How hormone imbalances impact your mental health

Mental health is a pertinent part of our wellbeing: wellness does not only encompass physical health, but also our mental and emotional health. Mental health can affect all aspects of our lives and can often have hidden-drivers, such as hormonal imbalances. By understanding the root cause of disease we can treat the underlying issue directly.

In this article we’ll be answering questions like:

• How do my hormones impact my mental health?
• How does my PCOS, endometriosis, thyroid disorder, or other hormonal imbalance make me more likely to suffer from poor mental health?
• What emotional symptoms should I look out for?
• Could my psychiatric medication be affecting my hormonal health or catalyzing a hormone imbalance?
• How can I take charge of my mental and hormonal health?

Mental health and hormonal imbalances are interrelated

Mental health conditions could stem from a hormonal imbalance. Inversely, if you have a hormonal imbalance you are more likely to develop mental health conditions. Sometimes psychological symptoms are side-effects of a hormonal treatment.

Norepinephrine, dopamine, and serotonin are well known in the psychiatric field to be pertinent biochemical regulators of our mood and psychological well-being. These three neurohormones form the foundation of current biochemical mental health pharmaceutical treatments in conjunction with psychotherapy and lifestyle modifications.

Although this triad is not exclusively the only group of hormones that can lead to mental illnesses; it is important to also consider the following hormones when working with your healthcare provider.

Estrogen

Estrogen  (E1, E2 and E3) is a group of hormones that play a major role in our body’s physiology, ranging from bone health, female characteristic developments, to our emotional well-being.

Focusing on mental health, estrogen regulates neurotransmitters such as serotonin, dopamine, epinephrine, and norepinephrine, which are involved in mood regulation. Estrogen increases both production of serotonin (the “feel good” or “happy” chemical), as well as serotonin receptors in the brain. Estrogen is involved in regulation of endorphins, a group of hormones that stimulate physiological pathways associated with blocking pain and bringing a rush of euphoria and happiness. Fluctuating levels of estrogen is associated with mood swings and irritability.

• Low levels of estrogen is linked to lower levels of serotonin, which can cause mood swings, depression, trouble concentrating, fatigue, and irritability.
• Overly high levels of estrogen along with low levels of progesterone, known as estrogen dominance, is associated with depression, irritability, fatigue, memory problems, mental fog, and anxiety as well.

Progesterone

Apart from the reproductive shifts associated with progesterone, high levels of the hormone is associated with increased amygdala sensitivity (the part of the brain associated with the fight or flight panic response) leading to a greater likelihood of anxiety, depression, insomnia, and a general glum. Low levels of progesterone can contribute to estrogen dominance and mood changes such as anxiety, depression, mental fog, irritability, and more..

Androgens DHEA and DHEA-S

Dehydroepiandrosterone (DHEA) and it’s sulfated form DHEA-S is the most highly concentrated hormone naturally occurring in our body. As a precursor to other hormones such as testosterone and estrogen, DHEA is essential for healthy functioning.

Low levels of DHEA and DHEA-S is associated with depression; some studies have even found positive results when treating older depressed patients with DHEA supplements. Although DHEA supplementation tends to quickly raise natural testosterone levels, and therefore comes with a long list of side effects including hirsutism, insulin resistance, insomnia, and abnormal menses.

Further research is needed to understand the physiological effects of DHEA; efficacy of DHEA supplementation is low and the risk of drug interactions or strong side-effects are high.

Thyroid Hormones T3 (Triiodothyronine) and T4 (Thyroxine)

Although our thyroid is usually associated with metabolic disorders, the metabolism affects energy rates for our entire body. Activated by Thyroid Stimulating Hormone (TSH) the thyroid gland releases hormones T3 and T4, which differ in the number of iodine molecules present.

T3 and T4 are mood regulators that influence the metabolic rate, and therefore can be directly associated with our energy levels and emotions. See “Thyroid Disorders” section below for more information on how our thyroid gland’s activity can impact our emotional wellbeing.

Cortisol

Known widely as the “stress hormone”, Cortisol is an essential hormone involved in our fight-or-flight response.

