Updated: Mar 2
"Call an ambulance, I think I am having a heart attack"
These were words that I never, in my wildest dreams, would imagine uttering at 39 years of age. Yet as I collapsed on the floor in my daughter's classroom, in front of my worried children, friends, other parents and teachers, these were the exact words that came out of my mouth.
No matter how hard I tried I could not get the air into my lungs to breathe properly, I had pins and needles all down my arms, my hands went numb so that I couldn't feel them and I had pains in my chest. My body went into shock and all I could do was lie down on the floor and wait for an ambulance while friends gathered up my children, contacted my husband and one stayed with me to keep me calm.
Working as a fitness instructor, eating well, drinking lots of water and highly sociable and outgoing, until that day I had not ever given my heart a moment's thought. Yet while I lay on the floor waiting for the ambulance, I truly believed that there was every possibility that I would die and that my poor children would forever be traumatised from me collapsing right in front of them.
When the ambulance arrived and the paramedics completed all their checks, it turned out I had just experienced my very first full blown panic attack. As the doctor explained to me later that day, I had probably shifted the balance of oxygen and carbon dioxide in my body over the previous few days when I had been highly anxious and was suffering from what I now know is called air hunger.
This can be caused by hormone fluctuations in perimenopause and it can sometimes feel as though you can't get the air into your lungs properly. We have hormone receptors all over our bodies, including our lungs, so when our hormones start to drop we can experience the feeling that it is harder to breathe. This is where I made my first mistake.
I was so panicked at the feeling of not being able to breathe deeply that I had spent the previous 3 days desperately trying to suck more air in. The doctor thinks eventually I had so much oxygen in my body that it had no choice but to shut down, hence the panic attack out of the blue. Turns out I should have been concentrating more on the exhale. But more on this later.
It was only after suffering this panic attack that a doctor first mentioned perimenopause to me. Until then I had seen the doctors over the previous few years due to bad insomnia, severe bloating at times and acute dizziness and vertigo. At no point in any of these chats had anyone discussed that my hormones could be causing it all. It was the anxiety and panic attack that made the doctor finally join the dots of everything that had been going on.
Unfortunately that panic attack was not in isolation and it led to a spell when I started to experience them regularly. Thankfully none of them were ever as severe again, I think knowing what it is was, did make a difference but it doesn't make them any less scary when they happen.
Since doing my menopause coaching qualification I have come to realise that this extreme anxiety is surprisingly common in perimenopause and it is often considered one of the most debilitating of all the symptoms. It can become all pervading, it can seep into your daily life and it can cause you to become frightened to go out and live your life like you used to as the fear of the anxiety taking over or having a panic attack in public can become overwhelming.
For a very long time I was triggered every single time I went to pick my children up from school. Whereas previously I used to bounce into the playground and chat to lots of other mums, these days you are more likely to find me outside the gates, holding back and sometimes my hands will be firmly tucked into my pockets where I will be stroking a smooth stone or rubbing the ends of my thumb and middle finger together to help me keep calm.
And that is the trouble with anxiety. It is often invisible. You may have no idea that someone you are talking to is actually counting in their head to make sure they are exhaling properly and slowly. Far too many people suffer in silence and try to ignore it but I learnt the hard way that this is simply not a sustainable way to live.
So what can you do if you are suffering regularly from anxiety in midlife?
HERE ARE MY TOP 5 TIPS:
1. ACKNOWLEDGE IT
One of the biggest mistakes you can make is to ignore the anxiety and hope that it will go away. This may work for a short time but your nervous system knows what is going on beneath the surface and it can end up bubbling away and building inside until it eventually explodes into a panic attack.
I studied a diploma in anxiety awareness so that I could learn how to live with mine and also help others and one of the tips they gave on my training was to give your anxiety a name. It is important to learn that it is only a part of you and does not define you.
So my example is that I have named my anxiety 'Anxious Agnes'. Next time you are feeling anxious and on edge, try stopping, acknowleding that feeling and saying to yourself "Oh hello Anxious Agnes, I see you have stopped in to say hello. It is kind of you to pop in but I would like to get on with my day now". You may feel crazy when you first say it but I promise you that if you get to your anxiety early it can really help!
2. BREATHE DEEPLY
If you don't know about my obsession with breath by now then you are probably new to my page, in which case hello!
As you saw above with my first panic attack, I was obsessed with this idea that I needed to get more oxygen into my lungs but I have now come to realise the importance of the exhale. It is really important to slow our breathing down and try to deepen our breath when feeling anxious and one of the best ways to calm rapid shallow breathing is to work on the exhale.
