HORMONES • MENTAL HEALTH
FEMALE HORMONES AND YOUR MENTAL HEALTH
Feb 26, 2024
Quick Answer
Female hormones affect mental health because estrogen and progesterone influence brain chemicals such as serotonin, dopamine, and GABA, which help regulate mood, sleep, and anxiety. When these hormones rise, fall, or swing sharply, as they do before your period, during pregnancy, after delivery, and in perimenopause, many women notice sadness, irritability, anxiety, or brain fog. These changes are common and treatable, and tracking them is the first step to getting help.
Key Takeaways
- Estrogen and progesterone influence the brain chemicals that shape your mood, sleep, and focus.
- Mood changes are most likely when hormones shift quickly, such as before your period, in pregnancy, after birth, and in perimenopause.
- No single hormone explains depression, so a hormone change is one piece of the picture and not the whole story.
- Tracking your mood, sleep, and periods for two to three cycles helps your OB/GYN spot a pattern.
- Symptoms most of the day, nearly every day, for two weeks or more are a reason to get help, and thoughts of harming yourself or your baby need help right away (call or text 988).
Although mental health disorders can be attributed to many factors, such as childhood trauma, social isolation, long-term illness, social disadvantages, severe stress, and family history, imbalances in our female hormones can also play a major role in the state of our mental well-being. Unfortunately, partly due to our complicated hormonal system, women are more susceptible to mental health disorders than men and, thus, more likely to be diagnosed with conditions such as anxiety and depression. In the United States, women are almost twice as likely as men to be diagnosed with depression.
Most of us know that estrogen and progesterone are female hormones that play important roles in our reproductive health, including puberty, menstruation, fertility, pregnancy, and menopause. These hormones naturally fluctuate throughout our menstrual cycle to keep things in balance, and for most women, cyclic reminders of these fluctuations can manifest as acne, bloating, energy level dips, changes in appetite, and sleep disturbances at certain points in the month. However, estrogen and progesterone do not affect just our reproductive health or monthly flow.
As part of the endocrine system (body hormone system), these hormones can travel throughout the body and exert additional effects on other body parts, including our brain. Together or individually, estrogen and progesterone can exert effects on many of our brain neurotransmitters (chemical messengers), especially serotonin and dopamine, which regulate brain functions like cognition, sleep, and mood, amongst so many other functions.
Familiar Hormones and Brain Chemicals
These hormones are the ones that many people already know about and are most commonly talked about.
Serotonin
Serotonin is a naturally occurring hormone and neurotransmitter that helps regulate mood, sleep, and appetite. It is one of several chemical messengers involved in mood, and changes in serotonin signaling are linked to depression, although low serotonin alone does not explain depression. Estrogen plays a role in the synthesis and regulation of serotonin, and progesterone, in the presence of estrogen, can also influence serotonin levels. Serotonin also plays a role in digestion, wound healing, bone health, blood clotting, sleep, and appetite regulation.
Dopamine
Dopamine, our brain’s “reward center” and generally known as the “feel good” hormone, plays an important role in executive function, memory, focus, motivation, and sexual arousal. Estrogen influences dopamine synthesis and regulation. In conjunction with estrogen, progesterone can also influence dopamine release. Changes in dopamine signaling are linked to low motivation, low energy, and low mood.
Other brain neurotransmitters that can also be affected by hormones include gamma-aminobutyric acid (GABA), the brain’s main calming signal, and glutamate, which plays a role in memory and learning.
Since the brain is largely responsible for our mental health as well as our general feeling of well-being, any direct or indirect changes to the brain chemistry caused by the actions of our hormones can have a profound effect on our mental health. For instance, swings and drops in progesterone can affect mood, and some women are especially sensitive to these shifts, which can bring feelings of sadness and anxiety. Changes in serotonin or dopamine signaling are linked to low motivation and energy, depression, anxiety, mood problems, sleep disturbances, impulsive behavior, irritability, and low libido.
Natural fluctuation of reproductive hormones due to the menstrual cycle and hormonal imbalances caused by many factors can also affect mental health. Conditions where estrogen or progesterone levels are too low, too high, or just fluctuate widely, such as menopause and premenstrual dysphoric disorder (PMDD), can cause varying degrees of mood swings and mental concerns. Some women also notice mood changes with hormonal birth control or hormone therapy, so tell your OB/GYN if you do.
Conditions and Life Stages That Affect Reproductive Hormones
Other common conditions that affect reproductive hormones and which, in turn, affect our mental health include:
Anorexia
Estrogen is stored and metabolized mostly in fat tissue. In health conditions like anorexia, where fatty tissue is less than optimal, estrogen levels may be dangerously low, leading to irregular or no menstrual cycles as well as mood swings, anxiety, frustration, and sadness.
