Hormones play an important role in women’s health. From the time women get their first period, through pregnancy, and then through menopause, women experience cycles of hormonal swings that affect their brain chemistry, and by nature, their mental health. Other than progesterone and estrogen, the more commonly known hormones which affect women’s reproductive health, many other hormones contribute to the ebbs and flows of women’s health, such as their energy levels, metabolism, weight, sexual health, and mood. 

When dealing with mental health issues, like anxiety and depression, it’s important to look at hormonal regulation and balance, as hormones play a vital role in both our physical and mental health. In this article we’ll discuss the role of female reproductive hormones, and how specific hormonal imbalances can cause or worsen women’s mental health.

What are Hormones and How Can Hormones Affect Women’s Mental Health?

Hormones, or chemicals made in the glands of the endocrine system, are the chemical communicators in your body. They travel through your bloodstream, delivering important messages from one organ to the next. Slowly, and over time, hormones affect every function of your body, including your metabolism, reproductive function, sexual health, mood, and overall wellbeing. 

The following female reproductive hormones are important to consider when assessing your mental and physical health with your healthcare provider:

Estrogen

Otherwise known as the growing hormone, estrogen is the female reproductive hormone that helps grow and mature the female uterine lining. Estrogen is produced in the ovaries, adrenal glands, and fat tissue of a woman’s body. The gradual rise in the level of estrogen in the first two weeks of the menstrual cycle, otherwise known as the follicular phase of the cycle, causes the build up of the uterine lining each month in preparation for pregnancy. A drop in estrogen and progesterone causes women to have a menstrual period each month. 

While it’s natural for estrogen levels to decrease with age, low levels of estrogen unrelated to menopause can be associated with a health condition, in which case women need to discuss their symptoms with a medical professional. 

Low levels of estrogen: Women who experience low levels of estrogen hormones may develop osteoporosis. Low levels of estrogen can also cause mood swings, depression, difficulty concentrating, fatigue, irritability, and poor sex drive.

High levels of estrogen: Women who experience overly high levels of estrogen hormones may develop estrogen dominance, which can cause depression, irritability, fatigue, memory problems, mental fog, and anxiety.

Progesterone

Progesterone is the female reproductive hormone whose function is to control the build up of the uterine lining. During a woman’s childbearing years, progesterone levels rise during the second half of her menstrual cycle, after the monthly egg is released from her ovary. Progesterone levels will rise, and keep the uterine lining thick for the developing baby, if the woman becomes pregnant. If the woman is not pregnant, the progesterone levels will fall, and the body will shed the uterine lining during menstruation. 

Low levels of progesterone: Women who experience decreased levels of progesterone may have abnormal menstrual cycles, and struggle to conceive because the progesterone doesn’t trigger an adequate environment for the egg to develop. Pregnant women with lower levels of progesterone face higher rates of miscarriage, or pre-term delivery, because progesterone helps maintain pregnancy. 

Low levels of progesterone also lead to estrogen dominance and mood changes such as anxiety, depression, mental fog, and irritability. 

High levels of progesterone: Overly high levels of progesterone are associated with increased amygdala sensitivity, the part of the brain that controls our fight or flight response, which can lead to increased anxiety, depression, insomnia, and overall low mood.

Testosterone 

While generally considered a male hormone, women produce low amounts of testosterone. Combined with estrogen, testosterone helps with the development and maintenance of a woman’s bone mass, energy levels, reproductive tissues, weight, and mood. Balanced testosterone levels can optimize women’s overall health. 

Low levels of testosterone: Low testosterone levels in women can lead to:

• Decreased sex drive
• Decreased sexual satisfaction
• Decreased mood 
• Muscle weakness
• Lethargy

High levels of testosterone: Overly high levels of testosterone in women can lead to the following health conditions:

• Polycystic ovarian syndrome (PCOS) 
• Ovarian tumor 
• Tumor on the adrenal gland 
• Congenital adrenal hyperplasia

Cortisol

Cortisol, otherwise known as the stress hormone, is an essential hormone involved in the fight or flight response. As your body perceives stress, your adrenal glands make and release cortisol in your bloodstream: which then increases your heart rate and blood pressure. Balanced cortisol levels help regulate your blood pressure and blood sugar throughout the day, and strengthen your heart muscle. Cortisol can also heighten your memory, increase your immune system, and lower your sensitivity to pain. 

High levels of cortisol: If your body is constantly under stress, you might be producing too much cortisol. Increased levels of cortisol can lead to:

• Increased blood sugar levels 
• Weight gain 
• Digestive problems
• Suppressed immune system 
• Heart disease
• Depression
• Anxiety 
• Chronic stress

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is a hormone produced by the body’s adrenal glands, whose function is to help produce androgens and estrogens, the male and female reproductive hormones. DHEA levels peak around age 25, and naturally decrease with age. Sufficient levels of DHEA help stabilize mood, bone density, weight, libido levels, skin health, and quality of life.

Low levels of DHEA: While results aren’t entirely clear, few research studies have found that low levels of DHEA are linked to depression and other mood disorders. Other studies suggest that low levels of DHEA are linked to increased levels of testosterone which can cause insomnia, decreased mood, decreased bone density, muscle weakness, and fatigue.

