Sex hormone imbalances

Low estrogen can manifest in the following mental health symptoms:

• Depression Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 38, p. 50. Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 4. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, pp. 47-9, p. 51, p. 91, p. 93. Cass, H. and Barnes, K. (2008). 8 Weeks to Vibrant Health. Brevard, NC: Take Charge Books, p. 50.
  • Dr. Sara Gottfried calls estrogen “nature’s Prozac” Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 151. because it regulates the availability of serotonin our feel-good neurotransmitter Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 95.
  • It has been proven that estrogen can help with depression and has a role in mood disorders in women over forty Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 27.
• Loss of pleasure and motivation
  • Estrogen also plays a role in regulating dopamine, the neurotransmitter for pleasure and motivation Ivanova, T. and Beyer, C. (2003). Estrogen regulates tyrosine hydroxylase expression in the neonate mouse midbrain. [online] Journal of Neurobiology, 54 (4), pp. 638-47. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12555275 [accessed 10 Oct. 2017].
• Poor sleep Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 51.Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 50.
• Poor cognitive function, brain fog and poor memory Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 50. Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 47, p. 170. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 8, p. 93, p. 115.
  • In part due to its vasodilating effect on the brain, estrogen can improve cognition and memory Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 50. Raz, L. (2014). Estrogen and cerebrovascular regulation in menopause. [online] Molecular and cellular endocrinology, 389 (1-2), pp. 22-30. Available at: http://www.sciencedirect.com/science/article/pii/S0303720714000197 [accessed 10 Oct. 2017].
  • Estrogen is linked to brain-derived neurotrophic factor (BDNF), a protein which promotes brain plasticity by increasing nerve cells and maintaining neurons, especially in the parts of the brain which deal with higher thinking, learning, and long term memory Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 63.
  • BDNF is increased by estrogen and exercise, and reduced by cortisol Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 63.
  • BDNF and estrogen also work in tandem to support serotonin, dopamine and glutamine neurotransmitters
  • Estrogen has a neuro-protective effect, and issues with the interactions between estrogen and BDNF are linked to schizophrenia and mood disorders Wu, Y. C., Hill, R. A., Gogos, A. and van den Buuse, M. (2013). Sex differences and the role of estrogen in animal models of schizophrenia: interaction with BDNF. [online] Neuroscience, 239, pp. 67-83. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23085218 [accessed 10 Oct. 2017].
• Anxiety and panic Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 115.
• Low libido Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 151, p. 180.
• Unpredictable moods Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 180.

• Night sweats
• Hot flushes
• Weakening of muscles including leaky bladder or incontinence – estrogen controls the strength of your urinary tract
• Vaginal dryness
• Thinning and dry skin
• Shrinking or sagging breasts

The effects of high estrogen on mental health can mimic those of low estrogen, making diagnosis from symptoms confusing. Using a combination of symptoms and lab results (blood, urine) can help with an accurate diagnosis.

• Depression
• Mood swings
• Anxiety Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 93. Gottfried, S. (2013). The Hormone Cure. New York: Scribner, pp. 152-3.
• Brain fog
• Insomnia
• Irritability Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 93. Gottfried, S. (2013). The Hormone Cure. New York: Scribner, pp. 152-3.
• Memory lapses
• Inability to concentrate Gottfried, S. (2013). The Hormone Cure. New York: Scribner, pp. 152-3.

• Puffiness
• Craving for carbohydrates
• Heavy Bleeding
• Fibrocystic Breasts
• Weight gain around the hips and difficulty losing weight
• Vaginal/Oral yeast (Thrush)
• Tender breasts
• Hair loss
• Fatigue
• Low libido
• Headaches/Migraines Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 95.

For optimal well-being, estrogen and progesterone levels should be balanced, as progesterone tempers estrogen’s effects. However if estrogens are relatively high compared to progesterone, especially during the second half of the cycle when progesterone should be higher than estrogen, this is called estrogen dominance.

Estrogen which is unopposed by progesterone, possibly due to anovulatory cycles, can create mental health symptoms. Northrup, C. (2017). What Are the Symptoms of Estrogen Dominance? [online] Christine Northrup MD. Available at: http://www.drnorthrup.com/estrogen-dominance/ [accessed 11 Oct. 2017].