Menstruation, PMS, and PMDD
The fluctuations of our hormones before and during menstruation can not only cause physical discomfort, such as bloating and cramping, but can also lead to psychological symptoms like sadness, anxiety, irritability, and diminished energy. This group of symptoms is typically mild to moderate and is known as premenstrual syndrome (PMS). Fortunately, it typically lasts only a few days. According to ACOG, PMS symptoms show up in the five days before your period for at least three cycles in a row and fade within four days after it starts. In some women, though, symptoms can be very intense and can last much longer. This is called premenstrual dysphoric disorder (PMDD), a severe form of PMS that affects a small percentage of women and can have prolonged effects on their mental health. If this sounds familiar, my posts on PMS symptoms and extreme PMS pain can help you sort out what is typical and what is not.
Polycystic Ovary Syndrome (PCOS)
PCOS is a condition where male hormones (or androgens), such as testosterone and androstenedione, are produced in larger than normal amounts, leading to other reproductive hormones becoming imbalanced. PCOS can lead to irregular periods, acne, male-pattern baldness, excess body hair, and weight gain. Unfortunately, this hormonal imbalance also affects mental health, and a review of studies found that women with PCOS had nearly three times the odds of depression and anxiety compared with women without PCOS. You can read more in my guide to PCOS.
Pregnancy
Pregnant women naturally experience sudden increases in estrogen and progesterone levels, which can drastically affect their hormones. These hormonal fluctuations, along with pregnancy itself being a vulnerable and challenging time, can bring mood swings, anxiety, or depressive symptoms. Studies estimate that roughly 1 in 7 women experience depression during pregnancy or after birth. It is important to keep a close eye on your mental health during pregnancy and seek treatment when needed.
Postpartum and Breastfeeding
Pregnancy hormones rapidly drop after delivery, and estrogen levels can stay low for a prolonged period during breastfeeding. This hormonal imbalance can lead to feelings of sadness, mood swings, irritability, and brain fog, particularly in the first few weeks following delivery. Mild to moderate symptoms in the first few weeks are often considered “baby blues.” They start about two to three days after birth and usually clear within one to two weeks without treatment. However, symptoms that are more severe or last longer than two weeks may point to postpartum depression, which about 1 in 8 women experience after giving birth. If you ever have thoughts of harming yourself or your baby, call or text 988 right away.
In Vitro Fertilization (IVF)
Infertility and the process of IVF can be very daunting and can increase the risk of anxiety, stress, and depression. The hormonal fluctuation that occurs with the process of IVF does not help either. During IVF, a woman may take medications that affect her hormones and menstrual cycle to stimulate the right reproductive environment. Some medications commonly prescribed for IVF include oral contraceptives, follicle-stimulating hormones (FSH), Gonadotropins (injectable hormones), and progesterone which can affect hormonal balance. Mental health symptoms such as mood swings, irritability, anxiety, and feelings of sadness are often common with these treatment options. Other possible side effects include physical symptoms such as bloating, hot flashes, nausea, breast tenderness, pelvic pain, and fatigue.
Perimenopause and Menopause
During the years leading up to menopause, there is a steady drop in estrogen and progesterone, and the levels of these critical hormones remain low once menopause is reached. These hormonal changes can lead to physical symptoms such as hot flashes, night sweats, sleep disruption, thinning tissue in the vagina, increased risk for osteoporosis, and heart disease. Mental-health-related symptoms, including mood fluctuation, sadness, anxiety, brain fog, and frustration, are also common during menopause. ACOG notes that most studies agree the risk of depression increases during the menopause transition. You can read more in my posts on perimenopause and the menopause transition and mental health.
Hormones and Mood at a Glance
Here is how the main hormone shifts line up with mood, and when it is time to reach out. Think of it as a map to bring to your OB/GYN, not a diagnosis.
| Life stage | What shifts | How it can show up | When to reach out |
|---|---|---|---|
| Before your period (PMS and PMDD) | Estrogen and progesterone fall in the days before your period | Sadness, irritability, anxiety, and low energy that ease within a few days after your period starts | When symptoms are severe or get in the way of work, school, or relationships, which can point to PMDD |
| Pregnancy | Estrogen and progesterone rise sharply | Mood swings, anxiety, or depressive symptoms | When low mood or constant worry lasts most days |
| After birth | Estrogen and progesterone drop quickly | Baby blues in the first one to two weeks, with sadness, mood swings, and irritability | When symptoms last longer than two weeks or feel severe, and right away for thoughts of harming yourself or your baby |
| PCOS | Androgens run higher than usual and other hormones become unbalanced | Higher odds of depression and anxiety | Whenever mood changes show up, since they are common with PCOS |
| Perimenopause and menopause | Estrogen and progesterone fluctuate, then stay low | Mood swings, sadness, anxiety, brain fog, and poor sleep | When mood changes last two weeks or more or your sleep is suffering |
| Low body weight (anorexia) | Estrogen can fall dangerously low | Irregular or missing periods, mood swings, and anxiety | As soon as your periods change or stop |
Thyroid and Cortisol Also Shape Your Mood
Estrogen and progesterone are not the only hormones that affect how you feel. Thyroid hormones also influence mood, and depression is a symptom of an underactive thyroid. I always think about the thyroid when a patient tells me her mood has changed, so you can read more in my guide to thyroid diseases in women.
