Anxiety

Hi ladies my next blog is enough to give you the jitters, its about Perimenopausal Anxiety thanks to master track athlete Clare Barr for sharing her story thus far.

In this blog I am going to highlight the symptom of Anxiety. I received a really useful email after my first blog from a Masters Track Athlete named Clare who was happy for me to share her experience:

Clare Barr Wed, Nov 14, 2018, 8:31 AM : Hi there, I hope you’re well.

My friend sent me your blog and I found it very interesting. It’s definitely a good subject to talk about as info seems so scarce for athletes.

I’m not a triathlete but I run track (current W50 800i British Champ) and I thought I’d briefly share my experiences.so far! I reckon this is an experience that will run for a few years yet.

My first symptoms were night sweats (sheets looked like the Turin Shroud) and I bought a fantastic Dyson fan for the bedroom which was really helpful. It’s got a little remote control so I can turn it on/off without having to get up. Husband wasn’t too impressed but hey ho.

I didn’t clock that symptoms were anything to do with peri-menopause - I’d never even heard the word. I just thought it was echoes of an awful flu I’d had the previous year.

I remember sitting delayed on the runway for a flight to the US and I had about a dozen hot flushes in the space of an hour. They didn’t really bother me though, just found it kind of weird.

When I got to the States though I had a few really unsettling incidents. I was doing a track session and had a 600 time trial to do. I was getting really anxious and upset beforehand, and I pulled up halfway through as I just couldn’t do it. Tried again and stopped again, in floods of tears. Not like me at all.

A day or so later I was in a cafe in Boston and started feeling really odd; spacey, faint, overheating. I was worried that if I stood up to go to the bathroom that I would faint in front of everybody. I managed to get to the cool air outside but just felt dreadful.

On an easy morning run the next day, I really struggled. HR up, no energy, just really hard work. I had to sleep all afternoon instead of enjoying a new city.

Over that winter I struggled with training. I was getting really anxious and finding myself pulling up in sessions and sitting in tears with my head in my hands.

In the New Year I had an indoor race - not a big important one - but I remember hardly sleeping the night before. I was so anxious in the morning. I knew I should probably pull out but we don’t like to quit without a good reason, do we? My warm-up was good and I felt better, but in the race itself I got my first DNF; I just stopped as the situation felt impossible. I wasn’t in control anymore.

The feelings of anxiety were the worst symptom I had. I could manage the night sweats and hot flushes no problem, but I had that ‘fight or flight’ feeling so often - like the adrenaline rush you get before something big is just about to happen - but this could be lying in bed in the morning. I’m definitely not an anxious/nervous person; I’m very practical and down-to-earth, so this was completely new to me and hugely unsettling.

I also started to feel like my hand and arm were about to twitch or jump - they never actually did - but I stopped holding my husband’s hand on the sofa at night as I was worried he would say, “Did your hand just jump?”, and then I would have to acknowledge that something was actually wrong. I was burying my head in the sand.

I got so worried that I paid to go and see a private neurologist. I thought I had early symptoms of Parkinson’s or a brain tumour. Result was all clear.

I went to my GP who did some routine blood tests and, bingo, my FSH numbers showed I was very definitely peri menopausal. “I’m what?”. The thought had never crossed my mind.

I decided to go on HRT and it has really, really helped. No more night sweats or hot flushes, and the anxiety is much better. Also no more ‘fight or flight’ adrenaline. I’ve been on it for a year now.

Another early symptom I had was awful bouts of UTIs; 5 in 6 months. Apparently your pH changes ‘down there’ and you can be much more susceptible. I ended up having to go on a quarter dose of antibiotics daily as a preventative measure, and that worked a treat with zero side-effects.

The only symptoms I have now are occasionally aching shoulder joints (it’s a ‘thing’; I looked it up on Dr Google!).