So next time you feel anxious, try finding a quiet place, sit down and make yourself comfy. Then place your hands on your belly and start to notice your inhalations and exhalations. Concentrate on your hands and make sure that you can feel them rise and fall as you breathe. That way you know that you are breathing deeply into your belly and not shallow breathing into your chest.
As you start to feel the body relax, start to count as you breathe in and out, see if you can make the out breath last a second or two longer than the in breath. Hopefully as your nervous system starts to calm and you begin to relax you will notice the anxious feelings begin to recede.
If you haven't yet started a regular yoga practice then your midlife is the time to try. There are many different forms of yoga so I encourage you to try a number of them to find one that suits you but make sure you include one that has some breathing, relaxation and meditation to help when it comes to anxiety.
The beauty of yoga is that it is the one of the best forms of exercise to encourage the connection between your body, your mind and your breath. In order not to let anxiety overwhelm you, it is really important to be able to look inwards and notice what is happening in your body.
On days when my anxiety is at its' absolute worst, I always find solace by coming to my mat. Sometimes I will literally just hold 3 or 4 gentle poses for 5 minutes at a time but by the time I step off my mat, it is the calmest I have felt all day.
Prior to perimenopause, I was guilty of being constantly busy and on the go, never really stopping to notice was happening in my body and certainly not paying attention to my mind or listening when my body was giving me clues that it needed a rest. Perhaps this is why perimenopause hit me so damn hard. But what I do know is, I wish every damn day that I had started regular yoga sooner!!
4. MOVEMENT AND MEDITATION
We all know that moving is good for us but sometimes we think that if we can't get to a gym for an intense workout then there is no point doing anything at all. When it comes to anxiety I want you to completely rid yourself of this notion.
Yes a workout is undoubtedly going to release endorphins and make you feel better. But if you are riddled with anxiety and the thought of driving anywhere fills you with fear then don't put yourself through it. Sometimes what your body needs is a gentle stretch, time outside in nature and some mindfulness and meditation.
You don't have to sit down cross legged for an hour to be mindful. You can go for a walk in the forest and stop to look at trees while you breathe. You can take a cup of tea outside and enjoy it slowly while listening to the sounds around you. You can take off your shoes and socks and stand with your bare feet on wet grass. All these little acts of moving and being mindful can lead to a meditative state and can release anxiety.
5. TALK, SHARE AND SEEK ADVICE
It is so important as part of acknowledging your anxiety to open up to others about it and share how you are feeling. I know that I have previously been guilty of just carrying on and trying to ignore it but I have learnt that this never serves me longterm.
At certain times of the month I find my anxiety can hit me with such force that it is all that I can think about. Sometimes this feeling comes on in the middle of the night and can wake me up in a cold sweat and accompanied by a feeling of impending doom. I used to try and keep it to myself as my husband does shift work and really needs his sleep. But if it gets really bad, on occasion I have woken him up. Just saying it out loud takes away some of the power it wields and often it is enough to help me get back to sleep again.
Sometimes though anxiety and panic attacks can completely rule your life and if this is happening to you, despite doing all the above, then I really encourage you to seek help. HRT, certain supplements and some antidepressants are all known to dramatically reduce symptoms of anxiety. Many women have also benefitted from Cognitive Behavioural Therapy (CBT).
The most important lesson I have learnt over the past few years is to really tune in and listen to your body. I take HRT and it has helped hugely with many symptoms but it has still not eradicated my anxiety completely. I need a holistic approach incorporating lots of deep breathing, good sleep, eating well, time spent in nature, regular movement, yoga, rest and opening up when I am struggling so people know not to expect too much from me. If you are struggling with anxiety then I really encourage you to do the same before it becomes all consuming. It may not go completely but you can learn to live well despite it.
“You can't stop the waves, but you can learn to surf”
Jon Kabat-Zinn If you enjoyed this blog blease leave me a comment below, then why not check out my top 5 tips for breathing well in midlife to help relieve menopausal anxiety, panic attacks and stress: https://www.emmabwellness.com/post/learn-how-to-reduce-your-anxiety-and-stress-with-your-breath If you want to join my private, supportive and friendly Facebook group, you will find more advice in there on managing your anxiety and some videos with breathing exercises and nice calming stretches to help you relax https://www.facebook.com/groups/emmabwellnesspoweringthroughmidlife