Mental Health and Hormones

As anyone who has experienced any of the 4 P’s (Puberty — Periods — Perimenopause — Post-Menopause), hormones can be a A LOT  to handle.

Women become more vulnerable to depression beginning with puberty. It can rear its ugly head throughout pregnancy, as well as around Perimenopause. Only quieting down with more stable rates AFTER  menopause. However, while the rate of new onset mood disorders may go down after menopause, more women (compared to men) suffer from mood, anxiety, and stress-related disorders, well into old age.

The incidence of Major Depressive Disorder (MDD) in women is two to three times higher than in men. In men, rates of MDD remain fairly constant from puberty to old age, but increase in women at puberty and remain higher until menopause. (Well, that explains a lot. —Ed.)

Depression risk for women is likely related to shifts in ovarian hormones across different stages of life.

We see this as PMS or PMDD around the monthly menstrual cycle and in relationship to pregnancy, post-partum and menopause.

➔ It is also clear that periods of low estrogen (such as prior to the period and during late perimenopause) may introduce windows of increased susceptibility to depression. Perimenopause is another transition period that increases one’s risk for both depressive symptoms and new onset depression even among women with no prior history of affective disorders.

While the reasons for this remain unclear, clinically we see that the CYCLING of ovarian hormones on neurotransmitter systems in the brain that control mood are highly sensitive to hormone levels and hormone fluctuations.

What Do Estrogen, Progesterone and Testosterone Do To Impact Mental Health?

1. Mood Regulation

• Estrogen helps regulate mood by influencing the production and activity of neurotransmitters like serotonin and dopamine, which are crucial for feelings of well-being and happiness.
• Progesterone can produce feelings of calm, relaxation and evenness.
• Testosterone is responsible for decision making, improved concentration, motivation and positive mood states.
• The decline in estrogen levels during menopause can lead to mood swings, irritability, and increased vulnerability to mood disorders such as depression and anxiety.
• The physical symptoms of menopause, such as hot flashes and night sweats, can increase stress and anxiety levels, further impacting mood.

2. Cognitive Function

• Hormones play a key role in maintaining memory and attention.
• Deficiency in estrogen may lead to brain fog, forgetfulness and depression.
• Some women experiencing such cognitive changes report feelings of fear, frustration or sadness.

3. Stress Response

• Estrogen can modulate the body’s stress response by interacting with the hypothalamic-pituitary-adrenal (HPA) axis, potentially reducing the impact of stress on the body.
• Low estrogen states have been found to reduce stress resilience and even reduce immune system function.

4. Neuroprotection

• Estrogen and progesterone help protect brain cells from damage and support overall brain health.
• Progesterone has been found to reduce inflammation related to traumatic brain injury.

➔ Deficiency in estrogen may lead to brain fog, forgetfulness and depression.

What Else Should You Consider Regarding Hormones & Your Mental Health?

Oftentimes I see women who are quickly placed on psychiatric medications for hormonally motivated mood issues. Not only does this often not help, it delays more impactful evaluations to understand the underlying causes.

➔ HORMONE REPLACEMENT AND HORMONE BALANCING therapies should be included in any discussion related to mood disorders. This should be evaluated and addressed instead of solely considering psychiatric medications that often do not perform better than placebo.

Exercise & Depression

A systematic review of studies that look at the effect of exercise for depression: such as one published in the British Medical Journal in 2024 showed a moderate impact on depression compared to placebo. This can rival the performance of SSRIs that typically show a 60% improvement in depression symptoms (placebo shows 50% in many cases).

Psychotherapy

Some evidences based psychotherapeutic techniques include:

• Cognitive behavioral therapy (CBT) is a common type of counseling that helps people understand how their thoughts and behaviors affect them. CBT is problem-oriented and focuses on helping people change the way they think and behave to better cope with current problems.
• Relaxation techniques — Some evidence suggests that relaxation techniques can help relieve mild to moderate depression. Examples include:
  • Progressive muscle relaxation
  • Music therapy
  • Yoga
  • Breathwork
  • Mindfulness meditation

Nutrition & Depression

Several recent research analyses looking at multiple studies suggests a link between what one eats and risk of depression. According to one study analysis:

“A dietary pattern characterized by a high intake of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression.”

All in all the headline here is to look to address all lifestyle factors, all hormone imbalances and manage all inflammatory stressors in your life to get a fully informed and effective plan for your mental health.

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Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!

Mental Health Hormones Doctor Anita Sadaty Share The Health board certified gynecologist New York Functional Medicine NY Women’s Wellness