I was never an anxious person. I want to say that first, because it's the whole point. I'm a zero-to-a-hundred sort, I'll have a go at most things, and for forty-odd years my nerves and I had an understanding. Then, in my mid-forties, anxiety turned up uninvited, sat down in the middle of my life, and brought panic attacks with it. I'd never had one of those either. The first time, I genuinely thought I was having a heart attack. Heart going like a drum, no breath, the certainty that this was it. I remember thinking, quite clearly, that I hadn't done the ironing and somebody was going to find it. It wasn't a heart attack. It was perimenopause, and nobody, me included, said that word for a long time.
Is anxiety a symptom of perimenopause?
Yes, and a common one, though you'd never know it from the leaflet. That's the thing about perimenopause anxiety. It doesn't come with a label. There's no hot flush to point at and say "ah, menopause". It just arrives, for no reason you can find, on an ordinary Tuesday, and because you've never been like this you assume something must be badly wrong with you. Your heart. Your head. Your life. Anything but the obvious.
It wasn't on its own, either. It arrived alongside a list of other things nobody warned me about, and I treated every one of them as a separate problem for far too long.
What a perimenopause panic attack felt like: the drive home
The worst one I can date exactly. My dad isn't well. Like a lot of dads his age, a long illness has got hold of him, and I'd driven four hours to look after him while Mum went to a funeral. New car, picked up the week before. Dad and I had a lovely few days. It was the drive home that nearly finished me.
Somewhere in the first hour I talked myself into not being able to drive. I can't tell you how it started. I was nervous, then worried about crashing, then I couldn't keep my eyes on the road properly. Dizzy. Shaking. Sweaty hands on the wheel. An upset stomach, then actually being sick at the side of the road. I'd pull over, and within a few minutes it would pass and I'd feel almost normal. I'd get back in, and a few miles later it would hit again. I made more stops than there were hours in the journey. By the end, the sat nav had stopped suggesting routes and was just suggesting lay-bys. I got home because I had to get home, and for no other reason. It has never happened to me behind the wheel since, which tells you something: it was never about the driving.
Why does perimenopause cause anxiety?
Here's what I've learned since, and I'm not a doctor, so take it as one woman's notes. The hormones that start wobbling in perimenopause, oestrogen in particular, are tangled up with the chemistry that keeps the brain calm. When they drop, and they don't drop gently, they lurch, the body's alarm system gets twitchy. It fires at nothing. Add a run of bad nights, which perimenopause also hands out for free, and the alarm is on a hair trigger. That's not a character flaw. It's chemistry. And it's common: a lot of women say anxiety was their first menopause symptom, long before anything they'd have called menopause.
What nobody tells you is that if you walk into a doctor's surgery and say "I've started getting anxious and I had a panic attack", the conversation often goes straight to antidepressants. Sometimes that's right. But if you're a woman in your forties and the word menopause hasn't come up, make it come up. Say it first. "Could this be perimenopause?" changes what happens next.
What helped my perimenopause anxiety: writing it down
What actually helped me wasn't a breathing app, though breathing helps in the moment. It was writing it down. Every day, four taps: how I slept, my mood, how clear my head was, and the flushes column, which in my case stays empty, because I don't get them. After a couple of weeks I could see the anxiety wasn't random at all. It was worse after two short nights in a row. It was worse in a certain week. On the days I'd walked, it was quieter. Once it had a shape, it stopped feeling like a verdict on me and started looking like weather. Weather you can plan for.
What gets me through a panic attack: a song
The other thing, and I found it by accident, is a song. When the wave starts, I put on something with a steady beat, or I sing one, badly, usually in the car. Regular rhythm, not too fast, nothing that builds to a big finish. It isn't magic, it's breathing. A panic attack runs on breath that's gone quick and shallow, and a chorus makes you breathe in and out in time whether you like it or not. It is very hard to hyperventilate and sing at the same time. Your lungs have to pick one, and if you give them a tune, they usually pick the tune.
I'm not going to tell you what I sing. The car knows, and the car isn't talking.
Three things to try for perimenopause anxiety
Three things to try this week, if this is you:
For two weeks, note your mood and your sleep every day. One word for mood, a number for hours. That's all. You're not fixing it yet, you're catching it in the act.
When the wave comes, name it out loud, even in the car: "this is a panic attack, it will pass in a few minutes, it has every time." Then put a song on, or sing one, something with a regular beat, and breathe with it. It sounds daft. Between them, that sentence and that song are the most useful things I own, and neither of them cost a penny.
Take the two weeks of notes to your doctor and say the word perimenopause before they do. Two weeks of facts is a different conversation from "I've been feeling anxious".
If it's more than you can carry, go sooner than two weeks. Anxiety that stops you leaving the house or driving home isn't something to wait out.
You're not losing it. You're not having a heart attack. You're in your forties and your chemistry has gone rogue, and there are a great many of us in the same lay-by, waiting for it to pass so we can get back in the car.
Emma
If this sounded familiar, there's more where it came from. I send a note like this once or twice a month (the sign-up is at the bottom of this page), and the Hot Mess Community is where we carry on the conversation. Hot Mess, the app I built because of all this, is on Google Play, free for 14 days; the mood circle is where this post started.
Hot Mess is a tracking aid, not a medical device, and none of this is medical advice. Chest pain, breathlessness and a racing heart can have other causes, so the first time it happens, get it checked. Perimenopause is one explanation for new anxiety, not the only one.