Female Hormones and Your Mental Health

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. 

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 

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 promotes optimism and satisfaction. Sufficient serotonin creates a long-lasting feeling of happiness and general well-being. High levels of serotonin also help with regulating mood, while low levels can lead to depression. Estrogen plays a role in the synthesis and regulation of serotonin. Progesterone, in the presence of estrogen, increases 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 increases dopamine synthesis and regulation. In conjunction with estrogen, progesterone can also increase dopamine release, leading to an overall feeling of mental wellness. Insufficient estrogen can lead to loss of dopamine cells and thus lead to depression and other mental health disorders.

Other brain neurotransmitters that can also be affected by hormones include Gamma-aminobutyric acid (GABA), which has anti-seizure and anti-anxiety effects, 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, low progesterone can lead to feelings of depression, sadness, and anxiety. Inadequate levels of serotonin or dopamine, for any reason, can lead to many mental disorders, including low motivation and energy, depression, anxiety, mood problems, sleep disturbances, impulsive behavior, panic disorder, cognitive decline, learning difficulties, irritability, mental decline, and low libido.

Natural fluctuation of reproductive hormones due to the menstrual cycle and hormonal imbalances caused by many factors can also lead to mental health disorders. For instance, conditions where estrogen or progesterone levels are too low, too high, or just fluctuate widely, such as menopause, premenstrual dysphoric disorder (PMDD), use of oral contraceptives, and hormone replacement therapy, cause varying degrees of mood swings and mental concerns. 

Conditions 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

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. In some women, though, symptoms can be very intense and can last much longer (premenstrual dysphoric disorder), thus leading to prolonged effects on their mental health.

Polycystic Ovary Disease (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 women with PCOS are three times more likely to experience depression and anxiety than women without 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, cause up to 20% of women to experience mood swings, anxiety, or depressive symptoms during pregnancy. It is important to keep a close eye on your mental health during pregnancy and seek treatment when needed.

Postpartum/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” and should pass on their own. However, prolonged or more severe symptoms may lead to a more serious diagnosis of postpartum depression, with about 1 in every 10 women experiencing this disorder within a year of giving birth.

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.

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.

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 should be considered as a possible reason for mental health conditions, especially in women of all ages. If you are experiencing any mood swings, drastic changes in energy levels, and other similar symptoms, you should consider keeping a diary of your feelings possibly associated with hormonal fluctuations and discuss this with your healthcare provider.