-3s and magnesium especially helpful during this transition. Adhering to a Mediterranean diet may also be associated with reduced anxiety. 

• Mindfulness practices: Even 5-10 minutes of meditation or deep breathing daily can help activate the “rest and digest” component of the nervous system, helping you move more easily out of anxiety (“fight or flight”) mode.

• Community support: Sharing experiences with other women going through the same phase can be incredibly validating and has been associated with improved symptoms overall. 

• Psychotherapy: Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) have been shown to help reduce anxiety in perimenopausal women.

• Medication: Some women find relief with antidepressants or other anti-anxiety medications (with or without hormone-replacement therapy).

Remember: Hormone Replacement Therapy (HRT) is an option worth discussing with your healthcare provider, as it can help stabilize hormones and has been shown to improve sleep (which is one important key to managing anxiety); although more research is needed to determine the efficacy of HRT in anxiety specifically. 

This week, I encourage you to simply notice: When does anxiety tend to peak for you? Is it tied to certain times or specific situations? Just observing patterns can be the first step toward finding relief.

Until then, please remember: your anxiety is real, it has physiological roots, and you deserve support in addressing it.

With care,

Amanda

Important P.S. If your anxiety feels overwhelming or is interfering with daily functioning, please contact a healthcare provider. While hormonal anxiety is common, you don't need to suffer through severe symptoms alone. You will find some mental healthcare practitioner resources/search tools here.