September 17th 2018
I suddenly started having panic attacks in my mid-40s and this was the surprising reason
August 17th 2018 / 0 comment
What felt like full-blown anxiety was in fact a hot flush, but even this doctor didn't recognise it when it happened to her. Here's what she wants you to know
A few years ago, when I was in my mid-forties, I was in the back end of a small, cramped plane and just after we pulled away from the gate, the pilot announced that we would be grounded for another three hours.
That’s when I started to panic. I’m not a nervous flier and never have been. But I felt as if this plane had lost oxygen. My heart was racing. I was gasping for air. I was sweating. I needed to get out. I needed space.
As I was removing my jumper and flapping my hand up and down in front of my face, I noticed this: no one else on the plane seemed bothered at all. No one was sweating. Was I going crazy?
I coped by burying myself in a book, assuming distraction was the best medicine, and in fact, the only remedy available at that moment. I also tried a soothing inner dialogue: “You’re fine! Look at all those calm folks around you!” (That didn’t work as well as the diversion tactic).
The whole episode lasted less than ten minutes but felt like forever. As soon as the plane began to race towards the sky, my racing heart slowed down.
I went to see my GP when I got home who said I had my first panic attack and suggested Cognitive Behavioural Therapy or the anxiety medication Xanax. She also told me that panic attacks tend to last between four and seven minutes and while it feels like you’re going to drop dead of a heart attack, these fleeting spells don’t kill.
That all made sense to me. I am a doctor, after all. But I just couldn’t figure out why now. Why me? I’ve been told I’m overly lax when it comes to my own health care and that of my children. When I went to medical school, I didn’t think I had every disease we studied. On the contrary, once I learned about the immune system, I figured my chemical defence system protected me from any kind of assault.
I didn’t do therapy or pills. Just having my doctor reassure me that these episodes would fade in less than ten minutes helped a little. I'm also just loath to drugs or therapy for myself - nothing to be proud of - and I’m not even sure why.
But here’s what my doctor didn’t tell me: I was not having a run-of-the mill panic attack for the first time in my mid-forties. I was entering menopause. And the chances of another episode were more likely than I assumed.
How could I not have known the tie between the change-of-life and that panicky feeling? How did she miss it? We both had MDs, after all.
Still, I can’t remember a menopause lecture that went much further than the physiology of oestrogen and menopause. And even though I’d been writing about women’s health issues for nearly 30 years, my interests tracked my own reproductive stage. I had covered puberty, fertility, pregnancy — I even wrote a book on the history of pregnancy.
But then two things happened: I started researching a book about hormones, and among other many topics covered, I dived into menopause, talking to experts, reading the scientific literature, interviewing women. At the same time, as if my research were contagious, menopause hit me. Or I hit menopause. Or we smacked into each other. All of a sudden I had a newfound appreciation for the word “hot flush.”
For some WOMEN these hot flushes and adrenaline rushes last for years
No one knows the precise chemical signal that triggers menopause (nor does anyone know what initiates puberty, for that matter). For most of us, the fall in oestrogen occurs with age and it’s this precipitous drop that leads to all the menopausal symptoms. For many women, the fall eventually tails off and symptoms subside.
As for my panic attacks? I learned that after oestrogen takes nosedive, it screws up your temperature control mechanism. A slight increase in temperature may go unnoticeable by your non-menopausal partner. But for you, this slight uptick, triggers sweating and an adrenaline rush - the fight or flight hormone, hence the panicky feelings.
I only had that one full-blown freak-out, but I continue to be claustrophobic in small spaces and I think my fear of feeling that old panic is worse than the feeling itself. So I just tell myself it's my new state and it's menopause and try to think of other things or bury myself in a book.
The good news is that we, women, are finally speaking up about the change of life, something our mothers were loath to discuss. I’ve since completed the book, Aroused: The History of Hormones and How They Control Just About Everything.
Here’s what we know about hot flushes:
• Hot flushes are not simply a moment of high heat.
Increased core body temperature feels like an internal furnace out of control. This is not heat like a day at the beach. This is the world closing in and you need to get out. You need space ASAP.
• Upwards of 80 per cent of women suffer from hot flushes in the early phases of menopause.
That’s because hot flushes are triggered by a drop in oestrogen and in the early phases of menopause with the greatest hormone changes happen. But then they fade. Unfortunately, they can last longer with some women, and for two per cent of women, they stick around forever.
It's also why women with chronically low levels of oestrogen (common among anorexics whose bodies are in a state of stress) do not have hot flashes. It’s the fluctuation, not the level.
• These hormonal swings screw with our internal thermostat.
Oestrogen seems to hit the same cell in the brain that controls body temperature. When oestrogen plummets, as it does in the beginning of menopause, the brain signals can get all screwed up, messing with our internal thermostat. Why? Well, that’s being unravelled in laboratories right now.
Most people don’t notice a bit of temperature change – our bodies shiver to get hotter or sweat to get cooler. But when menopause hits, a slight rise in the mercury and our insides are steaming up, adrenaline is rushing. We are hot and bothered.
• Feelings of panic are down to a rise in adrenaline.
The dramatic drop in oestrogen is often accompanied by a spike in adrenaline - it's not that the oestrogen itself that triggers the hot flush, but that the drop in oestrogen screws up your temperature control mechanism. For some women, their bodies find a new equilibrium after a few years of menopause. For some, these hot flushes and adrenaline rushes last for years.
What worked for me
For me, yoga, deep breathing, long slow runs and meditating helped somewhat for daytime flushes. I’m sure a tough, fast sprint would work too – burning out all that panicky energy – but my rickety ageing knees can’t do that sort of racing anymore. But no amount of running or stretching or belly breathing or savasanas cured the night sweats. I was waking every hour on the hour, flinging the covers that whacked into my husband, flipping my pillow in search of a cold spot.
I wanted to avoid drugs, despite all the stuff I had researched about the safety of hormone replacement therapy for most of us. Hormone replacement therapy (low dose oestrogen plus progesterone, or oestrogen alone for women who have had a hysterectomy) relieves hot flushes for most women in menopause, replenishing the depleted hormones. (Oestrogen can increase the risk of breast cancer slightly so pills are not for women with a history of cancer).
I was stupidly stubborn.
Finally, one night over a martini with a friend (a friend who happens to also be a reproductive endocrinologist), she told me I looked exhausted and that I’d been complaining for months about not sleeping and she reminded me that it wasn’t healthy for my physical and emotional wellbeing. I knew all that but I was too tired to think rationally.
Then she said this: you’re not making a lifetime commitment. Try hormone replacement therapy for a few weeks. Test it out. And so I did.
HRT doesn’t work for everyone, but it worked for me. I found myself sleeping through the night. The hot flushes and all the panicky stuff that went along with them subsided. I still wake up drenched in sweat, sheets soaking but at least I’ve made it through the night.
Most of my friends who are on hormones have opted for the patch, which is recommended for anyone who is at higher risk of strokes or clots. The vaginal creams are also popular with dryness down there, but do nothing for the head.
The latest guidelines no longer tell women to stop the hormones after a year or so. I’m not sure how long I’ll keep popping these evening pills. I still believe in the benefits of yoga and slow runs (moving meditation), but for now, the whole mix is making me a little calmer and cooler – and ready for take-off.