Dr. Gleb Tsipursky – The Office Whisperer
Nirit Cohen – WorkFutures
Angela Howard – Culture Expert
Drew Jones – Design & Innovation
Jonathan Price – CRE & Flex Expert
The discomfort of hot flashes is a well known side effect of menopause, but people going through this phase of life experience a much broader set of symptoms that can have a powerfully disruptive impact on their career.
Anxiety and insomnia are some of the most common symptoms of menopause, and lead to fatigue and difficulty concentrating. Considering that the age at which perimenopause and menopause begin typically coincide with career milestones, such as stepping into leadership roles, education and employer support are crucial for a thriving workplace.
Anxiety and Menopause
As women approach perimenopause and menopause, they’re typically already juggling a variety of potential stressors. They may be caring for kids or aging parents, busy at work in peak career years, or all of the above. Add physiological factors to that, such as hormonal changes, and anxiety can go through the roof causing workplace stressors to be amplified.
During perimenopause, estrogen, which typically helps increase levels of serotonin, the so-called happy hormone, is in decline. As estrogen levels drop, serotonin processing is impacted, which can result in anxiety and other mood changes. Symptoms of anxiety can be mental and physical, including:
- Tension and nervousness
- Ongoing worry or feelings of dread
- Panic
- Upset stomach
- Headaches
- Increased heart rate
- And, of course, sleep difficulties
Some women may also experience panic attacks – episodes of extreme anxiety that inhibit clear thinking. Panic attacks can elicit intense physical symptoms like heart palpitations, shortness of breath, and chest pain.
Insomnia and Menopause
Insomnia is a sleep disorder that makes falling and staying asleep difficult. We may experience acute (aka short-term) or chronic insomnia, the latter of which refers to cases where we experience insomnia three or more times per week, for three or more months.
During menopause, there are several forces that can create the perfect storm for this condition:
- Circadian rhythm interruption: As we age, our circadian rhythm shifts, which can cause unpredictable sleep-wake cycles. In other words, our internal clocks are interrupted, which can make falling and staying asleep more difficult.
- Increased cortisol: Around the menopausal transition, we are also experiencing an increase in cortisol – a stress hormone correlated with poor quality sleep.
Additionally, women who experience anxiety are 3-5x more likely to have vasomotor symptoms (the science-y term for hot flashes and night sweats) which can make sleep more challenging.
And of course, if we’re also experiencing anxiety and consequent rumination or negative thoughts, falling asleep is going to be even harder.
Menopause and Depression
While there is no one ‘root cause’ of Major Depressive Disorder (MDD), there are several factors that come into play to contribute to its onset and development.
Biological Factors
MDD has a strong link to our biology. Based on current research, here is what we know:
- Individuals with MDD often have high levels of cortisol in their blood, demonstrating over-activation of the hypothalamic-pituitary-adrenal (HPA) axis causing an increased stress response and altered mood and emotional state.
- MDD exhibits dysregulated neurotransmitter levels (i.e. serotonin, dopamine, and norepinephrine) contributing to altered mood, emotions, and cognitive functioning.
- MDD shows a strong familial and genetic link, with relatives of affected individuals at a higher risk of developing the disorder.
As a result of these biological factors linked to major depression, individuals experience a complex interplay of mood changes, emotional turbulence, and cognitive challenges.
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Psychological Factors
Decreased levels of serotonin in the brain can exacerbate symptoms of both anxiety and depression. Similarly, certain cognitive patterns, such as negative self-talk, can perpetuate feelings of worthlessness and hopelessness and worsen depressive symptoms. This study found negative self-talk can change our brain states, affecting our confidence, cognitive performance, and levels of motivation.
Environmental Factors
Our environment plays a prominent role in our health. Individuals experiencing adverse life events or unexpected stressors, such as divorcing a spouse, losing a loved one, or facing a trauma event are more likely to develop depression later in life. Other contributing environmental factors include:
- Lack of physical activity
- Harmful use of alcohol or other substances
- Poor diet (quality and quantity)
- Past emotional, physical, or sexual trauma
- Stressful living conditions (i.e. high crime locations or incidences of environmental disasters)
These factors can vary in their impact from person to person, and often, multiple factors may contribute to the development or exacerbation of depressive symptoms.
What Women Can Do to Reduce the Impact of Menopause Symptoms on Work
There are steps that any individual can take to manage their menopause symptoms, and the good news is these interventions are likely to be covered by their health insurance.
