Lowering Oestrogen levels in women and how it affects the brain and anxiety
There is a lot of information about perimenopause and ‘the change’ out there which can be helpful and in the case of a menopausal brain, sometimes overwhelming. With the help of ‘AI’ I wanted to post some salient facts which I hope will help you understand what may be going on.
Lowering oestrogen in women commonly increases risk of anxiety and alters brain function – especially during rapid declines (perimenopause, surgical menopause). The effects vary by age, individual vulnerability, and how quickly levels fall.
Key brain mechanisms
- Serotonin system:
- oestrogen upregulates serotonin synthesis, receptor expression, and transporter function. Lower oestrogen → reduced serotonergic tone, which can increase anxiety and mood symptoms.
- GABAergic inhibition:
- oestrogen modulates GABA (brain’s primary inhibitory system). Loss of oestrogen can reduce GABAergic regulation, increasing neural excitability and anxious arousal.
- HPA axis / stress response:
- oestrogen normally buffers stress reactivity. Low oestrogen → exaggerated cortisol responses and prolonged stress signalling.
- Amygdala / prefrontal cortex balance:
- reduced oestrogen is associated with greater amygdala reactivity to threat and weaker prefrontal regulation, promoting anxiety and impaired emotion regulation.
- Neuroplasticity and neurotrophic support:
- oestrogen promotes BDNF and synaptic plasticity (hippocampus, prefrontal cortex). Declines can impair cognitive flexibility and increase vulnerability to mood/anxiety symptoms.
- Neuroinflammation:
- lower oestrogen may increase pro-inflammatory signalling that can affect mood and cognition.
Clinical patterns and evidence
- Perimenopause (fluctuating then falling oestrogen) is a high-risk window for new or worsened anxiety and depression.
- Surgical menopause (oophorectomy) or abrupt treatment-induced menopause produces more pronounced mood/anxiety effects than gradual decline.
- Many women report worry, panic symptoms, irritability, sleep disturbance (which itself worsens anxiety), and cognitive complaints (concentration, memory).
- Not all women develop anxiety – risk is higher with prior mood/anxiety disorder, stressful life events, poor sleep, or lack of social support.
Implications for management
- Hormone replacement therapy (HRT) can reduce vasomotor symptoms and often improves mood/anxiety for many women when started appropriately; benefits vs risks depend on age, timing, and medical history.
- Antidepressants (SSRIs/SNRIs) can treat anxiety symptoms and are often effective during perimenopause/menopause.
- Counselling / Psychotherapy for anxiety, sleep interventions, exercise, and addressing lifestyle factors (sleep, caffeine, alcohol) help substantially.
- If symptoms are new, severe, or disabling, evaluate with a clinician to rule out other causes and to discuss HRT risks/benefits and psychiatric treatment options.
Behavioural strategies for anxiety and menopause-related symptoms
- Sleep hygiene:
- Regular sleep schedule, cool bedroom, limit screens before bed, avoid heavy meals/caffeine/alcohol near bedtime. Treat hot-flash-related sleep disruption (layered bedding, fan).
- Therapy for insomnia such as Cognitive-behavioural (CBT-I) techniques:
- stimulus control, sleep restriction, relaxation.
- Counselling / Pshychotherapy for anxiety:
- Cognitive restructuring, exposure for panic/avoidance, worry-management, problem-solving.
- Relaxation and mind-body:
- Progressive muscle relaxation, diaphragmatic breathing, mindfulness meditation, guided imagery. Short daily practice (10–20 min) reduces physiological arousal.
- Exercise:
- Regular aerobic exercise (150 min/week moderate) and resistance training; helps mood, sleep, and overall health.
- Weight, diet, caffeine, alcohol:
- Maintain healthy weight; reduce caffeine and alcohol if they trigger anxiety or hot flashes.
- Social support and stress management:
- Peer groups, counselling, time-management, and reducing chronic stressors where possible.
- Behavioural strategies for hot flashes:
- Layered clothing, portable fans, paced breathing, avoiding triggers (hot drinks, spicy food, alcohol).
Benefits of Counselling / Psychotherapy for anxiety in perimenopause
- Combined approach:
- Psychotherapy plus HRT or medications (SSRIs/SNRIs) often yields better outcomes than either alone for significant symptoms.
- Efficacy:
- CBT is well-supported for generalized anxiety, panic disorder, and insomnia across ages and retains effectiveness during menopause.
- Targets:
- Reduces worry, catastrophic thinking, avoidance behaviours, and physiological arousal; improves coping with menopausal symptoms (hot flashes, sleep loss).
- Symptom improvement:
- Reduces anxiety severity, panic frequency, and depressive symptoms; improves sleep quality and quality of life.
- Durability:
- Benefits often persist after treatment through learned skills; booster sessions can maintain gains.
- Mode and access:
- Effective in individual, group, and guided self-help formats.
I hope this no nonsense straight talking blog will help you understand what is happening to you. If you are struggling with change and your feel that talking with a Counsellor will support you please get in touch.
Remember, you are not alone in this and there is a lot of great support out there you. Do not suffer in silence, reach out and grab the support. Take care of you.
Menopause support
If you are experiencing menopause issues, you are not alone, there are many people who are here to support you. There are helplines and support groups who will offer support, below are some of those who can offer expert advice.
The Menopause Charity – https://themenopausecharity.org/
The British Menopause Society – https://thebms.org.uk/
Menopause Support – https://menopausesupport.co.uk/
This blog was collated from internet sources for information by a counsellor in Fleet, Hampshire – Caroline at Caroline Ellison Counselling – this is my experience and these are my opinions. Carpe Diem.