The reproductive lifecycle of women is fraught with many transitions that increase the susceptibility to mental and emotional symptoms. From puberty to premenstrual to pregnancy and postpartum to menopausal, these times of hormonal flux are fraught with several well-known physical symptoms, but what is not as well known, but just as problematic, are the psychological symptoms that may manifest during these times. Fatigue, depression, anxiety, attention issues, mood swings, low libido, and insomnia are common hormonally-mediated complaints that may develop at any time during the reproductive lifespan and, once experienced, are more likely to recur. Maybe you wouldn’t use such clinical terms as “depression” or “anxiety,” but do you find yourself weeping at commercials? Being testy with your kids or partner for no reason? Losing your car in the parking lot? Waking frequently at 1-3 am, unable to fall back to sleep due to the mind racing with worries? Feeling tired or anti-social? Many women simply, often tearfully, describe just not feeling like themselves.
What research has found is that even though all women go through these times of hormone flux throughout their lives, some are simply more sensitive to the normal hormonal changes that accompany puberty, the menstrual cycle, pregnancy, postpartum and perimenopausal transitions. As such, hormone tests often do not help to shed light on the exact cause of the problem; estrogen and progesterone levels are often in range, but it is the change in these levels that cause the distressing symptoms in some. Using a menstrual cycle tracker like Clue or a good old-fashioned paper chart can help you determine if your symptoms are caused or worsened by hormone fluctuations.
That said, there are several possible underlying contributing factors that should be excluded, like frank psychiatric illness, sleep disorders, thyroid disease, and nutritional deficiencies. However, there has been research confirming that these naturally occurring changes in hormones during menopause are enough to contribute to psychological symptoms. Though we are in the infancy of understanding the connection between hormones and the brain, there is a relationship between hormone levels and neurotransmitters that play a role in mood disorders. We know that serotonin-reuptake inhibitors like Zoloft and Lexapro not only help with the physical symptoms like hot flashes, but also improve mood, sleep, and quality of life in some patients. Vyvanse and Wellbutrin have been shown to help with attention and concentration difficulties. The reverse holds as well: Progesterone has well known antianxiety and sleep-promoting properties and estrogen can be an effective antidepressant in many women. Decreased levels of both DHEA and testosterone have been noted in women suffering from depression and anxiety. As such, a common therapeutic option for younger women suffering from mental/emotional symptoms that appear to have a hormonal connection is the contraceptive pill which basically puts your natural hormone production and fluctuation to “sleep” which provides a continuous, steady daily dose of estrogen and progesterone. For women who are perimenopausal, we can blunt the natural hormone fluctuations that happen as ovarian production decreases by using lower, bioidentical doses of estrogen, progesterone.
Depending on the severity of presenting problems and woman’s preference, several treatment options are available, including diet, exercise and lifestyle changes, herbal and nutritional supplements, acupuncture, as well as the aforementioned hormones and medications. Research supports the role of alcohol and sugar avoidance in attention issues, depression, anxiety, and insomnia at all life stages. In fact, a study released this month suggests the Mediterranean diet is effective at decreasing symptoms associated with depression and anxiety both alone and in conjunction with other therapies. Acupuncture, exercise, and yoga have been shown to improve PMS, menstrual issues, mood, sleep, anxiety, and libido. Chinese herbal medicine, GABA, Black Cohosh, St. John’s Wort, Maca, Magnolia, magnesium, valerian, calcium, B vitamins, vitamin D, and soy isoflavones have been shown to help decrease anxiety, depression, insomnia in some women. Research shows that cognitive behavioral therapy and meditation are effective treatments for anxiety, depression, and insomnia from any cause and may have a role in a comprehensive treatment plan.
The take-home message is that psychological symptoms are common in all hormonal transitions and may be more severe than the physical symptoms in some women. There is no right answer in terms of treatment and, like many medical therapies, a few may need to be tried before finding the right one for each individual. As a physician who has been credentialed in perinatal mental health and continues to pursue continuing education in women’s mental health across the lifespan, I can help you find the right combination of treatments and referrals to help you get started on the road to wellness today. Contact me with any questions.
For more information for postpartum mental health support: Postpartum Support International: Arizona Chapter
For more information on general women’s mental health: MGH Center for Women’s Mental Health