This blog post explains how the menstrual cycle and other hormone changes affect mood.Do some women need hormonal support or antidepressants? What are the roles of natural medicine, counselling, nutrition or exercise? Click below to find out more.
I see many women who are concerned about their energy and mood. They sometimes wonder if hormone changes or fluctuations are causing anxiety, depression, irritability, lack of motivation or poor quality of sleep.
The assessment and management of women’s mental health has a significant number of differences to mental health issues in men. For example, hormone levels are cyclical in women of reproductive age and then drop dramatically and erratically with perimenopause and menopause. Premenstrual Syndrome (PMS), Post-natal depression and menopause are associated with energy and mood changes that are unique to women.
Women are also subject to different economic, social, political and cultural influences that affect their emotional wellbeing. Dependence on a partner to support them during child bearing years can potentially be stressful.
Women have a greater frequency of psychiatric disorders than men, for a variety of disorders including mood, eating and anxiety disorders. An Australian Survey of Mental Health and Wellbeing in 1999 showed that depression was present in 6.8% in women compared to 3.4% in men in that 12 month period. The frequency of anxiety disorders was similarly increased for women, while eating disorders were found to be ten times more common among women than men.
There is increasing evidence suggesting that the reproductive hormones (such as oestrogen and progesterone) alter neurotransmitters that are implicated in the formation of a number of mental illnesses. Hence the different phases of a woman’s life cycle as well as menstrual cycle changes with the attendant reproductive hormone shifts affect mental health.
The first two weeks of a woman’s menstrual cycle are generally a time of stable mood. These stable low levels of hormones are produced largely by the adrenal glands. Ovulation occurs half way through this cycle, i.e. on day 14 in a regular cycle, and the levels of oestrogen and progesterone increase dramatically. Mood changes, fatigue, bloating, breast tenderness, acne, irritability, fluid retention and craving sweets signal an imbalance of hormones with oestrogen levels generally being relatively high compared to progesterone. A diet high in processed foods and sweets, as well as nutritional deficiencies such as a lack of iron can worsen these changes.
Pregnancy is a time of dramatic hormone increases as well as potential significant changes in career, personal and relationship focus.
Morning sickness is thought to be caused by a combination of factors. High levels of hormones including oestrogen, altered metabolism of carbohydrates, blood pressure (usually low) changes and other physical and chemical changes may be relevant.
The months following childbirth are a time of heightened vulnerability to depressive mood changes. There is an abrupt and dramatic change in hormone levels after delivery. Progesterone, oestrogen, prolactin, cortisol, oxytocin, thyroid, and vasopressin may all be involved. These changes are thought to contribute to depressive mood changes in some women following childbirth.
Perimenopause is a time of significant hormone fluctuations that can last two to five years leading up to menopause. Mood changes may be severe and the risk of suicide is increased. Other symptoms may include low self-esteem, lack of libido, irritability, weight gain, poor sleep (worsened by hot flushes), brain fog, forgetfulness and difficulty recalling words or numbers. It is thought that fluctuating oestrogen levels, as distinct from low stable levels, are the likely cause of this increased frequency of depression.
Menopause can be a traumatic time for some women. In particular, the decreases in circulating reproductive hormones as well as pituitary hormone changes are thought to cause or exacerbate the onset of depression and / or anxiety in some women. Physical symptoms of menopause such as hot flushes, night sweats, vaginal dryness, poor memory and weight gain may also worsen mood changes.
One reason for writing this article is to highlight addressing and treating underlying hormonal changes in addition to focusing on treating mood changes.
Do women need hormonal support or antidepressants? Will some women need both? What are the roles of natural medicine, counselling, nutrition or exercise?
Ideally, a woman will respond to a natural holistic treatment protocol where as many relevant factors as possible are addressed. Nutritional assessment and advice, an exercise program, stress management and nutritional herbs and supplements can often help balance hormone and mood changes.
Conventional pharmaceutical medication, psychological counselling and consideration of the woman’s specific cultural and social factors may be needed.
Antidepressants, like other medications, are distributed differently in women compared to in men due to differences in absorption and metabolism. The oral contraceptive (OC) pill, particularly the progesterone alone OC, can cause depression in some women and is the most commonly stated reason for women to cease taking the OC. Some of the newer combined oral contraceptives appear to be better tolerated.
Adding oestrogen is a consideration where menopausal symptoms such as hot flushes, night sweats, mood changes and lack of sleep are severe. Progesterone needs to be added in low doses unless the woman has had a hysterectomy.Even then, some progesterone may be helpful for its' calming and sleep enhancing benefits. Potential risks of hormone treatments need to be monitored regularly and weighed against the benefits. Changing the antidepressant may also be helpful.
There is no “one size fits all” approach to treating hormone and mood changes. Ultimately it is a matter of treating each woman as an individual and allowing her to make choices that are effective and make sense to her.
Dr Peter Holsman is a qualified Medical Practitioner, Naturopath and Professional Speaker based in Melbourne. An expert in his field with over 30 years of experience, he specialises in treating people with fatigue related illnesses including digestive problems, anxiety, stress, depression, chronic fatigue syndrome, menopause, thyroid and adrenal hormone concerns.
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