Cortisol, your main stress hormone, also affects sleep, energy, and mood, and long stretches of stress can throw your other hormones off balance. You can learn how in my post on the stress hormone cortisol. If daytime exhaustion and low mood go together for you, my post on depression naps explains the link, and can hormone imbalance cause depression goes deeper on the bigger picture.
What Helps
There is no single fix, because hormones are only one piece of mental health. These steps are a good place to start, and your OB/GYN can help you choose among them.
- Track your symptoms. Rate your mood, sleep, and energy every day for at least two to three cycles. ACOG recommends this kind of daily rating to confirm PMS and PMDD.
- Protect your sleep. Regular sleep habits make a real difference to mood, especially in perimenopause.
- Move your body. Regular aerobic exercise can lessen PMS symptoms and may ease fatigue and low mood.
- Talk to someone. Therapy and support groups can help, including for depression during and after pregnancy.
- Ask about medicine. Antidepressants called SSRIs can help depression and anxiety, and they help some women with PMDD. In perimenopause, medicine that contains estrogen may help depression for some women. Each option has benefits and risks to talk through with your OB/GYN.
- Ask for a thyroid check. An underactive thyroid can cause low mood, and a simple blood test can rule it out.
When to Get Help Right Away
I want you to know this before anything else. Mood changes from hormones are real, and you do not have to push through them alone.
Get help right away if you
- Have thoughts of harming yourself or your baby. In the United States, call or text 988 (the Suicide & Crisis Lifeline), or call 911 in an emergency
Make an appointment soon if you
- Feel sad, anxious, or irritable most of the day, nearly every day, for two weeks or more, which is the point where NIMH advises talking to a provider
- Still have baby blues more than two weeks after giving birth, or feel they are getting worse. Postpartum Support International has a HelpLine at 1-800-944-4773 (call or text), and the National Maternal Mental Health Hotline at 1-833-852-6262 is free and open 24 hours a day, although it is not a crisis line
- Have PMS symptoms so severe that they disrupt work, school, or relationships
- Notice a clear change in mood after starting a new medicine, including hormonal birth control
Although external stressors and other factors can lead to various types of mental disorders, hormonal fluctuations and imbalances also play a major role in mental well-being and are worth considering as one possible reason for mental health conditions, especially in women of all ages. If you are noticing mood swings, drastic changes in energy levels, or similar symptoms, keep a diary of your feelings alongside your cycle and bring it to your healthcare provider. You deserve answers, and you do not have to wait until things feel unbearable to ask for them.
Frequently Asked Questions
Can hormones cause depression?
Hormone changes can contribute to depression, especially during times of rapid change such as after childbirth and in perimenopause, but they are rarely the only cause. Genetics, stress, sleep, health conditions, and life events all play a part. You can read more in my post on whether hormone imbalance can cause depression.
Which hormone causes mood swings in females?
No single hormone is responsible. Estrogen and progesterone are the main ones, because they rise and fall across your cycle and influence serotonin, dopamine, and GABA. Thyroid hormones and cortisol also affect mood, which is why your OB/GYN may look at more than your reproductive hormones.
What is the difference between PMS and PMDD?
PMS causes mild to moderate physical and emotional symptoms in the days before your period. PMDD is a severe form of PMS that affects a small percentage of women, with symptoms that disrupt work, school, or relationships and fade soon after your period starts. If it sounds like PMDD, rating your symptoms every day for two to three cycles helps confirm it.
How do I know if my mood changes are hormonal?
Timing is the biggest clue. Mood symptoms that follow a pattern with your cycle, pregnancy, birth, or perimenopause point toward hormones, while symptoms that stay the same all month may have other causes. Keep a daily record of your mood, sleep, and periods for two to three months and bring it to your OB/GYN, who can also check your thyroid.
Do birth control pills affect mood?
Research is mixed. Some women notice mood changes on hormonal birth control, and women with a history of depression may be more likely to notice them. If your mood shifts after you start or change birth control, tell your OB/GYN, because there are other options.
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