Menopause and how it affects the Brain and Anxiety

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 you 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.

Emotionally Based School Avoidance (EBSA)

What is (EBSA)?

EBSA is when a child or young person repeatedly struggles to attend school because of intense emotional distress. It’s not defiance – it is usually driven by anxiety, panic, depression, sensory overwhelm, bullying, or undiagnosed neurodiversity. Distress often builds before school, and physical symptoms (stomach aches, headaches, nausea, panic) are common.

Key signs

High anxiety or dread about school mornings
Frequent physical complaints that ease when away from school
Avoidance behaviours (refusing to leave, clinging, hiding)
Mood changes: tearfulness, shutdown, irritability
Falling behind academically or missing lessons
Withdrawal from peers or teachers

How to support EBSA

Take a calm, curious, collaborative approach to find some understanding about what is evoking the symptoms. Avoidance may make sense as it reduces distress short-term, however this will not be a long term strategy.

What can you do?

Listen and assess safety (including risk of self-harm)
Build a simple formulation: triggers, thoughts, feelings, and avoidance patterns
Use integrative, evidence-informed methods:
- CBT for anxious thoughts,
- graded exposure to rebuild tolerance,
- emotion-regulation and sensory strategies,
- family coaching,
- and school liaison
Pace the work by the young person’s tolerance and build small, achievable steps

Practical steps families can try now

Validate feelings: “I can see you’re really scared” rather than minimising.
Keep routines steady: sleep, meals and morning structure help regulation.
Start tiny: short, achievable goals (e.g., visit school gate, stay 30 minutes).
Create a coping toolkit:
- breathing, grounding, headphones, safe space.
Avoid punishment;
- use problem-solving and celebrate small wins.
Talk with school: share the plan so everyone responds consistently.

When to seek more support

If avoidance is persistent, worsening, or accompanied by severe depression or self-harm, seek specialist help early—consistent intervention improves outcomes.

Here are practical support networks and services for families dealing with EBSA

Clinical and statutory services

GP — first contact for assessment, referrals to CAMHS, medication discussion, and sick-note advice.
CAMHS / community child mental health teams – assessment and therapy for moderate–severe anxiety, depression or risk.
Local authority Educational Psychology Service – school-focused assessment, attendance strategies, and advice for adjustments.
Local Inclusion/Special Educational Needs teams (SEN/Inclusion) – support plans, reduced timetables, EHCP advice, mediation with school.
School-based support – SENCo, pastoral leads, safeguarding teams, counsellors or wellbeing staff for daily adjustments and liaison.

Charities and specialist organisations

Anna Freud Centre — resources and training for child mental health and school-related anxiety.
YoungMinds — parent advice, crisis support info, guides on anxiety and school refusal.
Place2Be — school-based mental health services and resources.
NSPCC — support around safeguarding concerns, abuse or exploitation.
Ambitious about Autism — if neurodivergence is involved, practical resources and advocacy.
Social Anxiety UK — peer resources and coping strategies for social anxiety that often underpins EBSA.

Parent and peer support

Local parent/carer support groups — many areas have face-to-face or virtual groups for school refusal/mental health (search “school refusal support [your area]”).
Online forums and closed Facebook groups — peer advice, shared strategies, and emotional support (look for moderated, specialist-led groups).

Education & legal advice

SENDIASS (Special Educational Needs & Disabilities Information Advice and Support Service) — independent advice on school rights, EHCPs and exclusions.
Education Otherwise / Home education networks — if school absence becomes long-term and you consider alternatives.

Crisis and safety

NHS 111 / 999 — for immediate medical or psychiatric emergencies.
Samaritans (116 123) — emotional support 24/7.
Local crisis teams — check local CAMHS crisis or urgent care lines.

Dive Response to Regulate Emotions

Using the Dive Response to Regulate Emotions

Have you ever splashed water on your face to settle your nerves? That instinctive action taps into the Dive Response. When you put your face into water, it triggers this natural reflex, helping your body reset and manage your emotions.

What is the Dive Response?

The Dive Response, also called the mammalian dive reflex, is an automatic physiological reaction that happens when your face contacts water. It involves a set of autonomic nervous system responses aimed at conserving oxygen and keeping your vital organs safe during submersion. Although it’s well-known in diving mammals and human breath-holding, recent research indicates it might also be a powerful tool for emotional regulation.

Understanding the Dive Response

This reflex brings about three main changes in your body:

Bradycardia – your heart slows down
Peripheral vasoconstriction – blood vessels in your extremities tighten
Apnea – a pause in breathing

These reactions work together to save oxygen for organs like your brain and heart. When water touches your face, it activates the trigeminal nerve, which sends signals to your brainstem to automatically kick in these responses.

The Connection Between the Dive Response and Emotions

Studies show that activating the dive response can influence your emotional state in multiple ways:

Reducing Stress and Anxiety:
The calming effects of slowing your heart and controlling your breath mimic meditation. Using controlled breath-holding exercises can help you feel more relaxed, lowering stress hormones like cortisol.
Balancing Your Nervous System:
The dive reflex stimulates your parasympathetic nervous system, the part that promotes rest and recovery. Regular practice, like underwater breathing (meaning breath-holding, free diving, or specific breathing techniques) or face immersion, can build emotional resilience and help manage mood swings.
Boosting Focus and Mindfulness:
The intense concentration required during breath-holding can create a meditative state. This heightened awareness can break negative thought cycles, supporting emotional stability.