Thyroid Hormones T3 (Triiodothyronine) and T4 (Thyroxine) 

Thyroid hormones play an important role in balancing our body’s central nervous system. The inactive thyroid hormone, T4, is secreted by the thyroid gland and transported across the blood-brain barrier, where it’s converted into T3, the active thyroid hormone. Balanced thyroid hormones support the neurons, which are the structural units of our body’s nervous system, and the glial cells, which connect and support the brain and spinal cord. T3 and T4 are mood regulators 

Low levels of thyroid hormones: T3 and T4 are mood regulators that influence our body’s metabolism, and therefore can affect our emotions and energy levels. Decreased levels of T3 and T4 can lead to anxiety, depression, personality disorders, and schizophrenia.

Common Symptoms of Hormonal Imbalances in Women:

• Depressed mood
• Feeling anxious
• Mood swings
• Memory loss
• Sleep disturbances 
• Muscle aches, stiffness, and weakness 
• Headaches
• Irregular periods
• Infertility
• Constipation and digestive problems
• Dry skin
• Temperature intolerance
• Weight gain or weight loss
• Decreased sex drive
• Vaginal dryness
• Hot flashes or night sweats

Indirect Side Effects of Hormones on Mental Health:

Many women are familiar with the physical and mental health changes that happen often in a monthly cycle: bloating, headaches, irritability, fatigue, and mood changes. These symptoms, especially those around mood, can be signs of naturally occurring changes in hormonal levels. When these symptoms become more pronounced and severe, at key stages of women’s lives: puberty, pregnancy, and menopause, it can be difficult to understand and accept these changes in our body. Changes in weight, hair thinning or excessive hair growth, facial acne, and other physical transformations can make a drastic difference in how women perceive themselves. It’s important to recognize that hormonal imbalances can impact our physical appearance, which can affect our emotional and mental well-being.

Specific Hormonal Imbalances and Their Impact on Mental Health:

PCOS: People with PCOS are three times more likely to experience depression and anxiety than those without PCOS. It’s still unclear what causes the increased risk of depression and anxiety among people with PCOS, though it could be linked to PCOS symptoms and hormonal imbalances, such as lower levels of certain neurotransmitters such as serotonin. 

Symptoms of PCOS can include hirsutism, infertility, body weight fluctuations, excessive body hair or facial hair, and a general lack of control over health and body which can cause depression and anxiety. 

Endometriosis: Endometriosis is a common, painful condition in which the type of tissue that forms the lining of the uterus is found outside of the uterus. The physical pain of endometriosis, often chronic pelvic pain just before and during the menstrual period, can cause depression, anxiety, psychosis, and anger issues.

Premenstrual Dysphoric Disorder (PMDD): Premenstrual Dysphoric Disorder (PMDD) is an extremely severe form of premenstrual syndrome (PMS). It can cause major emotional and physical symptoms every month during the week or two before the start of a period. 

Emotional symptoms of PMDD can include:

• Mood swings
• Feeling low or upset
• Decreased energy
• Decreased interest in activities
• Suicidal feelings
• Feeling anxious 
• Difficulty concentrating
• Feeling tense or on edge
• Feeling out of control  

Physical symptoms of PMDD can include: 

• Breast tenderness or swelling
• Headaches
• Joint pain
• Fatigue 
• Bloating 
• Sleep problems 
• Increased anger or conflict with other people
• Changes in appetite 

The body functions as a machine with many moving parts that work independently and in unison all at the same time. When hormone levels are thrown off, it can manifest as depression or anxiety. 

Menopause and Perimenopause: Menopause and perimenopause are naturally occurring shifts in hormones, which mark the end of a woman’s period and reproductive years. As estrogen and progesterone levels drop during menopause and perimenopause, so can a woman’s mental wellbeing. While the process is an essential part of the female body’s evolution, severe mental health symptoms such as depression and mood swings are not. 

Symptoms of menopause and perimenopause can include:

• Depression
• Anxiety
• Mood swings
• Fatigue
• Decreased energy levels
• Irritability
• Night sweats
• Hot flashes 
• Heart palpitations

Postpartum: The intense hormonal changes that occur during and after childbirth can cause many mothers to experience mood swings: this is often called “postpartum blues.” If symptoms like decreased mood and emotional imbalance persist after several weeks, it might be a sign of postpartum depression. It’s important to keep note of your overall emotional state following childbirth, and notify your healthcare provider of any changes.

Take Charge of Your Mental Health:

While most of us understand female hormones through the lens of reproductive health, hormones have a huge impact on women’s brain chemistry. At Handel Behavioral Health, our trained therapists and counselors know that our body’s do not operate in isolated segments; our hormones and mental well-being function as a whole. When our hormone levels are balanced, our mental health can flourish. 

If you or someone you love is struggling with a mental health condition, it’s imperative to work with a trained mental healthcare provider to help implement proper lifestyle changes, supplements/medications if necessary, and complementary therapies such as Cognitive Behavioral Therapy and mindfulness meditation. 

Our trained therapists and counselors at Handel Behavioral Health proudly offer support for the entire Massachusetts community from our offices in Franklin, Amherst, West Springfield, and Wilbraham. We also offer online telehealth services. Please contact one of our experienced therapists or counselors today and begin your mental and hormonal health journey.

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