Mental health effects of estrogen dominance

These are similar to the symptoms of low progesterone, as they are linked with low progesterone.

• Anxiety
• Insomnia
• Irritability
• Mood swings
• Brain fog
• Memory loss
• PMS

Physical effects of estrogen dominance

• Possible endometriosis and painful periods
• Difficulty getting pregnant, poor gestation
• Headaches around your period
• Oedema around your feet and ankles
• Restless legs
• Bloating
• Fatigue
• Low libido

The following factors can contribute to low estrogen levels.

Time of month

Prior to menstruation, estrogen levels are naturally low, which can contribute to PMS.

Time of life

• After giving birth, and during breastfeeding, estrogen levels lower
• Perimenopause and menopause – Estrogen levels can plummet in women around 43/47 Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 50.

Nutritional imbalances

• Certain foods and nutritional deficiencies can decrease estrogen levels (link)
• Eating disorders such as anorexia and bulimia
• Gluten intolerance

Lack of appropriate exercise

Extreme exercise can lead to the over-production of testosterone. Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 187.

Stress

Chronically high cortisol can reduce estrogen levels.

Ageing

• As you age and approach menopause, your estrogen levels fluctuate more than usual
• As your ovarian reserves diminish with age, your hypothalamus and pituitary encourage the release of more estrogen in order to procreate before it’s too late Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 157.

Stress

Anything that lowers progesterone, such as stress and high cortisol levels can also cause symptoms of estrogen dominance.

Toxicity

• A heavy toxic load due to environmental pollution can tax the liver, and hamper its ability to detoxify estrogen
• Chemical pollution and toxins, especially from “endocrine disruptors” such as xenoestrogens
  • Xenoestrogens are synthetic chemicals that mimic estrogen Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 159.
  • Found in plastics, flame retardants, cosmetics, lining of tin cans, mercury, etc.
  • Stored in fatty tissues
• Pesticides/herbicides such as Glyphosates which is an endocrine disruptor and may exhibit estrogenic properties

Poor metabolism and detoxification of estrogen

• In order to maintain healthy estrogen levels, you need to inactivate excess estrogen in the liver
• A healthy liver normally breaks down estrogens, and the inactivated estrogens are then cleared by the kidney in the urine
• Poor liver function can therefore cause elevated blood estrogens
• Furthermore, for the liver to inactivate estrogens, sufficient levels of B-vitamins are needed Talbott, N. B. (1939). The Inactivation of endogenous estrogen by the liver. [online] Endocrinology, 25 (4), pp. 601-4. Available at: https://academic.oup.com/endo/article-abstract/25/4/601/2772710/THE-INACTIVATION-OF-ENDOGENOUS-ESTROGEN-BY-THE?redirectedFrom=PDF [accessed 11 Oct. 2017]. Cantarow,A., Paschkis, K. E., Rakoff, A. E. and Hansen, L. P. (1943). Studies on inactivation of estradiol by the liver. [online] Endocrinology, 33 (5), pp. 309-16. Available at: https://academic.oup.com/endo/article-abstract/33/5/309/2773790/STUDIES-ON-INACTIVATION-OF-ESTRADIOL-BY-THE-LIVER1?redirectedFrom=PDF [accessed 11 Oct. 2017].

Hormone Replacement Therapy (HRT)

If estrogen is given during HRT there can be a resulting increase in cortisol, which then blocks progesterone with the net effect of increasing anxiety.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 158. Holtorf, K. (2009). The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? [online] Postgraduate Medicine, 121 (1), pp. 73-85. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19179815 [accessed 11 Oct. 2017].

Being overweight

• Fat cells produce estrogen, so people who are overweight tend to produce more estrogen
• Estrogen is 50-100 times greater in overweight menopausal women than in lean women
• Excess weight and lack of exercise can lead to chronically high insulin levels, which increases estrogen levels

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 163.

Nutrition

• High consumption of alcohol and red meat can increase estrogen
• Low consumption of fibre can increase estrogen as fibre is necessary for the detoxification of estrogens

Gut issues

Gut dysbiosis (an imbalance between good and bad gut bacteria), often caused by a diet high in sugar and low in fibre can increase estrogen levels and hamper the body’s ability to detoxify excess estrogen.Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 96.

