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Hot flushes and night sweats are commonly associated with the menopause – but the vast majority of menopausal women also suffer from mood and emotional problems, such as stress and anxiety. Research recently carried out by GP and menopause specialist Dr Louise Newson, founder of Balance Menopause, found 95% of nearly 6,000 perimenopausal and menopausal women had experienced a negative change in their mood and emotions during the menopause, with stress and anxiety being the most common psychological symptoms. Speaking to mark Mental Health Awareness Week (May 15-21), Newson says: “Because we often frame the menopause in terms of physical symptoms, such as hot flushes and night sweats, psychological symptoms, such as anxiety and depression, can go under the radar. “Every year I see hundreds of women struggling with menopause, and thousands more reach out on social media, looking for advice on symptoms that can impact relationships, social lives, confidence and careers.” Here, Newson, and other menopause and anxiety experts, discuss the link between the menopause and anxiety, and how to deal with it… What causes anxiety during the menopause? Low mood and anxiety can be common features of the perimenopause and menopause due to fluctuating and falling hormones, says Newson. “When oestrogen falls, levels of the mood-boosting hormone serotonin fall, too, while cortisol (the primary stress hormone) rises,” she explains. “In addition, the knock-on effects of physical symptoms, such as fatigue, hot flushes and aches and pains, can affect mood and self-esteem.” How common is menopausal anxiety? Newson’s research shows most women (95%) have some sort of mood dip during the menopausal period. Indeed, Dave Smithson, operations director at Anxiety UK, suggests anxiety is one of the key symptoms, if not the main symptom, affecting women during the perimenopause and menopause. “Often anxiety fails to receive the attention it warrants as a symptom of the menopause among the medical profession and indeed the public, which is concerning given the profound impact it can have,” he stresses. Who is likely to suffer from anxiety during the menopause?Sexual and reproductive health consultant Dr Paula Briggs, chair of the British Menopause Society, says the menopausal period has been described as a ‘window of vulnerability’, explaining: “Some women experience anxiety and low mood or depression in addition to other better-recognised menopausal symptoms. Sometimes these symptoms occur in isolation and the link with menopause may be less clear. “Mood-related changes are more likely in women who’ve had previous mental health problems, and in women experiencing surgical menopause [removal of the ovaries and or womb].” Can you get menopausal anxiety when you’ve never been anxious before? Anxiety caused by the menopause can strike women who’ve never had an anxiety problem before, Smithson points out. “Many women report new-onset anxiety, having never previously experienced anxiety at a level that it could be termed an anxiety disorder,” he says. “Others report a worsening of their pre-existing anxiety condition, as a result of the menopause.” “For women who’ve lived with anxiety for many years, when the menopause hits, they may report finding their anxiety has taken on a whole new identity, becoming more severe, intense, frequent or disabling, and consequently very challenging to manage.” What are menopausal anxiety symptoms? Although there are different types of anxiety, the symptoms tend to be the same irrespective of the underlying cause, explains Briggs. She says they can include feeling tense and nervous, being unable to relax, having difficulty concentrating, feelings of panic and dread, being unable to cope with normal daily activities, being overwhelmed, self-consciousness, and feelings of weakness and fatigue. Physical signs of anxiety include sweating, trembling, rapid heart rate and hyperventilation. “Where there’s no history of mental health problems and the symptoms and signs coincide with the menopause, they are more likely to be related to hormonal variability,” she says. “If there’s a background of anxiety and depression, then the symptoms and signs might be exacerbated by the menopause.” How is menopausal anxiety treated? Smithson says there’s still a taboo around the subject of anxiety, although he admits “great strides” towards breaking it have been made recently. “That said, access to support and treatment remain patchy, with many women left to cope alone and battle on through what can be one of the trickiest phases of their life. “Anxiety is both treatable and manageable and we would urge any women experiencing new-onset anxiety or worsening of pre-existing anxiety to seek support.” Briggs and Newson say HRT, if appropriate, is often the first treatment for menopausal anxiety, although Newson stresses: “HRT is