How Hormones Impact Mental Health
Hormones are linked to the activity of our brains – and accordingly, to mental health. As hormone levels change as we age, so too do the moods we experience. It’s important to recognise the impact this has on mental health, and to develop individual treatment plans to maintain a happy and healthy life.
What are hormones?
Hormones are produced by a network of glands that regulate growth, sex, metabolism, mood – you name it, hormones impact it. Hormones act as chemical messengers; they carry information between all our organs, and powerfully impact the brain, acting as ‘gate-openers’ to help connected cells in the brain communicate.
Hormones have significant effects on women’s health, and mediate important life phases such as puberty, menstruation, pregnancy and menopause. Estrogen is primarily produced by the ovaries and, is responsible for triggering changes during puberty and controlling cholesterol as well as contributing to bone health. Progesterone is a steroid hormone produced by a temporary gland that appears after ovulation. The hormone prepares the lining of the uterus for potential pregnancy after ovulation, encouraging the uterine lining to accept a fertilized egg. Additionally, women produce small amounts of testosterone in the ovaries and adrenal glands, contributing to sex drive, muscle strength and bone density. Finally, the thyroid – a butterfly-like gland sitting at the front of the neck – secretes a range of hormones that interact with many of our body’s roles
How hormones change as we age
As women move through life phases, levels of all hormones fluctuate. A surge in estrogen at around 12 years of age marks the first major hormonal change: puberty. This is the beginning a woman’s reproductive years, regulated by the menstrual cycle. The menstrual cycle has three phases, before release of an egg (follicular), during egg release (ovulatory) and after egg release (luteal)
Monthly periods and hormonal cycling continue until perimenopause: the transition into menopause. This can last for several years, typically when in your late forties – though it can start earlier, with the first signs appearing in your thirties. The first symptom of perimenopause is irregular periods, marking the end of reproductive years. Estrogen levels begin to rise and fall unevenly, initiating physical symptoms such as hot flashes; sleeping problems; changes in sex drive; decreased bone density; and increased cholesterol levels.
How do hormones impact mental health?
Menopause is marked by a complete year without menstruation, the cessation of egg release by the ovaries, and a significant reduction in estrogen production. The altered production of female hormones can see an increase facial hair and a decrease in energy, along with estrogen-associated mood changes due to the degradation of the limbic system (part of the brain involved in our behavioural and emotional responses) – a set of evolutionary basic brain structures located under the cerebral cortex. By this stage, progesterone is no longer produced, and levels of testosterone are at half of their peak.
By postmenopause, hormones will remain at a constantly low level. It is critical during this time to be aware of the increased risk of certain physical conditions that come with this reduction in hormonal levels. This includes osteoporosis, breast cancer and cardiovascular disease, as well as changes in vaginal health. Hot flashes may still be experienced during this stage.
While the physical changes that accompany fluctuating hormones are easier to spot, poor mental health is a commonly reported symptom of hormonal flux. But rather than simply being ‘grumpy’ or overly emotional, these changes in mood can be distressing and diminish quality of life. Understanding why and how mood changes occur is key to preventing and managing any impact on mental health.
The Reproductive Years
During the reproductive years, approximately 85% of women experience some form of premenstrual syndrome (PMS). These hormonal changes are widely discussed and frequently joked about – but these hormonal fluctuations over the month have a serious effect on emotions, well-being and thought processing. During the luteal phase progesterone levels rise, but the accompanying moodiness can be tempered by healthy lifestyle habits. Hormone levels are influenced by diet, sleep patterns and exercise – so it stands to reason that eating a range of fruit and vegetables, getting eight hours of sleep and exercising regularly can help combat the down feeling that comes with increased progesterone. However, it is important to take note when mood changes are more severe than the norm or if PMS becomes associated with a loss of joy or low energy that affects daily life, it’s time to seek professional help.
Premenstrual dysphoric disorder (PMDD) – a more extreme variation of premenstrual syndrome (PMS) – affects up to 5% of women, with symptoms including anger; despair; panic attacks; wide mood swings; apathy; brain fog and binge-eating. The interaction between estrogen and serotonin is thought to underlie this mood-disorder, in turn diminishing the role of hormones in reducing stress and increasing happiness. Certain brain regions are also altered which may result in prolonged anxiety and tension, as well as sensitivity to negative stimuli. This is directly linked to increased progesterone, as dysfunction of the hormone in this brain region is a major risk factor for premenstrual dysphoric disorder. It is critical that this disorder is treated professionally without delay, as suicidal thoughts can be associated with premenstrual dysphoric disorder.