When progesterone levels drop and become relatively low, this can lead to the following mental health symptoms:

• Anxiety
• Mood swings
• Sleep issues
• Irritability
• Depression
• Lack of resilience to stress
• PMS

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 6, p. 43, p. 122. Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 55. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 81, p. 102.

• Fluid retention
• Breast tenderness
• Inability to lose weight
• Headaches
• Heavy menstrual bleeding

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 122, p. 126. Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 100.

The following factors can contribute to low progesterone and its symptoms.

Time of month

Progesterone is naturally lower the week before your period and during your period.

Time of life

• After giving birth, progesterone levels drop
• High prolactin (the breastfeeding hormone), lowers progesterone Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 130. (and estrogen), which may contribute to post-partum depression and anxiety, though the link is not clear
  • Some studies show an increased risk of post-partum depression with breastfeeding, while others show a decreased risk or no association Borra, C., Iacovou, M. and Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. [online] Maternal and Child Health Journal, 19 (4), pp. 897-907. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353856/ [accessed 9 Oct. 2017].
• Progesterone generally starts to drop dramatically from thirty-five onwards, and especially in the 40s Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 100.
  • During peri-menopause and menopause (35-55), women do not ovulate as regularly, and can have anovulatory cycles
  • Since it is during ovulation that the ripe egg releases progesterone, if no egg is released, progesterone will be low Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 127.

Stress and adrenal dysregulation

• High cortisol, which is produced by the adrenal glands, blocks progesterone, and chronic stress (when cortisol levels are high) can thus lead to chronically low progesterone Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 129. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 102.
• When under stress, our body may struggle to make sufficient stress hormone cortisol in the adrenals
• Therefore, it will make it from the “mother hormone” pregnenolone, which will make less progesterone in order to make more cortisol
  • This is known as the “pregnenolone steal” Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 129.
  • However the pregnenolone steal theory has been more recently somewhat debunked http://blog.zrtlab.com/reassessing-pregnenolone-steal
• When cortisol levels rise due to stress, this will also block progesterone receptors, as cortisol will be using the progesterone receptor, therefore progesterone cannot get into the cell nucleus
• According to Dr Sara Gottfried high cortisol and low progesterone (and/or low estrogen) is a common hormone imbalance in women under the age of 35

Progesterone resistance

For reasons we don’t totally understand, certain women have more progesterone resistance than others. This is when after ovulation, progesterone affects the GABA receptor so that it can no longer respond to progesterone, creating “progesterone resistance”.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 125. 

Luteal phase defect

When women’s ovaries aren’t producing enough progesterone during the luteal (second) phase of the menstrual cycle, which can be due to high stress levels and high cortisol and adrenaline, which can detract from progesterone production.

Hypothyroid

• Low thyroid hormone (hypothyroid) can lower progesterone,Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 103. as low thyroid impacts pregnenolone production, and pregnenolone is the precursor to progesterone Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 283.
• Hypothyroidism can decrease progesterone receptor sensitivity, causing progesterone resistance Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 284.
• However low progesterone can also lower thyroid function, triggering a vicious circle Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 130.

Too much exercise

• Intense and sustained exercise can lower progesterone and cause luteal phase defect (when the ovaries don’t produce enough progesterone in the luteal/second phase of the cycle)
• As many as 48% of women considered to be recreational athletes (women who exercise at least one hour four times per week) have been shown to have low progesterone Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 126.

Antidepressants

Anti-depressants can lower progesterone. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 102.

Nutritional deficiencies

• Lack of vitamin A, B6, C and zinc, which are required for the production of progesterone, can cause low progesterone
• A diet high in refined sugar can cause low progesterone

Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 102.

Progesterone tends to affect mental health mainly when it is too low and rarely when it is too high as the body does not over-produce progesterone like it does estrogen.Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 99.

However the main symptom of high progesterone is fatigue Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 38. and depression.Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 101.

• Indecisiveness
• Low libido Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 149. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 80, p. 107.
• Poor body image Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 171. Cass, H. and Barnes, K. (2008). 8 Weeks to Vibrant Health. Brevard, NC: Take Charge Books, p. 143.
• Increased anxiety
• Low mood and depression, especially in men Talbott, S M. (2007). The Cortisol Connection. 2^nd ed. Alameda, CA: Hunter House, pp. 66-7, p. 69, p. 71. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 80, pp. 93-107.
• Fatigue Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 80.
• Insomnia
• Lack of confidence
• Cognitive impairment Talbott, S M. (2007). The Cortisol Connection. 2^nd ed. Alameda, CA: Hunter House, p. 69. Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 107.
• Memory issues, including Alzheimer’s Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 80.

