Anxiety

Anxiety is worry, nerves or fear that is bigger than whatever is in front of you, or that arrives with nothing in front of you at all. It can come as a steady hum, or as sudden attacks of panic.

The NHS website lists anxiety among the symptoms of perimenopause and menopause, and NHS inform, Scotland's health site, counts it among the common ones. The Pakistan Menopause Society's recommendations list anxiety among the early symptoms, which can start while your periods are still coming, and ask doctors to ask about panic too.

On edge, restless, tense in the shoulders and jaw. Rehearsing every way a trip could go wrong. Dreading the phone. Leaving a dawat early because the room feels too full. Lying awake running through tomorrow.

Then the body joins in: a racing heart, a tight throat, breath that will not go all the way down. Those overlap with heart palpitations and breathing difficulties, which is why they deserve a check of their own rather than a guess.

In Urdu most women say bechaini, or dil ghabrata hai. Leaflets and doctors often use a more formal word. Same thing.

The NHS website links anxiety to other menopause symptoms in two ways. A hot flush can bring on anxiety or palpitations. And poor sleep can leave you irritable, stressed and anxious, so sleep disruption feeds it.

It also says symptoms change over time, so anxiety can arrive just as the flushes ease. And the Pakistan Menopause Society says women who have had anxiety or depression before are at higher risk of it getting worse during the transition.

• The NHS website lists rest, regular exercise, relaxing activities such as yoga, tai chi or meditation, and talking to other people going through the same thing.
• The Pakistan Menopause Society says reducing stress, better sleep and mindful practices can improve mental health, and describes mindfulness as practical, low-cost and culturally adaptable (sections 4.2.4 and 4.2.4.2). Stress management and mindfulness and meditation have more.
• The same recommendations ask doctors to screen for anxiety at menopause appointments with validated questionnaires (section 4.2.4.6). You can ask for it.

The NHS website says CBT, a talking therapy, can help with low mood and feelings of anxiety, and with sleep problems. The Pakistan Menopause Society recommends CBT for mood problems in the menopause, face to face, in a group or remotely, with self-help CBT where specialists are hard to reach (section 4.2.4.1).

The PMS recommendations also say MHT, their word for HRT, may improve mood, sleep and quality of life, especially when hot flushes are part of the picture, and keep anti-anxiety medicines and antidepressants for moderate to severe mood disorders after a specialist has assessed them (section 7.2). Which of these fits you is your doctor's call.

See a doctor if anxiety is getting in the way of your days, your sleep or your relationships, or if you are avoiding places and people because of it.

Get emergency help if a racing heart comes with chest pain, shortness of breath, or feeling faint or fainting. The NHS website lists anxiety as a common cause of palpitations, but also lists heart problems, and you cannot tell which it is on your own.

The Pakistan Menopause Society's recommendations describe dhikr as something that can slow the heart rate and bring calm, and salah as a built-in pause in the day (section 4.2.4.7). Questions about faith and worry belong with a qualified scholar, and leaning on faith never rules out seeing a doctor.

The same recommendations ask for honest talk at home about hormonal changes, and for husbands and families to share the load of stress (section 4.2.6). Partner and family support has more.