No doubt there will be other hurdles down the line, but I think it is helpful it women (especially active, sporty types) share their experiences. We’re all different but there will be common threads we can identify with, and it helps to know you’re not alone.

Kind regards, and all the best to you.

Clare

Thanks Clare x This is a really interesting email and I’m sure this will resonate with many of our readers and hopefully provide a solace in the fact that you are not on your own experiencing these symptoms.

My colleague, had terrible bouts of anxiety that would cripple her to the point of not wanting to go to work. During her attacks she was clammy, pale, frightened and had palpitations. She is an outstanding teacher and well respected by all pupils. I thought no more of it until I had a very similar experience. It was not like Clare’s or my colleague's, and it was not race or training related, it just happened one morning over a brew. I felt a wave of absolute panic come over me and I can’t even remember what I was thinking of at the time but I do remember feeling out of my depth and needing to take control immediately.

Dr L. Newson states (2018) that ‘Low mood and feelings of depression can be very common symptoms of the menopause and perimenopause. Other psychological symptoms include feelings of low self-esteem, having reduced motivation, anxiety, irritability, panic attacks, poor concentration and low energy” As a doctor she has seen these symptoms ‘mistaken for depression and many women have wrongly been given antidepressants by their doctors for these symptoms’. Newson believes that ‘It can be common for women to feel more tearful and frequently have mood swings. They can also become more irritated and angry than they used to which can really affect their families and their ability to function at work. She also makes the conclusion that if women have had postnatal depression in the past, or a history of PMS, then it is more likely they will experience these types of symptoms during their menopause. This is because their body is more sensitive to changing levels of hormones.’ J. Bromber & Kravitz et al. however, concluded that ‘women with low anxiety premenopausal may be more susceptible to high anxiety during and after the menopausal transition than before’? Either way, both studies found perimenopausal women can suddenly have increased bouts of anxiety. Freedman, Sammel, Lin, Garcia et al. looked into the correlation and links between hot flushes and anxiety experiences with their cohort of women and found that ‘Anxiety is strongly associated with menopausal hot flashes’. And that ‘Anxiety preceded hot flashes’ in their cohort which was supported by E. Durward (2019 A Vogel) who states that ‘Women may feel an increase in anxiety before other symptoms of menopause, such as hot flushes, set in’. The programme ‘the Truth about the Menopause’ BBC also raised this matter. Mariella Frostrup, told viewers that she suffered with anxiety and sleeplessness. Like Clare, Mariella was prescribed HRT. I am trying to get my head around HRT currently and want to dedicate a whole blog to this topic at some point so if you’re and expert and you’re reading this, please get in touch or write something for us, we’d all love to know what HRT is all about especially the arguments for natural HRT and the norm, synthetic HRT. It is believed that anxiety is a result of ‘fluctuating hormones’ (E. Deward 2018).  During the peri-menopause, levels of the female hormones start to fluctuate; Oestrogen, Progesterone and Testosterone! Yes we make that too! These changes can lead to PMS symptoms which appear and worsen in the week or so before each menstrual period because for some the balance of hormones may well be out.   ‘During perimenopause hormone levels fluctuate as a result of fewer ovulations, so less progesterone is produced in the second half of the menstrual cycle. Periods can be erratic, skipped or have heavy bleeding /clots. Symptoms result from the change in ratio of Oestrogen to progesterone so the imbalance creates the symptoms’ Dr E Schroeder (2019)

Images below show a regular monthly hormone cycle and the other one shows the depletion of hormones through a woman’s life cycle (fig 1. E Schroder 2019, fig 2 L. Brown Swigart 2015)

With such drastic changes in hormone levels no wonder we think that something else is going on with our bodies when we experience for the first time, the ‘evils’ of the Menopause. We were never taught about this at school and women seldom discuss it. I think I came across an article in a national newspaper about anxiety explaining that it could be related to the menopause, I gave it to my colleague because I felt it made a connection, she seemed interested and relieved to read it and promptly went to the doctors. She is not the type to discuss anything personal or related to ‘women’s issues’, but I do know that we both thought it was something more serious. She seems a lot better now and puts it down to ‘giving up caffeine’, I dare not ask her if she is using HRT as well, that’s crossing the line!