• Weak muscles and flabbiness
• Hair loss (which can also be a symptom of high testosterone!)
• Lack of energy and stamina
• Loss of coordination and balance
• Decreased pubic and body hair Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 166. Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 164.

The effects of high testosterone on mental health are especially prevalent in women.

• Depression and low mood
  • High testosterone results in lower estrogen levels. Estrogen benefits mood
  • Especially notable during menopause Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 209.
  • Too much of testosterone’s pre-hormone, DHEA can also contribute to depression in women Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 210.
• Aggressiveness and irritability Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 38.
• Anxiety Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 209.
• Bossiness

• Oily skin
• Acne
• Loss of hair on head with growth on face

• Chronic stress
  • Even mild anxiety can increase DHEA, which in turn could lead to an excess production of testosterone, as DHEA is a building block for testosterone,Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 215. and chronically high stress levels are linked to both high cortisol and high androgen levels Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 132.
• Excess body fat Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 214.
• Toxicity
  • Women with PCOS have higher levels of BPA, a plastic found in plastic linings, bottles, flame retardants, etc. These women also exhibited a correlation between BPA levels and higher androgen levels and insulin resistance Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 228.
• Various diseases such as diabetes, adrenal disease and ovarian tumours
• Medications such as anabolic steroids used by bodybuilders and other athletes for performance enhancement

• Ageing
  • Testosterone levels diminish as we age
• Stress
  • While most testosterone is manufactured by the sex glands (testes for men, ovaries in women) a large amount is also manufactured by the adrenal glands
  • During periods of high stress the adrenals are busy making cortisol, and therefore do not make as much testosterone or DHEA Talbott, S M. (2007). The Cortisol Connection. 2^nd ed. Alameda, CA: Hunter House, p. 68, p. 211.
  • Adrenal or pituitary gland dysfunction
• HRT
  • Estrogen therapy
• Various diseases such as such as renal disease and COPD

DHEA (Dihydroepiandrosterone) also part of androgen family, converts into testosterone, but also into estrogen and progesterone.Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 212. Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 93-107.

It is produced mainly in the adrenal glands, but also a small amount is produced in the testicles

It produces in men and women a feeling of vitality, drive and motivation.Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 212.

• Depression Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 210.
  • DHEA levels tend to be lower in people suffering from severe depression than in others Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 93-107.
• Memory and cognition issues, including Alzheimer’s
  • DHEA protects brain cells from beta-amyloid protein found in Alzheimer’s Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 132.
  • A combination of low DHEA and high cortisol has been found to have a negative impact on memory and cognition Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 132.
• Since low DHEA can lead to low estrogen and low testosterone, the same mental health effects as low estrogen and low testosterone can be listed (link)

• Chronic stress, which causes excessive cortisol levels and impairs DHEA production
• Ageing
  • Production peaks in our 20s and steadily declines until it reaches very low levels in our 60s

A blood test or a saliva test can show levels of DHEA.Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 93-107.

When levels of pregnenolone are low, other hormones will be low, because pregnenolone is necessary to produce other hormones. Symptoms of low progesterone and low estrogen are similar to symptoms of low pregnenolone.

• Poor memory
• Poor concentration and attention
• Anxiety
• Depression
• Brain fog
• Social phobia

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 47, p. 90.

• Ageing
• Stress
• Low cholesterol

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 98.

High prolactin levels lead to low progesterone levels. This can result in similar mental health effects of low progesterone such as:

• Anxiety
• Mood swings
• Insomnia
• Irritability
• Depression
• Lack of resilience to stress
• PMS

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 130.

• Pregnancy and birth
• Breastfeeding
• Stress

Often caused by low progesterone leading up to a woman’s period (due to anovulatory cycles, or simply lower progesterone relative to estrogen during the second half of the cycle),Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 127. PMS can cause such bad mental health symptoms that it is sometimes treated with SSRI antidepressants mid-cycle, as SSRIs can increase the formation of the progesterone derivative allopregnanolone.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 12, p. 45.