Therapeutic Possibilities

More and more, professionals are exploring how to use the dive response for emotional health. Techniques such as static apnea or simply immersing your face in water are being looked at as safe, non-invasive ways to ease anxiety, PTSD, and mood issues. These methods harness your body’s natural responses to cultivate calm and emotional balance.

In Summary

The mammalian dive reflex isn’t just a survival tool for underwater adventures, it is a promising method for emotional regulation, helping reduce stress, clear your mind, and build resilience. As science advances, incorporating dive response techniques into mindfulness and therapy could become a valuable part of emotional wellness strategies.

Grief 3 months after a Traumatic Death

Three months after a traumatic death, grief can be particularly intense and prolonged, potentially leading to complicated grief or prolonged grief disorder. Symptoms like intense sorrow, difficulty accepting the death, and difficulty enjoying life may persist or worsen, requiring support and professional intervention if they don’t improve.

Complicated Grief:

This occurs when grief symptoms persist or worsen beyond the initial stages, hindering the healing process. It can manifest as intense pain, difficulty accepting the loss, and a persistent focus on the deceased.

Prolonged Grief Disorder:

This is a formal diagnosis characterized by persistent and intense grief symptoms that interfere with daily life, including difficulty accepting the death, marked sense of disbelief, and avoidance of reminders of the deceased.

Signs and Symptoms:

Beyond intense sorrow, individuals experiencing trauma-related grief may also experience:

- Difficulty accepting the death
- Persistent longing for the deceased
- Numbness or detachment
- Bitterness or anger
- Feeling life holds no meaning
- Lack of trust in others
- Inability to enjoy life
- Physical symptoms like fatigue, changes in sleep or appetite

Factors Influencing Grief:

Traumatic deaths, like those involving violence or sudden accidents, can intensify grief, making it more challenging to cope. Additionally, factors like social support, cultural background, and pre-existing mental health conditions can also impact the grieving process.

Seeking Support:

It’s crucial to seek professional help if grief symptoms persist or worsen, or if they interfere with daily life. Therapists can provide support and guidance in navigating the grieving process, including techniques for managing intense emotions and developing coping strategies.

I am a Specialist Bereavement and Grief Counsellor in Fleet, Hampshire working in person and online counselling and offer a safe, supportive space for clients experiencing grief and loss through bereavement.

Contact me to book an initial session and I will support you through this difficult time.

For additional links please visit this page https://www.carolineellisoncounselling.co.uk/grief-counsellor/ to find a comprehensive list of charities who may be able to support you.

Collated by your local counsellor in Fleet, Caroline at Caroline Ellison Counselling.

Seasonal Affected Disorder and how to manage it

Seasonal Affective Disorder (SAD) is a type of depression which is can be experienced during the shorter days which are in the Autumn and Winter months. The days have less natural sunlight which is why we refer to them as being shorter.

Why do shorter days evoke SAD?

As the days are shorter we experience changes in light exposure. Which is believed to disrupt the body’s internal clock and lead to imbalances in certain neurotransmitters, such as serotonin and melatonin. SAD is more common here in the UK due to the long, dark winters.

What are the symptoms of SAD?

The symptoms of SAD can vary in severity but often include:

Persistent low mood or sadness.
Fatigue and low energy.
Difficulty concentrating.
Changes in appetite, often with cravings for carbohydrate-rich foods.
Oversleeping or difficulty sleeping.
Weight gain.

How to support SAD symptoms

If you suspect that you or someone you know is experiencing SAD, here are some strategies to help support and manage it:

Light Therapy: Light therapy, or phototherapy, is a common treatment for SAD.. Use a light therapy box that emits bright light (10,000 lux) to simulate natural sunlight. Aim for 20-30 minutes each morning. These special lights can help alleviate symptoms.
Outdoor Exposure: Try to spend more time outdoors during daylight hours, even on overcast days. Take walks, go for a run, or engage in other outdoor activities to increase your exposure to natural light. It is recommended that we spend at least 20 minutes a day outside to support our mental health.
Diet and Exercise: Maintain a healthy diet and regular exercise routine. Eating well and staying physically active can help boost your mood and energy levels. If possible, aim for at least 30 minutes of physical activity most days of the week.
Limit Alcohol and Caffeine: Reducing intake can help stabilize mood and energy levels.
Supplements: Some people find relief from SAD symptoms by taking vitamin D supplements, due to the connection between vitamin D deficiency and SAD.
Counselling and Psychotherapy: Talking with a counsellor can be effective in supporting and managing SAD. It can help individuals develop coping strategies and address negative thought patterns.
Medication: In some cases, a doctor may prescribe antidepressant medication to help manage SAD symptoms. This is usually considered when other treatments are not effective.
Mindfulness and Stress Reduction: Practicing relaxation techniques, meditation and mindfulness can help reduce stress and improve your overall mood.
Maintain a Routine: Stick to a regular schedule to help regulate your body’s internal clock. This includes consistent wake and sleep times.
Seek Professional Help: If your symptoms are severe or persistent, it is important to consult a mental health professional or a general practitioner (GP) who can help determine the most appropriate treatment plan for you.
Supportive Social Network: Talk to friends and family about how you are feeling. Their support can be invaluable during this time.