Due to the fast pace of modern society, oftentimes our bodies can perceive unending chronic stress; our adrenal glands can continuously release cortisol which stimulates chronic inflammation throughout the body. Besides resulting in increases in blood sugar, blood pressure, and fat storage, raised cortisol and inflammation levels are correlated with higher rates of depression, anxiety, and other mental health conditions. Serotonin is reportedly dysregulated with a consistently high level of cortisol, chronic stress and bodily inflammation.

The source of excessive cortisol can be an adrenal tumor, genetic disorder, or more commonly chronic stress from work, exercise, relationships, and life in general. Lifestyle modifications, such as mindfulness and meditation, can help to reduce stress and cortisol levels.

Indirect effects of our hormones on mental health

Hormonal changes often lead to fluctuations in body weight, hair thinning or excessive growth, facial acne, and other physical transformations which can contribute to our self perception, body image, and self-esteem. It is important to recognize how physical changes, due to hormonal imbalances or treatments, can affect our emotional well-being.

Furthermore, hormonal imbalances are a source of physiological stress which is felt by our insular cortex, a part of our brain that senses our internal state. Similar to feeling down or fatigued at the beginning of a bad cold, we may sense hormonal imbalances and subconsciously allow it to affect our emotional state.

How specific hormone-related imbalances may impact your mental health

PCOS

People with PCOS are 3 times more likely to experience anxiety and/or depression than people without PCOS and are more likely to report a higher severity of symptoms.

Although the exact reason for this association between conditions is unknown, many symptoms of PCOS, such as hirsutism, infertility, body weight fluctuations, and a general lack of control over one’s health and body can be frustrating and anxiety-provoking. Some studies have suggested that insulin resistance or higher androgen levels could be a factor that predisposes people with PCOS to develop mental health conditions.  

Endometriosis

Either directly or due to the mental toll of chronic pain, people with endometriosis are more likely to experience depression, anxiety, psychosis, somatization and anger-management issues. Based on a 2009 study of 104 endometriosis patients in the European Journal of Obstetrics, Gynecology, and Reproductive Biology, 86.5% of endometriosis patients presented depressive symptoms (mild for 22.1%, moderate for 31.7%, and severe for 32.7%) and 87.5% presented anxiety (minor for 24% and major for 63.5%).

Chronic pain alone can take an emotional toll, although chronic pelvic pain (CPP) associated with endometriosis is hypothesized to create a vicious cycle with psychopathic conditions in which they each heighten each other. On a positive note, treatment focused on helping with chronic pain from endometriosis may help one’s emotional well-being.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a disorder in which mental health is a primary concern; people with PMDD recurrently fall into a severe depression premenstrually. 3-8% of menstruating people fall into this bucket with a higher sensitivity to the hormonal fluctuations of menstruation in that it deeply changes their emotional and mental health.

More intense than premenstrual syndrome (PMS), PMDD debilitates those afflicted from keeping up with their daily lives. Although PMDD tends to clear up a few days before one’s period starts, the depression, anxiety, irritability or anger, panic attacks, lack of interest in daily activities or relationships, and other symptoms can be treated with antidepressants, birth control pills, or stress management techniques.

Thyroid disorders

Thyroid disorders are difficult to distinguish from depression due to many shared symptoms; fatigue, weight gain, depressed mood, reduced sexual desire, and trouble concentrating. The conditions overlap so extraordinarily that treatment of SSRI-resistant depression with T3 was reported to help reduce symptoms of depression and even help patients reach remission.

When the thyroid is functioning at below-normal rates (hypothyroidism), our organs and systems’ metabolic functions are slowed, which can lead to a range of symptoms including depression, fatigue and trouble concentrating. Recent studies have found that adults with higher levels of TSH and lower levels of T3 and T4, characteristic of subclinical or clinical hypothyroidism, were more likely to have memory deficits, depression, and PTSD.

Alternatively, an overactive thyroid, called hyperthyroidism, is associated with nervousness, insomnia, and pro-inflammatory signaling throughout the body, which can contribute to trouble with anxiety and mood disorders.