When PMS is so severe that it is considered disabling, it has its own psychiatric name: premenstrual dysphoric disorder (PMDD).Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 133.

Dr. Julie Holland attributes PMS to progesterone being too high relative to estrogen as it peaks day 21, and adversely affects mood. Lower estrogen levels cause serotonin levels to drop a few days before menstruation, which can contribute to PMS symptoms.Holland, J. (2015) Moody Bitches. New York: Penguin.

60-80% of women experience some kind of PMS.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 146.

PMS is a great indicator of progesterone levels being out of balance. It is a problem between progesterone, GABA and serotonin interaction.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p.125.

According to Dr. Amen “PMS is more than just a hormonal issue. It’s actually a brain disorder”, based on seeing the brain scans of a small group of women with PMS which demonstrate an increased activity in brain regions that are in charge of emotional expression emotions.Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 102. Protopopescu, X., Pan, H., Altemus, M., Tuescher, O., Polanecsky, M., McEwen, B., Silbersweig, D. and Stern E. (2005). Orbitofrontal cortex activity related to emotional processing changes across the menstrual cycle. [online] Proceedings of the National Academy of Sciences of the United States of America, 102 (44), pp. 16060–5. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16247013 [accessed 11 Oct. 2017].

Mental health symptoms of PMS

As PMS can be caused by low progesterone, it is not surprising that the symptoms of low progesterone and PMS are similar:

• Depression
• Anxiety and panic
• Insomnia
• Irritability
• Anger
• Confusion

Physical symptoms of PMS

• Bloating
• Fluid retention and oedema
• Food cravings, especially salty or sweet foods (in order to replenish the minerals that are depleted due to changes in estrogen and progesterone levels)

Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 137.

Causes of PMS

While some mild symptoms of PMS can be normal due to normal fluctuations of hormone levels, more extreme symptoms of PMS can be caused or exacerbated by:

• Oral contraceptives
• Pregnancy
• Miscarriage
• Abortion
• Tubal ligations
• Ageing
• Low magnesium
• Low blood sugar
• Caffeine
• Alcohol
• Nutritional deficiencies

Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 105.

There is a correlation between PCOS and high androgens. Indeed 50-82% of women with polycystic ovarian syndrome (PCOS) have high androgens.

PCOS is linked to an overactive HPA axis, which has been correlated to mood problems.

Mental health symptoms of PCOS

• Increased rate of body dissatisfaction
• Depression and low mood
• Anxiety
• Anger
• Diminished sexual satisfaction

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 219.

Physical symptoms of PCOS

• Obesity or high BMI
  • However this is not always the case, and many lean women also have PCOS
• Excessive hair growth on face, chest or back (hirsutism)
• Irregular periods
• Infertility
• Thinning of hair on head
• Acne

Pregnancy and postpartum are times of tremendous hormonal upheaval, and some women are more sensitive to it than others, usually for a combination of biochemical, life circumstance and psycho-behavioural reasons.

The baby blues, or feeling low a few days or weeks is a normal reaction to the drop in hormones (especially the sex hormones estrogen and progesterone) which occurs after giving birth, the psychological adjustment to motherhood, fatigue, etc. (2016). The Baby Blues. [online] Baby Center. Available at: http://www.babycenter.com/0_the-baby-blues_11704.bc [accessed 11 Oct. 2017]. Mitra, M., Iezzoni, L. I., Zhang, J., Long-Bellil, L. M., Smeltzer, S. C. and Barton, B. A. (2015). Prevalence and risk factors for postpartum depression symptoms among women with disabilities. [online] Maternal and Child Health Journal, 19 (2), pp. 362-72. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24889114 [accessed 11 Oct. 2017].

However if low mood, and/or other symptoms persist and last for several months or years, this can be postpartum depression.

Postpartum depression

In some women, post-partum hormones take longer to return to their optimal state, possibly due to other biochemical issues (such as nutritional imbalances) or psycho-behavioural issues (anxiety around motherhood) or difficult life circumstances. The resulting hormonal imbalances can cause postpartum depression, and sometimes this state can last for years and recur with subsequent pregnancies.