the first-line treatment for all menopause symptoms, including mood-related symptoms. But the first piece of advice I give to any woman struggling with her mental health is to see a healthcare professional to discuss treatment options.” She suggests recording symptoms on the free balance menopause support app symptom tracker. Briggs says if necessary, antidepressant medication can improve outcomes, and talking therapies, such as CBT (cognitive behavioural therapy), are also important to help manage anxiety and depression, irrespective of the underlying trigger. “Some women, particularly those who respond partially to HRT, may need to consider adding an antidepressant, specifically one recognised to help with anxiety,” she says. However, Newson warns: “Often women are incorrectly prescribed antidepressants for menopause-related low mood and anxiety, but these mood changes are very different to clinical depression.” Can lifestyle changes help? The experts stress healthy lifestyles can really help improve anxiety symptoms, and Newson advises: “Beyond HRT, it’s so important to optimise your exercise and nutrition. A balanced diet with lots of fresh fruit and vegetables can help regulate your mood, and watch your alcohol and caffeine intake, as both can increase anxiety. “Regular exercise will lift your mood, and help you sleep, as anxiety can be a real barrier to a good night’s sleep.” She says studies suggest mindfulness can help with symptoms of anxiety and depression in menopausal women, and stresses: “Find time to focus on yourself and find some coping mechanisms you can turn to when you need them. If talking to a good friend helps with anxiety, give them a call. I find writing lots of lists helps me feel in control and calmer.” And Briggs adds: “Many women have unrealistic expectations about HRT, and it’s important to stress that lifestyle management is also an important aspect of managing the menopause, along with considering things such as cognitive behavioural therapy, hypnotherapy and mindfulness.” Read More Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live How to encourage green-fingered kids Cost of sunscreen could be increasing risk of skin cancer, charity suggests Ukraine Eurovision winners Kalush Orchestra invite Princess Kate to join them on tour

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A factory worker from Indiana has been charged with attempted murder for repeatedly smashing his colleague over the head with a hammer, before walking calmly out of the workplace and telling another colleague: “S*** happens”. Austin Hahn, 27, allegedly attacked the unidentified victim at their workplace, the Bright Sheet Metal Co. in Indianapolis, on the morning of Sunday 20 August, according to court records obtained by Law & Crime. Witnesses told law enforcement that Mr Hahn attacked his coworker from behind with a tinner hammer, using the sharp edge to strike the victim at least six times. He then allegedly threw the hammer in the bin as he calmly went to leave the warehouse. Before he left, Mr Hahn approached another colleague who was outside at the time and was not aware of the attack that had just taken place. According to court records, Mr Hahn patted the colleague on the chest and simply said: “S*** happens”. After the attack, Mr Hahn proceeded to get into his car and reportedly drove to his mother’s home. Officers from the Indianapolis Metropolitan Police Department were called to a report of a possible battery at the warehouse at around 7.30am, according to the arrest report. The victim was taken to St. Vincent’s Hospital in a serious but stable condition. He was found to have suffered skull fractures, brain bleeds, a broken jaw and missing teeth. Mr Hahn’s mother called Anderson Police Department to turn her son into authorities later that morning. He was then arrested at his mother’s house. Police were told by Mr Hahn’s colleagues that he and the victim were “the best of friends” until an argument took place several weeks before, according to court records. Mr Hahn’s roommate told the police that the two were not on good terms because lately, Hahn had been using cannabis “a lot”, WXIN reported. Yet Mr Hahn allegedly apologised, and their dispute was thought to have been forgotten. The unnamed victim, who was at his workstation at the time of the attack, told police he did not know who struck him from behind, but said his colleagues would have witnessed the attack. Mr Hahn is being held without bond on charges of attempted murder, aggravated battery and battery by means of a deadly weapon. He is due to appear in court for his next hearing on 19 October. Read More Lady of the Dunes’ late husband has been linked to two other deaths - now his friend speaks out Texas family of four found dead in apparent murder-suicide weeks after daughter drowned Rachel Morin – updates: Maryland police warn Bel Air suspect could be a serial killer