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What you should know about the impact of hormones on women’s mental health

Hormone dysregulation can complicate issues like anxiety and depression

When dealing with mental health issues like anxiety and depression, it’s easy to overlook hormone dysregulation—but balanced hormones are vital not only for a healthy body, but also for a healthy mind. Hormones, or chemicals made in glands of the endocrine system, are regulators of many bodily processes. They help to control metabolism, mood, reproductive function, and sexual health. 

Hormone dysregulation occurs when too much or not enough of a hormone is released by the endocrine system. In women, hormonal imbalances can cause or worsen symptoms like insomnia, mood fluctuations, anxiety, or depression. Because female hormone levels and fluctuations are complex, it’s important to be aware of how hormones and mental health are connected.  

How hormone dysregulation affects women’s mental health

Hormones have a powerful effect on women’s brain chemistry, mental health, and mood, says Darren Salinger, MD, the chief of Obstetrics/Gynecology for KIDZ Medical Services in Miami-Dade. “Estrogen, progesterone, and testosterone all have important roles in women’s health and emotions,” he says. These hormones, when out of balance, can contribute to or worsen existing mental health issues.

Reproductive hormones and stress hormones can also cause mental health symptoms. “Drops in estrogen and progesterone can make us irritable and anxious,” says Gillian Goddard, MD, NY-based endocrinologist. “The stress hormone cortisol can cause anxiety and depression that can be severe if left unaddressed.” 

According to the National Institute of Mental Health, continuous stress can result in a wide array of health issues, including mental health disorders such as anxiety or depression. “When stress occurs,” Dr. Salinger says, “it can raise cortisol and DHEA, which leads to a spike in blood sugar and insulin. This in turn can lead to lower serotonin, which provides the calm, feel-good brain neurotransmitter. Ultimately, this sequence causes many kinds of psychological issues.”

Hormonal imbalances of the thyroid can also be problematic when it comes to mental health. “Both an underactive and overactive thyroid can cause anxiety, although the quality of the anxiety can be different,” Dr. Goddard says. “An underactive thyroid tends to worsen underlying anxiety [and] can also cause depression, [while] an overactive thyroid can cause jittery anxiety similar to drinking too much caffeine.”

Common symptoms of hormone dysregulation

Hormonal dysregulation can lead to emotional problems, says Dr. Salinger. Unfortunately, it also works the other way around. “Hormone imbalance can lead to stress, and stress can lead to hormone imbalance,” he says.

In those with underlying depression or anxiety, hormonal dysregulation can worsen emotional issues like irritability, depression and anxiety, Dr. Goddard says.

Symptoms of hormone dysregulation can include:

  • Depressed mood
  • Anxiety
  • Sleep disturbances (fatigue and insomnia)
  • Changes in weight (gain or loss)
  • Muscle aches, stiffness, or weakness
  • Memory loss 
  • Brain fog
  • Confusion
  • Difficulty concentrating
  • Fast or slow heartbeat
  • Constipation or diarrhea
  • Hair loss
  • Dry skin
  • Temperature intolerance

Health conditions caused by hormonal imbalances  

Though thyroid hormone and cortisol imbalances affect men and women similarly, the reproductive hormones estrogen and progesterone can cause mental health changes that are unique to women. 

“For some women, the regular fluctuations of estrogen and progesterone associated with our menstrual cycles can cause extreme changes in mood called Premenstrual Dysphoric Disorder (PMDD),” Dr. Goddard says. “The more extreme changes in hormone levels after giving birth or during menopause can lead to a lot of sudden changes in mood that can be quite disconcerting, and for some women can cause depression and/or anxiety.”

Common hormonal health conditions include: 

Causes of hormonal imbalances

Lifestyle factors such as poor sleep, poor eating habits, not getting enough exercise, or existing medical conditions can lead to chronic stress, which can result in hormone imbalances that contribute to mental health issues. 

Thyroid imbalances may occur during periods of hormonal fluctuations such as menstruation, pregnancy, postpartum, and menopause. Estrogen levels rise during a routine menstrual cycle,  drop a lot after ovulation, and rise again. 

“These shifts can lead to mood changes, eating changes, sleep disturbances, anxiety, and for some people even depression,” Dr. Salinger says. “These chronic stressors can lead to thyroid dysfunction.” 

Elevations in estrogen, progesterone, and testosterone levels during pregnancy can cause hormone imbalances leading to thyroid dysfunction. “About 5% of people during pregnancy have thyroid dysfunction,” Dr. Salinger says, who adds that it can take three to four months for levels to return to normal.

Postpartum thyroiditis, which is the inflammation of the thyroid after giving birth, affects 5% to 10% of people, according to The American Thyroid Association. This condition can be mistaken for postpartum blues or depression because it causes depressed mood and fatigue. 

Menopause is also a period of many hormonal changes. “The ovaries still produce hormones, but the levels may be 50% of baseline, causing symptoms of hormone imbalance leading to stress which can affect the thyroid,” says Dr. Salinger. 

During all of these periods of greater hormonal fluctuation, it’s possible to see an increase in mental health symptoms.

Treatment options for hormonal dysregulation

Hormonal dysregulation can be treated with a combination of medications and lifestyle changes.

Medications

The following medical treatments may be useful in treating hormonal dysregulation: 

  • The diabetes medication Metformin regulates insulin and sugar, which may cause many mental health concerns when out of balance.
  • The thyroid medication levothyroxine can help to regulate thyroid function in cases of underactive thyroid.
  • Hormone replacement therapy is considered when a hormonal imbalance is causing concerns with mental health. “Hormones may be replaced with what are termed bio-identical formulations for estrogen, progesterone, and testosterone,” Dr. Salinger says.
  • Estrogen and progesterone can be prescribed individually or together to help regulate mood. “For many people, a low dose birth control pill that contains both hormones will improve mental health even into menopause,” Dr. Salinger says. “There are other hormone replacement formulations for menopausal treatment.”
  • Methimazole, a medication that blocks the release of thyroid hormone from the thyroid, is used in cases of hyperthyroidism.

Lifestyle changes 

The following lifestyle factors may improve hormone levels

  • A healthy diet that both limits sugar and refined carbohydrates and includes sufficient protein and foods high in omega-3 fatty acid (like salmon) may help to regulate hormone levels, says Dr. Salinger, who also recommends drinking decaffeinated green tea and plenty of water. 
  • Get plenty of regular exercise. 
  • Practice stress reduction techniques such as meditation.
  • The supplement inositol, occurring naturally in cantaloupes, citrus fruits, and legumes, may be helpful in improving symptoms.

If non-medicine therapies are insufficient in controlling symptoms, providers such as endocrinologists and obstetricians/gynecologists, internal medicine, or family practitioners should be consulted to develop a treatment plan.