1. Review Your Workplace Benefits
Many employers offer mental health and menopause resources as part of health insurance plans and employee assistance programs. Find out what your employer can provide to help you navigate this.
2. Find a great therapist
There are many evidence-based treatments a therapist can provide to help manage menopause-related anxiety. One popular method is cognitive behavioral therapy (CBT), which teaches recognition of and adjustments to unhelpful thought patterns brought on by anxiety or depression. CBT is often used in conjunction with mindfulness practices involving breathing techniques, meditations and body awareness. You can tailor search to find a therapist specializing in anxiety, women’s issues, CBT and mindfulness, alongside many other options for customization.
It is encouraging to know that the majority of people who receive treatment for moderate-to-severe anxiety achieve a clinically significant improvement in symptoms.
3. Know that medications can help
You may be familiar with the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These medications increase the levels of serotonin in the brain (the happy hormone), which can improve symptoms of both anxiety and depression. SSRIs are one of multiple options that may help improve anxiety.
4. Move your Body Regularly
Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes your mood, improves sleep, and boosts self-esteem.
5. Limit Caffeine
No one wants to hear this, but we have to say it. Caffeine is a stimulant and stays in our body for about 10-12 hours after consumption, albeit in smaller quantities as time goes on. As a general rule of thumb, try to avoid it after 2 p.m.
6. Create a Wind-Down Routine
Create a bedtime routine that involves practices that help you relax. Doing so will lower sympathetic activation (your body’s fight or flight system…which is not helpful for good sleep!). This might look like a regular bath, cup of tea, yoga sequence, or any other activity that calms you.
7. Stick to a Regular Sleep Schedule
For women experiencing sleep disturbances, going to bed and waking up at roughly the same time every day can be helpful, due to our circadian rhythm (aka our internal clock), which typically synchronizes with light and dark, so that we are essentially most alert during the day and least alert at night.
8. Keep a Cool Sleep Environment
Right around bedtime, our body temperature drops 1-2 degrees, which signals to our internal clock that it’s time to hit the hay. We recommend keeping your bedroom at a cool 60 – 67°F. If that’s not enough, you can even try bamboo cooling sheets.
9. Research Over-the-Counter Sleep Aids
There are several over-the-counter sleep aids that may help you get better sleep, including melatonin, magnesium, valerian root, lemon balm, and maca. While these aids are not intended for long-term use, they can be helpful as a short-term solution for insomnia.
A quick note on supplements: The U.S. FDA does not verify that supplements contain what they say they do or whether they’re contaminated with harmful ingredients, but there are several independent organizations that offer quality testing and seals of approval that we can look for as an indication of responsible manufacturing. Three of the most well-known organizations include: NSF International, U.S. Pharmacopeia (USP), and UL.
10. Know When to See a Doctor
Insomnia, in particular, can snowball quickly –– and when left untreated, a handful of poor nights’ sleep can become the norm. For women struggling with insomnia and/or anxiety, it’s never too soon to see a doctor.
Given the inextricable relationship between insomnia and anxiety, if you are experiencing both, there really isn’t a bad place to start when it comes to treatment. If you begin by addressing one of the conditions, it will likely benefit the other.
Some of us may require a multi-modal approach, but treatment for each is doubly beneficial. Starting with a therapist can be a great option, and a physician or nurse practitioner can also help to address these conditions.
It could also be worth discussing Menopausal Hormone Therapy (MHT) with your doctor. While MHT (previously known as hormone replacement therapy or HRT) is not currently recognized as a first-line treatment for insomnia or anxiety, oral progesterone may improve sleep quality for women who take it.
That said, more research is needed to fully understand the relationship between MHT and these symptoms.
How Employers Can Support Menopausal Workers
Employers should create a supportive workplace culture that improves a sense of belonging. Here are some things employers can do to support employees who may be experiencing menopause.
Help Employees Navigate Benefits: Create educational resources specifically for people who may be experiencing menopause symptoms making them aware of the physical and mental health coverage available to them as part of their benefits package. Do not gloss over this important life event during open enrollment either, make sure it is part of helping employees choose the right health plan option.
Offer Flexible Work Options: Give workers the ability to work from home when needed or flexible hours to derive their best work during their most productive hours of the day (which may not be 9 a.m. to 5 p.m.).
