Are Women Prone to Worry?
How to cope when anxiety gets out of control
Jeanne L Alexander, MD Vivien Burt, MD, PhD
August, 2004

Below is an excerpt from the above article but it's worth going to the link and reading the entire article:

Anxiety and quality of life
Anxiety has a global effect on a person's life. Psychiatric researcher Ronald Kessler[8] found that anxious rated their mental health as "fair" or "poor" six times more often than healthy individuals. Thirty-five percent of those with severe anxiety problems considered themselves moderately to highly socially impaired. Anxiety can also affect job performance: 11 percent of those with an anxiety problem in this study reported missing six or more days of work in a given month.

A woman's anxiety response can also be heightened by premenstrual symptoms, childbirth, the perimenopausal transition, hot flashes, and certain hormone treatments.

We explore these factors below.

PMS and anxiety
Premenstrual irritability and mood changes can increase anxiety. These need not be significant enough to be considered a premenstrual dysphoric disorder (PMDD), a serious form of cyclical depression that occurs one week prior to menstruation.

While some patients may have a sub-clinical form of premenstrual dysphoric disorder, others simply experience a magnification of their anxiety symptoms the week prior to menstruation. These women often blame their problems on PMS when, in fact, the menses is simply intensifying a problem they have during the entire month.

Perimenopause
Women who have had intermittent but tolerable anxiety may also have increased emotional difficulties when they approach the "change of life." Ellen Freeman writes in a 2004 paper that perimenopausal women with a history of depression are twice as likely to have depressive symptoms at this time of life.[9] Perimenopausal women with hot flashes and night sweats are also four times more likely to suffer from depression compared to those without vasomotor symptoms; thus, hot flashes in and of themselves present a risk for mood problems.[10]

A combination of ongoing low-level anxiety, hot flashes, and related sleep disturbances may also increase emotional discomfort .[11] Women often complain that menopause causes their anxiety, yet a careful inspection of their history reveals that they have long suffered low-level anxiety that has blossomed under the biological stress of "the change."[12]

Not all women with low-grade anxiety experience this sudden flowering of symptoms, however. Further, the SWAN study (a large multi-site study designed to examine the health of women during their middle years) found that psychological symptoms are likely to be associated with estrogen and progesterone hormonal fluctuations in the early stages of menopause.

Hot flashes
It is important to distinguish between a hot flash and an anxiety attack. Hot flashes occur during the day as well as at night. They are associated with increased core body- temperature, a feeling of heat rising from the chest to the face, and profuse sweating.[12][13]
This change in core body temperature occurs with hormonal shifts and is related to neurotransmitters in the part of the brain called the hypothalamus.[14]

An anxiety attack is not associated with a change in body temperature, even though it produces sweaty and clammy hands and feet, accompanied by an increased heart rate. This anxiety response is triggered by neurotransmitters in the part of the brain responsible for cognition known as the locus coeruleus.

Hot flashes are linked to variable and declining estrogen levels that occur during the change of life.[15] Not all women suffer from hot flashes. Reports vary depending on culture, ethnicity, and diet.

In the U.S. approximately 20 percent of menopausal women complain of significant hot flashes.[16] At this time of life, the ovaries "sputter," monthly egg production decreases, and it finally shuts down altogether.

At this point, a woman may produce different levels of estrogen and progesterone from month to month. The constant change in hormones levels causes thermoregulation problems in some women, affecting the hypothalamus.

Hot flashes are also related to a woman's ability to manage stress and whether she has a history of anxiety or depression. It is important to note that depression and anxiety, as well as stress, can intensify hot flashes.[17] Hot flashes can also disturb one's sleep and make depression and anxiety worse.[18]

Progesterone
A small number of women have difficulty taking synthetic progesterones, and as a result, they become depressed.[19] (Progesterone affects a number of mechanisms in the brain that control serotonin levels.)

Others experience a "Valium®-like effect" when they take natural progesterones.[20] In fact, some feel as though they have just taken a sleeping pill.[21] This appears to be a result of the conversion of natural progesterone to "allopregnenolone," the brain's own natural sedative. Allopregnenolone works on the benzodiazepine receptors responsible for calming or exciting the brain. (Valium®, Xanax®, Ativan®, and Klonapin® are all benzodiazepines.)

Women who feel irritable on progesterone or find that it makes them anxious and depressed generally have difficulty tolerating hormone replacement or birth control pills that contain this substance.

A clinician will usually offer a natural progesterone as an alternative to a synthetic progesterone, such as Provera®. If the patient is still reactive, there are other options.

Progesterone-sensitive women may be able to tolerate a Mirena® IUD (a progesterone IUD), or a low-dose vaginal progesterone gel (4 percent). These choices have the advantage of limiting the brain's exposure to progesterone but require careful monitoring.
These solutions are suitable for those on hormone replacement therapy. The woman who is irritable or anxious on the birth control pill is often advised to try another form of birth control. (We will discuss the progesterone-sensitive woman in a future article —Ed.)

Post-partum anxiety
Post-partum anxiety (anxiety that persists for several weeks after delivering a baby) appears to be more common than depression.[22] Amy Wenzel reports that 30 percent of these women suffer from worry and generalized anxiety while only 12 percent were depressed. Other studies show anxiety in 18 percent to 20 percent[23] of the post-partum population.

The vulnerable woman who has had pre-existing problems with anxiety is more at risk for recurrence or worsening of her symptoms following childbirth. If a woman feels that the demands on her have mushroomed out of control, she is more likely to be anxious.[24] The post-partum period is a challenging time when women sleep less, have to
adjust to the needs of the child, must restructure the family environment, and cope with any financial stress associated with the baby's arrival.

The treatment of post-partum anxiety is important for the quality of life of the mother,[25] for the family, and the growing child.

Sometimes post-partum anxiety is confused with a post-partum thyroid condition. For this reason, a clinician should always check the thyroid when determining the nature of mood and or anxiety problems post-partum.