The ‘centre for anxiety disorders’ has a really useful website; http://centerforanxietydisorders.com/treatment-programs/menopause-anxiety/

It shows a useful link between ‘Menopause and Anxiety’. Their link page explains that;

‘The changes that come with menopause affect a woman’s life physically and emotionally. The most recognizable changes are hot flashes, mood swings, and restless nights. But what many people may not realize is that menopause may also bring with it anxiety, panic attacks and depression.’ They highlight and explain ‘Menopausal Anxiety’ by stating that ‘Medical studies suggest that even under normal circumstances, women are twice as likely to experience anxiety as men. However, the hormone imbalances that arise during menopause can also contribute to the development of anxiety or worsen existing anxiety and depression. Menopausal anxiety symptoms include:

• Panic Attacks

• Shortness of breath

• Fatigue

• Dizziness

• Chills

• Heart palpitations

• Chronic sweating

• Nausea

• Muscle tension

Finding that you have increased anxiety is obviously a very worrying and debilitating. Especially if you are a confident woman and athlete who has never experienced such feelings before to this degree.

I think it’s fair to say that all sports people experience pre-race nerves;

‘There are many reasons why athletes feel nervous before an event. Whether it’s your first race or your 50th, when you roll up to the start line or you’re standing on the beach waiting for your swim start, you’re probably going to experience some race-day anxiety. It’s normal to feel nervous when you’re about to take on a new challenge or about to tackle something important to you and you’re unsure of the outcome. The nerves you feel are a part of your fight-or-flight response. Your heart starts to beat a little faster and your palms get sweaty. It’s hard to focus, your breathing is shallow, your stomach is in knots, and you’re looking at the line for the bathroom wondering if you have time to go again before your race starts’ (C. Cheadle 2015)

However, experiencing these types of feelings whilst you’re in bed relaxing or just going about your business is something else and quite overwhelming.

As a sports woman with a keen interest in sports psychology, I have learnt some skills that have allowed me to keep a ‘check’ on my levels of anxiety (well I do my best) and when I experience episodes of ‘panic/ anxiety’ I use some ‘Neuro-Linguistic Programming’ (NLP I. McDermott  & W. Jago 2002) Techniques which I learnt on a ‘Life Coaching’ Post Graduate Course with Barefoot coaching. Only last night did I tune into the Triathlon Coach’s (Simon Ward) Podcast (TheTriathlonCoach SWATcast - Episode 78. Feb 2019) with John Thompson (Psychologist and Yorkshireman!) which highlighted the importance of developing a stronger mental attitude alongside your physical capabilities in terms of getting the most out of your triathlon performance and proves a useful listen if you take your sport seriously.

When I started Triathlon 7 years ago, I was absolutely terrified of the open water swim. I’m not a good swimmer but I’ve improved in the pool and can now cope well in the open water.  I always invest a lot of time ‘coaching’ myself through the OW swim (and elements of the race) the day before by developing a ‘mental movie’ of how I want tackle elements of the race. I mentally rehearse where I’ll start the swim, my pace, how I’ll breathe and relax into my stroke and sight. I visualise getting hit and pulled on in the water, I feel that breathless anxiety and panic then calm myself down knowing I can deal with it in the water by slowing down, relaxing & catching my breath, sighting and recovering. I also think aggressively too I’ll be holding my line, kicking hard and surging until I’m in clear water. It’s part and parcel of and open water triathlon swim, you will get mobbed deal with it.  If I did not have this ritual, I’d be a bag of nerves, I’d start panicking about getting ducked and held down, swam over and drowned as Harry Potters mermaids coming to get me! This would make me very sick, I would under-perform and maybe not even race. (Cheadle 2015 lists ‘5 Simple Strategies for Overcoming Race Day Nerves’ on Training Peaks https://www.trainingpeaks.com/blog/5-simple-strategies-for-overcoming-race-day-nerves/  Do take a read her strategies are very useful too.)