Post-partum depression affects 8-15% of women in Britain.Halliwell, E., Main, L. and Richardson, C. (2007). The Fundamental Facts. [online] London: Mental Health Foundation. Available at: https://www.mentalhealth.org.uk/sites/default/files/fundamental_facts_2007.pdf [accessed 20 Aug. 2017].

Many women are prescribed anti-depressants and tranquilizers, however a more sustainable approach, and one with less side effects would be to examine the causes of postpartum depression in the form of hormonal imbalances (sex, stress and thyroid), nutritional deficiencies, and psychological factors.

Mental health symptoms of postpartum depression

• Depression
• Insomnia
• Anxiety and panic

Some individuals experience all of the symptoms of postpartum depression while others only experience one or two. For example, it is possible to have postpartum depression and suffer from extreme anxiety without experiencing low mood.

Postpartum psychosis

This is an extreme form of postpartum depression. It can be very dangerous for the baby and the mother, and must be treated immediately by a qualified clinician.

Mental health symptoms of postpartum psychosis

• Desire to harm self or others
• Desire to harm the baby

Please seek professional help immediately if you have any of these symptoms. Remember that this can happen to any new mother, and is largely caused by hormonal issues over which you have little control.

Postpartum thyroiditis

7% of women develop postpartum thyroiditis after giving birth. Similar to Hashimoto’s, this is caused by an overactive immune system attacking the thyroid.

Postpartum thyroiditis often lasts several weeks to several months.(2013). Postpartum thyroiditis. [online] Mayo Clinic. Available at: http://www.mayoclinic.org/diseases-conditions/postpartum-thyroiditis/basics/definition/con-20035474 [accessed 11 Oct. 2017].

Many doctors never think to check a woman’s thyroid after she has given birth and too many new mothers suffer from an unrecognized thyroid condition.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, pp. 240-1. This is partly due to the fact that postpartum thyroiditis can be difficult to recognize because its symptoms are often mistakenly attributed to the stress of having a newborn and postpartum mood disorders.(2013). Postpartum thyroiditis. [online] Mayo Clinic. Available at: http://www.mayoclinic.org/diseases-conditions/postpartum-thyroiditis/basics/definition/con-20035474 [accessed 11 Oct. 2017].

Mental health symptoms of postpartum thyroiditis

• Mood swings
• Low libido
• Insomnia
• Anxiety
• Weight fluctuations
• Fatigue

Physical symptoms of postpartum thyroiditis

• Heart palpitations
• Tremors
• Aching joints
• Thinning hair

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 240.

Causes of postpartum mental health issues

Hormonal imbalances

• Sex hormones
  • During pregnancy, the blood is flooded with very high levels of estrogen and progesterone, but after the birth, the levels of these hormones, especially progesterone, come crashing down to menopausal levels
  • Breastfeeding keeps estrogen and progesterone at menopausal levels
  • Some women are more sensitive to hormonal fluctuations and low hormones than others
• Stress hormones
  • Pregnancy and post partum takes a toll on the adrenals both for bio-chemical, and psychological reasons, and can cause or exacerbate HPA axis dysregulation
  • High stress hormones can further lower sex and thyroid hormones, exacerbating hormonal imbalances and the resulting mental health symptoms (anxiety, panic, low mood, insomnia, cognitive issues, etc.)
• Thyroid hormones
  • Pregnancy and childbirth can lead to postpartum thyroiditis with symptoms of anxiety, depression, insomnia etc.

Nutritional imbalances

Pregnancy and post partum, including breast feeding can take a toll on our nutritional status, as it depletes our reserves of vitamins, minerals and essential fatty acids, especially omega 3s, B vitamins, alpha lipoic acid, coenzyme q10, calcium and magnesium.Raffelock, D. (2008). How Pregnancy Depletes Nutrients. [online] Well Postpartum. Available at: https://momswellness.wordpress.com/2008/12/30/how-pregnancy-depletes-nutrients/ [accessed 11 Oct. 2017].

Difficult life circumstances

• A lack of support from partner, friends or family can take its toll on the new mother, causing stress, unhappiness, and feelings of isolation
• Financial difficulties or concerns can cause stress
• Difficult living conditions can also take their toll on the new mother who is trying to cope with a new baby’s needs as well as her own

Psychological issues

Becoming a mother can bring up many psychological difficulties for some women

• The burden of being responsible for a newborn can create a lot of anxiety
• The loss of one’s identity as a women, and taking on the identity of a mother can raise some profound existential issues which can be painful

Balancing work, motherhood, relationships and self care can be very challenging

While not typically a “syndrome”, menopause and peri-menopause do have their own profile when it comes to mental health, and therefore we will consider them as hormonal syndromes.

