Why doctors miss menopause when treating anxiety.
I noticed something interesting in my late 30s.
My anxiety started creeping up. Nothing dramatic—just a persistent low-level worry that hadn't been there before. No major life changes. No new stressors. Just this feeling that something had shifted in my baseline.
Around the same time, I started a progesterone-only pill to manage endometriosis.
Within days my anxiety improved significantly. And suddenly the connection became obvious to me. This wasn't a psychological pattern I needed to work through. This wasn't a character flaw or a life problem. This was hormonal.
That experience shaped how I think about anxiety and menopause. In my practice I’ve sometimes met women who’ve been struggling with anxiety for years, cycling through antidepressants with limited or no effect, only to experience dramatic relief when someone finally considers menopause.
And when that happens, their first emotion isn't relief. It's frustration. Why didn't anyone connect these dots earlier?
The Misdiagnosis Pattern
Here's what I'm hearing from women: They notice anxiety rising in their 40s. They see their doctor. The doctor recommends an SSRI. The woman tries it. It doesn't work well, or it works partially, or it comes with side effects she doesn't want to manage long-term.
So she tries another SSRI. Then another.
Months pass. Sometimes years. The anxiety persists. The woman starts to wonder if she's broken, if nothing will ever help, if this is just who she is now.
Then—sometimes by accident, sometimes because she reads something online, sometimes because she finds a doctor who asks the right questions—someone suggests menopause-related anxiety. She tries MHT.
And the anxiety that resisted multiple antidepressants resolves.
This isn't rare. This is a pattern I hear repeatedly.
Why This Happens
The research clearly shows menopause causes real, measurable changes in brain chemistry. Estrogen and progesterone aren't just reproductive hormones. They're crucial for maintaining the brain structures that regulate anxiety. When they fluctuate dramatically during perimenopause, anxiety can emerge or intensify—even in women with no previous mental health history.
But here's the problem: doctors trained in psychiatry or general practice are trained to recognize anxiety disorders. They're not necessarily trained to recognize menopause. And once a woman gets an anxiety diagnosis, the focus stays there. Menopause doesn't get considered.
The result? Women get offered treatment for the wrong condition.
The Overlooked Option
What's particularly frustrating is that menopause-related anxiety often responds dramatically to MHT—the one treatment option that frequently doesn't get tried first.
This isn't to say SSRIs are wrong for everyone. For some women, they're absolutely appropriate. But when menopause is the driver of anxiety, MHT should be an option considered early, not a last resort after years of unsuccessful antidepressant trials.
Yet that's not what's happening in many doctor's offices.
What This Means for You
If you're dealing with anxiety in your 40s or 50s, here's what matters:
First, know that menopause-related anxiety is real. It has a hormonal basis. It's not in your head (metaphorically), even though it involves your brain.
Second, if antidepressants aren't working well for you, that's important information. It might mean you need to look beyond psychiatric frameworks and ask: Could this be menopause?
Third, you deserve a doctor who considers the full picture. That might be an SSRI. That might be MHT. That might be both, or neither. But the decision should be informed, shared, and based on understanding what's actually driving your anxiety.
You shouldn't have to suffer through years of ineffective treatment before someone asks the right question.
If you're struggling with anxiety in your 40s or 50s and antidepressants aren't helping, it's time to look at the full picture. That's exactly what my consultations address—understanding whether menopause is driving your anxiety and what treatment options actually fit your situation.
The full article I’ve written here on my blog (click the link to read more) https://www.liferenomedic.com/blog/when-your-anxiety-is-actually-menopause-the-misdiagnosis-problem-and-what-you-need-to-know explores the research on menopause-related anxiety, why doctors miss it, and what conversations you need to have with your healthcare provider to get proper diagnosis and treatment.
💡TIP: Your anxiety isn't a character flaw. And if treatment after treatment isn't working, the problem might not be with you—it might be that you're treating the wrong condition.
Stay happy and healthy,
Erika.