SAD is real and treatable

Remember that SAD is a real and treatable condition and seeking professional help is an important step if you or someone you know is struggling with it. Implementing these strategies can help manage symptoms and improve quality of life during the shorter days. If you’re struggling, it’s always a good idea to seek professional advice. You can start by consulting your GP or a mental health specialist to discuss your symptoms and explore treatment options tailored to your specific needs.

For individual counselling I am here for you. Contact me to book an initial session and I will support you.

If you are in crisis and want immediate support please call the Samaritans who offer a free 24 hour helpline – Phone: 116 123 – Website: www.samaritans.org

Helpful Contacts

Anxiety UK – can provide advice and support for people living with anxiety, which may be related to SAD.
Helpline: 03444 775 774
Text service: 07537 416 905
Website: https://www.anxietyuk.org.uk

CALM – The Campaign Against Living Miserably CALM is another organisation that provides listening services, information, and support for anyone who needs to talk, including a web chat service.
Telephone: 0800 58 58 58
Website: https://www.thecalmzone.net

Depression UK – is a self-help organisation made up of individuals and local groups that can provide support and information related to depression, which is a common symptom of SAD.
Website: https://www.depressionuk.org

Rethink – Rethink Mental Illness provides support and information for anyone affected by mental health problems, including local support groups.
Telephone: 0808 801 0525
Website: https://rethink.org

Written by your local counsellor in Fleet, Caroline at Caroline Ellison Counselling – this is my experience and these are my opinions. Carpe Diem.

Vulnerability is Nectar for Narcissists

Unveiling the Manipulative Dance

Vulnerability, often regarded as a human quality that fosters connection and empathy, can paradoxically become a breeding ground for narcissistic individuals to exploit and manipulate. The interplay between vulnerability and narcissism is a complex dance, where the vulnerable often find themselves unwittingly ensnared in the web of self-serving individuals. In this article, we explore how vulnerability acts as nectar for narcissists, drawing them in with the promise of empathy only to be used as pawns in their self-centred games.

What is Vulnerability?

Vulnerability is an inherent part of the human experience, which signifys openness, emotional transparency and the willingness to expose oneself to the potential for harm or rejection. It is a crucial aspect of genuine human connections, allowing individuals to forge bonds based on shared experiences, emotions and trust. However, when vulnerability encounters a narcissistic force, the dynamics take a dark turn.

The Narcissistic Persona

Narcissists, characterised by an inflated sense of self-importance, a constant need for admiration and a lack of empathy, often seek out vulnerabilities in others to serve their own agenda which is why vulnerability is nectar for narcissist. Their charismatic and charming facade can be particularly alluring to those who are susceptible to emotional openness, creating a perfect storm for manipulation.

The Manipulative Dance

Narcissists are adept at identifying and exploiting vulnerabilities in others. They employ a variety of tactics to gain control and feed their insatiable need for attention and validation. One such tactic is the love bombing phase, where the narcissist showers their target with excessive praise, attention and affection. This creates a false sense of security and emotional connection, leading the vulnerable individual to lower their guard.

As the relationship progresses, the narcissist gradually exploits the vulnerabilities they have identified. They may undermine the target’s self-esteem, gaslight them into questioning their reality, or exploit their emotional wounds for personal gain. The vulnerable individual, initially drawn in by the apparent empathy and understanding, becomes entangled in a toxic web of manipulation.

The Cycle of Exploitation

Narcissists thrive on the emotional energy of their victims. The more vulnerable an individual is, the more susceptible they become to the narcissist’s tactics. This cycle of exploitation often leads to a power dynamic where the narcissist maintains control while the vulnerable party is left emotionally drained and confused and in many cases isolated from their friends and families.

Breaking Free

Recognising the toxic dance between vulnerability and narcissism is the first step toward breaking free from the manipulative grip. Building resilience, setting boundaries, and cultivating self-awareness are essential tools for individuals to protect themselves from falling prey to narcissistic manipulation.

Conclusion

While vulnerability is a genuine and valuable aspect of the human experience, it is crucial to be aware of the potential dangers when it encounters narcissistic individuals. Understanding the manipulative dance that ensues allows individuals to navigate relationships more cautiously and protect themselves from falling victim to the insidious tactics of narcissists. By fostering a culture of awareness and resilience, society can mitigate the impact of narcissistic exploitation and promote healthier, more authentic connections.

For individual support I am here for you. Contact me to book an initial session and I will support you.

This blog was collated from internet sources and your local counsellor in Fleet, Caroline at Caroline Ellison Counselling – this is my experience and these are my opinions. Carpe Diem.