CBT, Cognitive Behavioural Therapy, is also thought to help reduce anxiety especially around the Hot flushes as suggested in ‘The Truth about the Menopause’ (BBC 2018). Here they tracked a group of women and taught them how to use breathing techniques and thought patterns to help them understand the reality of what was happening and helping them relax with some centred breathing to help them get a grip on reality. It seems that a few seconds before our hot flush we start to engage in negative thought patterns like, ‘Oh no’ I’m having a power surge/ tropical moment/ hot flush etc’ then we imagine negative connotations; everyone will see, think it’s bad etc. Fundamentally we get ourselves into this fight or flight scenario which exacerbates the situation and intensifies the hot flush.

It’s a funny thing really because you really do know that you are about to have a hot flush, those few seconds just before. I’ve had them at night and during the day at work but have yet to put into practice any techniques. I guess for me as an athlete, I’m used to sweating but in the classroom on a cold day? I must say I think some kids raise their eyebrows when I roll up my tracksuit bottoms and get out my flannel to mop up the sweat? But maybe not, no one has ever said 'look miss is having a meltdown' or 'Are you OK Miss' and to be honest I never really noticed my mother’s hot flushes only when she pointed them out. 'look at me I'm dripping, I'm not normal'.  Generally I believe people are too wrapped up in their own worlds to notice; the kids are so busy writing notes/ learning? (trying to get out their phone, looking out of the window, chatting to each other, etc.) they are simply not that interested in me and in all honesty very few people will actually notice unless you do something physical or say something!

To conclude what can you do about Peri-menopausal Anxiety?

“Possible treatments for menopause-related anxiety can include hormones, hormone therapy, antidepressants, psychotherapy, or supplements for better mood. Cognitive Behaviour Therapy (CBT) has been shown to be effective as a treatment for menopause. This therapy helps women examine the connections between their feelings, thoughts, and behaviour. By using these techniques, women can learn how to modify their behaviour to help reduce the severity of menopausal symptoms.

• Watching your diet – Caffeine and alcohol can worsen symptoms while complex carbohydrates act as a mild tranquilizer and steady your emotions.

• Getting some exercise – This can help your body relax and serve as a stress-reliever. Perhaps take up ‘Yoga. Certain combinations of poses can help melt the anxiety away and leave you feeling stronger and more relaxed’ (HOLLY OSTERMAN 2019).

• Relaxation techniques – Simply doing things that relax you such as listening to music or going for strolls through the park can have a dramatic impact on any anxiety you might experience. “Meditation creates feelings of well-being and relaxation, lowers your blood pressure and heart rate, and can reduce menopause anxiety and stress” (HOLLY OSTERMAN 2019)

• Focus on Your Breathing. Couldn’t be any simpler and you can do it anywhere—car, office, elevator, etc. Too often do we get ourselves caught up in a moment and then, after a few, deep relaxing breaths, things slow down and get much clearer.

• Take Time to Meditate. Use meditation to focus, quiet the mind and become present in the moment.

• Maintaining a positive attitude – Focusing on negative thoughts only makes anxiety and depression worse. On the other hand, focusing on the positive can keep anxiety and depression at bay.”

• Getting enough sleep – Deep sleep is a natural relaxer.

• Explore Herbal/ Alternative Remedies. Certain products contain natural ingredients that might provide relief for your menopause symptoms. But do be careful with this maybe take advice from you doctor first. Emotional Freedom Techniques (EFT) or Tapping can help. Maybe even Acupuncture and reflexology?