Menopause & perimenopause

Menopause and perimenopause are naturally-occurring shifts in hormones which together slow down and eventually end one’s menstrual cycles; although the process may be essential, struggling with your mental health throughout is not.

Because both estrogen and progesterone are major players in setting our mood, as the baseline levels for both hormones drop down, so can your emotional wellbeing. As the emotional effects of menopause are most often milder (according to Harvard Health Publishing), most people that struggle with their mental health during perimenopause and menopause have had mental health struggles at earlier points in their lives.

Depression and menopause have a direct research-backed interconnection but anxiety disorders seem to be a bit more blurry; anxiety disorders and panic attacks could be due to hormonal and physiological changes but it is hard to decipher from hot flashes and the commonly stressful and anxiety-inducing age in which menopause tends to occur.

Postpartum

Many women struggle with the significant shift in hormonal levels and colossal recovery that comes with birthing a baby. The postpartum period can be a beautiful time but also a new and challenging period; taking care of your emotional health is a major component of recovering from giving birth. While periodic moments of sadness and melancholy are normal (“baby blues”), if this persists you may be experiencing postpartum depression. Keeping tabs of your feelings and overall emotional state and seeking help when necessary is important for all new birthing parents to keep in mind.

Signs & symptoms of a mental health struggle

1 in 4 adults experiences a mental health issue at some point in their lifetime, and hormone imbalances leave you even more likely to fall into this category. Below are common signs that it may be time to seek support:

• Anxiety
• Irritability
• Depression
• Insomnia or problems with sleeping
• Mood swings - irritability, short-temper
• Difficulty concentrating
• Short-term memory lapses
• Decreased mental sharpness / Mental fogginess
• Problems with weight or appetite
• Obsessive compulsive disorder (OCD)
• Feelings of hopelessness
• Thoughts of death or suicide
• State of confusion

Psychiatric medications & hormonal interactions

While imbalanced hormones can leave you more likely to experience anxiety, depression, and other mental health issues, it is also important to know that psychiatric medications can create or worsen off-kilter hormones.

That said, remember that every body is unique and for many, the benefits of these medications will outweigh the negative symptoms. This section is intended to be educational and give you a starting point if you want to discuss the impact of these medications on your hormones with your doctor. Do not make any changes to your medication regimen without consulting your care team.

Antidepressants

Selective serotonin reuptake inhibitors (SSRI), a major class of antidepressants, directly change our neurohormonal levels.

Recent studies have found that hormone replacement therapies (in which estrogen and other hormones may be supplemented) can have a reciprocal relationship with antidepressants; people taking antidepressants may be missing an underlying endocrine condition, and people treated with hormonal replacement therapy feel the effects not only physiologically but mentally as well. Additional studies have reported antidepressants’ interactions with estrogen receptors.

Anti-androgen hormonal therapies

Androgen-blocking drugs are commonly used to treat endocrinological conditions or as an oral contraceptive yet they also affect our neurohormonal levels and mental health.

Common anti-androgen prescriptions include cyproterone acetate (co-cyprindiol or Diane™-35, Estelle™ 35 and Ginet-84™), drospirenone (Yasmin™, Yaz™) or dienogest (Valette™).  Since hormonal fluctuations of estrogen, testosterone, and other hormones act on your brain as well as the rest of your body, blocking our androgens for physiological changes affects your mental health too. It is important to talk with your healthcare provider about the ways in which your treatments for either mental or endocrine conditions interact.

Take charge with treatments

When struggling with any condition, it can be incredibly effective to treat the underlying cause. Our body does not work in isolated segments; our hormones and emotional well-being function collectively. If you are struggling with a mental health condition, it could be rooted in a hormonal imbalance.

As your hormone levels are stabilized your mental health can follow. Working with the proper healthcare providers can help you implement proper lifestyle changes (diet and exercise), supplements/medications, and complementary therapies (such as yoga, meditation, acupuncture) to take charge of your hormonal and mental health.

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