Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D.— a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program—to address a woman riddled with anxiety, which she likens to a gnawing feeling of dread.

Dear Dr. Pat:

I can’t seem to stop worrying.  I feel like I am anxious much of the time.  Sometimes I can pin it on certain things — like needing to give a presentation at work or dealing with my ex-husband — but most of the time it is just there, this gnawing feeling of dread. I find myself getting headaches fairly often, and went to my primary care doctor, but he couldn’t find anything wrong and said it was probably stress. While I can get through my day and do what I need to do, I find myself just not going out and doing things because it makes the anxiety worse.  I am 52 years old and had only two periods in the last year. So, I was wondering whether this might be part of menopause. Looking back, though, this isn’t new. I’ve always been a pretty Type A personality, worrying about getting things right and being somewhat of a perfectionist. That served me well and I’ve been very successful in my career. I am just tired of feeling this way all the time, and I think things are somewhat more stressful at work, which makes the anxiety  much worse. Or maybe I’m just less able to tolerate it. When I was at my last check-up with my doctor, I mentioned it to him and he offered to write me a prescription for lorazepam, but I turned it down because I don’t want to be on anything that could be addictive. What should I do? I feel like I need to do something to relieve all this tension I’m feeling, but really don’t want to just start popping pills. Any advice?

Thanks,
Helen

Dr. Riddle Responds:

Dear Helen,

It seems like this is something you have been managing on your own for quite a while and I am glad you are seeking help as it sounds quite miserable to be dealing with that much anxiety all the time.

Anxiety can come in many flavors. For some, it takes the form of excessive worry or irritability while for others the symptoms are predominately physical with headaches, tight shoulder muscles and stomach aches. Anxiety can run the spectrum from actually helpful — at low levels, giving you that extra edge to do your best under pressure — to completely debilitating. You describe that, in the past, anxiety has been a component of your perfectionism and it is not uncommon for people with high levels of perfectionism to also have elevated levels of anxiety. When we try to distinguish between what makes one person perpetually anxious while another is laid back, there appears to be a combination of genetic and environmental factors, including the way you were raised and life experiences.  People who are anxious have been shown to have increased levels of activity in the amygdala, the fear center of the brain.  Studies have also shown that a higher number of traumatic life events is associated with elevated levels of anxiety.

Up to one in ten individuals are thought to meet criteria for a diagnosis of generalized anxiety disorder (GAD) at some point in their lifetime. Having GAD consists of having excessive, difficult to manage worry that causes problems in a person’s life and occurs on most days, lasting for at least six months. GAD is twice as common in women as in men and it is often is not an isolated condition, but is rather an addition to other issues, such as depression, post-traumatic stress disorder, drug and alcohol abuse, or panic disorder.

Anxiety does more than just make you feel miserable and limit your daily activities — it can also have very real effects on your physical health. Anxiety has been shown to worsen heart disease, for example.

You ask specifically whether your anxiety might be related to menopause. Given higher rates of anxiety in women, there has long been a proposal that hormones may be playing a significant role. Some studies in fact have shown that, while pre-menopausal women develop anxiety disorders at higher rates than men, this actually equalizes after menopause. During the menopausal transition, the jury is out as to whether rates of anxiety are higher.  Some studies have shown that those with lower levels of anxiety may experience a slight uptick in symptoms, with those with higher levels noting no change.  In contrast, other researchers have found no such connection between anxiety and the menopausal transition, or even lower than average levels.  The bottom line? Individual results may vary. Given what you describe, being anxious for much of your life, menopause may be a piece of the puzzle, but is less likely to be the primary cause of your current experience.

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