Perimenopausal mood swings often resemble PMS – feeling irritable, low energy and brain fog, and feelings of sadness. Yet compared to the brief period of time PMS lasts for, during perimenopause these feelings can last for weeks to years. Research shows between 18% and 38% perimenopause experience symptoms of depression and anxiety, which is often associated with decreasing functionality in the frontal and parietal lobes (processes sensory information it receives from the outside world, mainly relating to touch, taste, and temperature). Anxiety is particularly common in the lead up to menopause and can be marked by panic attacks. During this time, it is likely that certain brain regions are particularly sensitive to hormonal fluctuations.
Worryingly, it is not uncommon for women to report that doctors consider these mood changes as simply a normal transition to be weathered; offering little-to no advice as to how to treat or understand symptoms.
The reduction of estrogen production and its mood-enhancing effects following perimenopause may lead to depressive feelings during menopause. During menopause, women are two-to-four times more likely to experience a major depressive episode than at any other time in their lives. Additionally, perturbed sleep associated with hot flashes and heart palpitations contribute to increased anxiety and irritability. Approximately 30% of those who develop depression or anxiety during the menopausal period will ultimately have this become a persistent or recurrent condition.
These episodes are likely caused by similar events in our brains as in Premenstrual Dysphoric Disorder – where the interactions between estrogen and other chemicals are dysregulated, and brain regions change in volume and function, resulting in sensitivity to negative stimuli and events.
Postmenopause is most commonly marked by complaints of memory and cognitive problems. Women who report a difference in memory and attention capabilities often display physical changes in the corpus callosum – which make up the nerves connecting the left and right brains – and structural changes in other brain regions.
These regions include the hippocampus, amygdala, and parahippocampal regions, which together form the medial temporal lobe – a part of the brain that is involved in emotions and learning, and memory and cognition.
Estrogen is a potent neuroprotectant and can boost cognitive processes; declining levels of the hormone are thought to be a key factor behind cognitive issues and the two-fold increased risk of developing Alzheimer’s disease in postmenopausal women.
When Should You Seek Help?
Social taboos, denial and a lack of information often leads to women ignoring symptoms of the serious mental health changes associated with hormones. Generally, routine check-ups with your general practitioner will ensure you are in tune with any changes occurring. If experiencing symptoms that reduce quality of life – trouble sleeping, working, mental fatigue and brain fog – it is best to seek a specialist such as a gynaecologist, who may then suggest seeking further help from a mental health professional.
Mental Health Checklist
Answer how regularly you experience the feelings below as honestly as possible. You are the expert on your body and your experiences; the results here are simply a guide to help you decide what actions to take next and are not a diagnosis.
ARE YOU FEELING?
Tired all the time?
Having trouble sleeping?
Loss of appetite?
Crying more than usual?
Daily work is suffering?
Loss of interest in hobbies?
If you answered mostly ‘rarely/never’, this suggests you’re doing well. If you are concerned, or if what you are feeling isn’t captured here, speak to your GP or someone you trust.
If you answered mostly ‘sometimes’, then it’s worth checking in with yourself more regularly. Do these feelings impact your quality of life? Are they becoming more frequent or more intense? If so, prevention is the best cure and it may be helpful to reach out to a professional to create a plan that can combat these feelings when they arise.
If you answered mostly ‘often’, you may be experiencing symptoms of poor mental health. This can be a result of your environment – stressful life events and circumstances – and of your body – changes in hormones or an imbalance in brain chemicals. You don’t need to weather these negative feelings alone; the links below can provide guidance and help you to treat your symptoms. Seeking help from a mental health professional may also be beneficial.
Useful links for Australians - please check your local directories
Lifeline is a free 24-hour, seven day a week phone counselling and crisis support service: call 131114 or text 0477 13 11 14
The Australian Menopause Society is a hub of health professionals dedicated to the better health of women, and with an interest in hormonal changes with ageing.
Head to Health provides links to digital mental health resources and services from Australian organisations, consolidating app, programs, forums, phone services and information.
Beyond Blue provides services for depression and anxiety-related symptoms.
Black Dog Institute provides resources for diagnosis, treatment and prevention of mood disorders.
PANDA is a national perinatal depression hotline, providing support, referrals, counselling and support for families and parents.
SANE is a national charity helping those with mental illness maintain a good quality of life.