Peri-menopause and menopause (ages 35 to 55) are times of hormonal upheaval for women. Both signal a natural stage in the ageing process. As women age, the ovaries produce less progesterone and less estrogen, leading to a gradual decline in sex hormones.

As women age, ovulation becomes less regular; instead of releasing one egg per cycle, the ovaries occasionally skip ovulation, which is called an anovulatory cycle. This leads to a drop in progesterone and estrogen levels. Furthermore as women age, the brain becomes less responsive to the progesterone and estrogen still produced by the ovaries, which may lead to lower production of key neurotransmitters such as serotonin.Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 59.

As a woman goes through perimenopause and menopause, production of sex hormones shifts from the ovaries to the adrenal glands. The health and balance of her HPA axis is essential to her adrenals being able to pick up the slack from her ovaries.

The thyroid usually slows down during perimenopause, which can lead to symptoms of hypothyroidism. Pearce, E. N. (2007). Thyroid dysfunction in perimenopausal and postmenopausal women. [online] Menopause International, 13 (1), pp. 8-13. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17448261 [accessed 11 Oct. 2017]. Jones, C. M. and Boelaert, K. (2015). The Endocrinology of Ageing: A Mini-Review. [online] Gerontology, 61 (4), pp. 291-300. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25471682 [accessed 11 Oct. 2017].

As Dr. Sara Gottfried puts it, peri-menopause is “a perfect neuroendocrine storm: all three hormonal systems – ovaries, thyroid, adrenals – working together to pull the rug out from under you.” Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 62.

Meanwhile our liver, the main organ for detoxification, can no longer break down harmful chemicals or estrogens as efficiently, exacerbating estrogen dominance for instance,Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 194. and our digestive systems slow down, which can cause dysbiosis, bloating and slow detoxification of hormones.Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 195-6, p. 199.

Mental health symptoms of perimenopause and menopause

• Exhaustion
• Insomnia
  • Perimenopause and menopause are often accompanied by low levels of cortisol by day (causing feelings of exhaustion) and high cortisol by night (causing insomnia) Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 48.
  • Cortisol tends to rise during perimenopause and menopause, which can lead to sleep issues and lower melatonin Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 274.
• Brain fog and attention issues
  • Rising levels of cortisol and lower levels of estrogen are accompanied by diminishing levels of BDNF (brain-derived neurotrophic factor), the brain chemical which encourages the growth of new nerve cells and neuroplasticity (the brain’s ability to reorganize itself by forming new neural connections), affecting cognition and memory Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 63.
• Depression
• Low motivation
• Lack of pleasure
• Anxiety and panic
• Feeling overwhelmed
• Irritability
• Low libido

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, pp. 56-8. Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 32, p. 155.

Andropause is the male version of menopause. Like menopause, it is characterised by a gradual decline in adrenal and gonadal androgen hormones such as testosterone and DHEA, and an increase in cortisol. Wang, C., Nieschlag, E., Swerdloff, R., Behre, H. M., Hellstrom, W. J., Gooren, L. J., Kaufman, J. M., Legros, J.-J., Lunenfeld, B., Morales, A., Morley, J. E.. Schulman, C., Thompson, I. M., Weidner, W. and Wu, F. C. (2008). Investigation, treatment and monitoring of late-onset hypogonadism in males. [online] European Journal of Endocrinology, 159, pp. 507-14. Available at: http://www.eje-online.org/content/159/5/507.long [accessed 11 Oct. 2017].

Mental health symptoms of andropause

• Depression
• Anxiety
• Insomnia
• Mood swings
• Irritability
• Exhaustion
• Poor memory

Jakiel, G., Makara-Studzińska, M., Ciebiera, M. and Słabuszewska-Jóźwiak, A. (2015). Andropause–state of the art 2015 and review of selected aspects. [online] Przeglad Menopauzalny, 14 (1) (2015), pp. 1-6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440190/ [accessed 11 Oct. 2017].