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Our series with Dr. Melanie Santos continues with a focus on how reproductive hormones affect women’s mental health.
Levels of estrogen and progesterone fluctuate throughout a woman’s menstrual cycle, which has a direct impact on your mood.
Other times in a woman’s life – including puberty, pregnancy, postpartum and menopause – also bring changing levels of estrogen and progesterone.
The hormones cortisol, adrenaline and epinephrine also impact our mood and mental health.
Our women’s health series focuses on conversations women may want to have with their primary care providers about their changing bodies. Last month, we covered how hormones impact bone health. This month, we’re diving into the broader role hormones play in almost every aspect of our health and wellness.
As part of our series, we spoke with Melanie Santos, M.D., FACOG, FPMRS, medical director of pelvic health for St. Jude Medical Center in Fullerton, California. While Santos is a urogynecologist who specializes in treating women with incontinence and other pelvic floor disorders, she is very well acquainted with many of the other health issues women encounter throughout their lives.
How do reproductive hormones regulate mental health for women?
Santos: Reproductive hormones like estrogen, testosterone and progesterone can have a big impact on your mental health. These hormones – among others – can ebb and flow throughout your cycle. For example, estrogen levels begin to fall during the second half of your cycle as you’re nearing your period. Because estrogen helps regulate your mood, dropping levels can cause irritability, depression and anxiety.
On the flip side, progesterone is a reproductive hormone that can sometimes help lift your mood. Typically, your body produces the most progesterone around ovulation, or during the second half of your cycle. Ideally, rising levels of progesterone would help combat dropping estrogen levels, but many women know that’s not always the case.
How does an imbalance/fluctuation in reproductive hormones happen?
Santos: There are many things that can cause changes or imbalances in your hormones. Hormone changes around your monthly cycle are to be expected. They don’t cause long lasting changes or imbalances. Sometimes, an underlying medical condition can also cause an imbalance in reproductive hormone levels, such as:
- Ovarian insufficiency (premature menopause)
- Polycystic ovary syndrome (PCOS)
- Thyroid disorders
- Unhealthy diet
- Excessive stress
- Pituitary tumors
- Certain cancers
- Autoimmune disorders
What do imbalances cause?
Santos: Imbalances in reproductive hormones can cause a wide range of symptoms, including:
- Hot flashes
- Mood fluctuations
- Weight gain
- Difficulty sleeping
- Hair loss
- Heavy periods
- Vaginal dryness
It’s important to talk to your gynecologist if you’ve noticed consistent, unusual symptoms.
When are there major fluctuations in our reproductive hormones?
Santos: Reproductive hormones can fluctuate throughout our lives. As I’ve mentioned, they change throughout your cycle. However, these changes can be more noticeable at certain times in a woman’s life:
- Puberty. During puberty, a teen’s body begins to release a special hormone called gonadotropin-releasing hormone (GnRH). These hormones then release luteinizing hormones (LH) and follicle-stimulating hormones (FSH). LH and FSH target the ovaries and trigger the production of estrogen. Hormones that have never been present before are suddenly coursing through the body.
- Pregnancy. Hormones, like everything else, are changing rapidly during pregnancy. In fact, your body will make more estrogen during pregnancy than you do your entire life when you’re not pregnant. Progesterone levels are also very high. Your body will also produce human chorionic gonadotropin, or hCG. (This is the hormone that pregnancy tests detect.) These hormones – along with others – help your body support a growing fetus.
- Postpartum. The time after childbirth is one of adjustment for a woman’s body – not only physically but also psychologically. Hormone levels can fluctuate wildly in the weeks and months after giving birth. Sometimes, these changes can lead to serious mental health issues, including postpartum depression, postpartum anxiety and, rarely, postpartum psychosis.
- Menopause. As we age, our ovaries begin to produce lower levels of estrogen and progesterone – and stop altogether with menopause. These falling hormones can trigger many different symptoms, including:
- Hot flashes
- Problem with short-term memory
- Low sex drive
- And many others
- Surgical removal of ovaries. Also referred to as surgical menopause, the surgical removal of ovaries can cause a rapid decline of sex hormones. The effects can be even more significant, with a 50% increase in postmenopausal symptoms compared to the natural decline on hormones as one approaches the postmenopausal status.
Is there anything women can do to prevent hormone-related symptoms?
Santos: It’s not possible to completely prevent fluctuating or changing levels in reproductive hormones. However, that doesn’t mean you have to live with uncomfortable, painful or embarrassing symptoms. There are many effective treatments and therapies to help address the symptoms that can come with falling hormone levels in menopause, including hormone replacement therapy, surgery and medication. Certain changes to your lifestyle can also help you manage symptoms of hormonal imbalances:
- Exercise regularly
- Eat a healthy diet
- Manage stress
- Get enough sleep
How is the thyroid related?
Santos: The thyroid is a small but very powerful gland. It’s responsible for making two hormones: thyroxine (T4) and triiodothyronine (T3). These hormones are secreted into your bloodstream and carried throughout your body to support many different bodily functions – from metabolism to developing ovarian, uterine and placental tissue. Low or high levels of thyroid hormones can cause several issues relating to your reproductive health, including:
- Irregular periods
- Heavy periods
- Light periods
- Amenorrhea (absent periods)
- Early or late puberty and menstruation
- And many others
What other hormones affect mental health?
Santos: Just as there are many physical and environmental factors that can affect your mental wellness, there are also several hormones that can affect your mood and mental health.
- Adrenaline helps our bodies respond to stressful or dangerous situations. Prolonged stress and anxiety can cause our bodies to release adrenaline when we’re not in danger. These high levels of the hormone can cause health issues, from lightheadedness to heart damage.
- Cortisol is a stress hormone that helps control blood sugar, metabolism and reduce inflammation. High levels can cause stress and depression.
- Norepinephrine has two functions: It’s a hormone and neurotransmitter (it sends signals across nerve endings in the body). Norepinephrine plays an important part in several essential body functions, including sleep cycles and heart rate. Research has found that problems with levels of norepinephrine can lead to depression, anxiety, post-traumatic stress disorder (PTSD) and substance abuse.
Find a doctor
Your gynecologist can answer any questions you may have about hormones and your mental health, and connect you with the care and resources you need to feel your best. If you need to find a gynecologist, you can use our provider directory. Through Providence Express Care Virtual, you can also access a full range of health care services.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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