• Educate Yourself. Learn more about menopause symptoms so that you can make wise decisions about what’s best for your mind and body and prepare yourself for what may be yet to come!

• Talk to Your Doctor. By keeping an open dialogue and developing a good relationship with your doctor, you may be better able to manage physical causes of your menopause anxiety. Consider asking about hormone replacement therapy (HRT). While some women are not comfortable with the pills or creams, HRT has made a big difference for many

If you are experiencing the symptoms of menopause, anxiety and depression, please do speak with your doctor immediately. Seeking help can make an already difficult time of your life easier to handle and get you back to enjoying your life.”  ‘centre for anxiety disorders’ 2019

In the meantime, if you have tried anything else, please get in touch and let me know so I can share your ideas/ update this blog.

Thanks for reading,

The Peri-Menopausal Triathlete

tpmtriathlete@gmail.com

References:

BBC 2018 The Truth about the Menopause https://www.bbc.co.uk/iplayer/episode/b0bt4c3m/the-truth-about-18-the-menopause Bromberger. Joyce T, Ph.D.,a,b Howard M. Kravitz, D.O., M.P.H.,c,d Yuefang Chang, Ph.D.,e John F. Randolph, Jr., M.D.,f Nancy E. Avis, Ph.D.,g Ellen B. Gold, Ph.D.,h and Karen A. Matthews, Ph.D.a,b

‘Does Risk for Anxiety Increase During the Menopausal Transition? In Study of Women's Health Across the Nation (SWAN) found in  May 2013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641149/

Brown Swigart. Lamorna Estrogen, exercise and endorphins – the ups and down of menopause March 11, 2015 by lamornaswigart https://wegoforgood.wordpress.com/2015/03/11/estrogen-exercise-and-endorphins-the-ups-and-down-of-menopause/ Cheadle 2015 ‘5 Simple Strategies for Overcoming Race Day Nerves’ on Training Peaks https://www.trainingpeaks.com/blog/5-simple-strategies-for-overcoming-race-day-nerves/

Cooke. S Race nerves and how to cope with them  06-Nov-18 in Run Ultra https://www.runultra.co.uk/Training/November-2018/Race-nerves-and-how-to-cope-with-them

Durward. E in 2019 ttps://www.avogel.co.uk/health/menopause/symptoms/anxiety/

Freeman, Ellen W PhD1,2; Sammel, Mary D ScD3; Lin, Hui MS4; Gracia, Clarisa R MD1; Kapoor, Shiv PhD5; Ferdousi, Tahmina PhD4. ‘ The role of anxiety and hormonal changes in menopausal hot flashes’   Menopause: May-June 2005 - Volume 12 - Issue 3 - p 258-266   found in https://journals.lww.com/menopausejournal/Abstract/2005/12030/The_role_of_anxiety_and_hormonal_changes_in.6.aspx

McDermott. I & Jago. W 2002 The NLP Coach. A comprehensive guide to Personal Well-being &professional Success. Piatkus (publishers Ltd)

Dr L. Newson  ‘Menopause, Depression and Anxiety’  feb 2018 https://www.menopausedoctor.co.uk/menopause/menopause-and-depression

HOLLY OSTERMAN 2019, ‘Ten Ways to Relieve Menopause Anxiety’ http://menopausechitchat.com/2011/08/ten-ways-to-relieve-menopause-anxiety.html

Dr E Schroeder 2019 Women in Balance institute. National university of Natural medicine. ‘About Hormone Imbalance. How Does My Hormone Cycle Work?’

Ward Simon. Feb 2019.  TheTriathlonCoach SWATcast - Episode 78 with John Thompson ‘yorkshire Psychology’ http://www.thetriathloncoach.com/podcasts or https://simonward.podbean.com/e/simon-ward-and-john-thompson/?fbclid=IwAR0iPoH5YwxoKZO4fDMcNCw8XAaN0VA2MNSGqdEBFY4ufhMVK97aR7EfcgM