Understanding the Link Between Women's Mental Health and Hormones

In the past year, 1 in 5 women experienced a mental health condition in the United States. This includes anxiety, depression, body dysmorphic disorder, and borderline personality disorder. While there are many causative factors to mental health, hormones can be a primary contributor to the development and severity of these conditions for women. Hormone imbalances can lead to a broad spectrum of health-related issues. In this article, we're going to connect the dots between the causes of hormone imbalances and the implication that has on your mental health. 

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Women's Mental Health

Your mental health includes all aspects that make up your emotional, social, and psychological determinants of health. The status of someone's mental health impacts their ability to make sound decisions while also being able to cope with life stressors, engage in their work, participate in their community, learn, and how they perceive their capabilities. Sex and gender differences play a role in developing mental health conditions. Women are more likely than men to develop depression, anxiety, PTSD, eating disorders, and attempt suicide. Although not all cases of this are due to hormonal input, there are many instances where female hormonal fluctuations or imbalances are dictating mental well-being. 

Female Hormones

Fluctuations and imbalances in female hormones can influence how your brain processes the contexts of life. Estrogen, progesterone, LH, FHS, and testosterone are the key sex hormones involved in female health. When there are imbalances, such as estrogen dominance or progesterone deficiency, they can lead to dysfunction in the communication between hormones and neurotransmitters, impacting neurocognitive function. 

Hormonal Imbalance Symptoms in Females

Depending on the variation of hormone imbalance, one could experience a multitude of symptoms. Here are some common signs and symptoms correlated to sex hormone imbalances:

• Irregular menstrual cycles
• Heavy periods
• Absent periods
• Hot flashes
• Low libido 
• Infertility
• Vaginal dryness
• Depression 
• Anxiety
• Sleep disturbances
• Anger, irritability, or panic attacks 
• Fatigue 
• Suicidal thoughts 
• Unexplained weight loss or gain
• Acne on the face or body

What Causes Hormonal Imbalance? 

Hormones play a vital systemic role in our health. They influence reproductive functions, cognitive function, metabolism, mental and emotional well-being, and bodily processes such as urination, body temperature, and heart rate. When your hormones are not synthesizing, processing, or transmitting properly, this can impair all these areas, especially mental well-being. The primary areas of hormone imbalance are dysfunctional reproductive stages, life stressors, and autoimmune endocrine disorders. 

Reproductive Health Dysfunction

Female reproductive health issues cover a broad spectrum. The most pertinent contributors to mental health are puberty, pregnancy, and menopause, as all are stages in which your body goes through hormonal shifts. During puberty, your hormones are setting the stage in order for menstruation to occur. Some women suffer from PMS, which often includes emotional highs and lows, anxiety, or depression. In its most extreme form, women can experience Premenstrual Dysphoric Disorder (PMDD). A systemic review on PMDD and suicide revealed that women with this condition are significantly more likely to report previous suicide attempts than non-PMDD women. 

After pregnancy, around 10% of mothers will experience postpartum depression (PDD). The drastic drop in estrogen and progesterone are significant contributors to those who develop PDD. Depression in women during menopause is said to double. The hormone drop during menopause is a confounding factor that distresses the body, impacting neurotransmitters from properly doing their job.

Stress

Chronic stress can result in impacted communication between organ systems. The HPA axis's primary role is to help our body physiologically manage stress. When this system is on overdrive and releasing excessive cortisol, it can negatively impact sex hormone release. Stress is not only a major contributor to hormone imbalances but is also directly related to mental health distress, such as anxiety and depression.  

Autoimmune Endocrine Disorders

Immune system hijacking is what occurs in conditions of autoimmunity. Hashimoto's thyroiditis, Graves' disease, and Postpartum Thyroiditis are all conditions in which the immune system has been triggered to mount an immune response to the thyroid gland. These endocrine organs, which normally have input into sex hormone regulation, will no longer function optimally. Often in clinical practice, when we see autoimmune thyroid conditions, there is an imbalance in hormones at some point. One review on the topic explains how estrogen is an immune stimulant and inhibitor, which in excess, could be a cause for concern in autoimmune disorders. 

Functional Medicine Hormone Testing for Women

Functional medicine labs can help practitioners monitor women's hormones and better understand the root cause of why they are imbalanced. Below are the most commonly ordered helpful labs for women with mental health concerns. 

Complete Hormone Testing

The DUTCH Complete evaluates sex hormones and metabolites. In addition, this test will give a comprehensive look at cortisol, organic acids, and melatonin. Using this information in conjunction with the clinical picture is helpful in treatment recommendations and can be a tool used to monitor success outcomes. 

Gut Health Test

The integrity of your gut and microbiome can influence hormone production, stress, and immune function. The GI-MAP stool test by Diagnostic Solutions will look at the microbial balance in your gut flora. This can provide insight into whether or not gut inflammation or dysbiosis is negatively contributing to your health concerns. 

Neurotransmitter testing

Your brain has receptors for sex hormones. During hormonal imbalance, you can experience mental and emotional impairment as your brain tries to figure out how to respond without the necessary signals. Estrogen, in particular, is a hormone that influences serotonin, dopamine, and norepinephrine in the brain. Doctor's Data offers a Comprehensive Neurotransmitter Profile urine test that evaluates the secretion and metabolization of 21 biomarkers. 

Cortisol 

With stress being a major contributor to hormone imbalances, getting a Cortisol Awakening Response (CAR) test may benefit you. The CAR test entails collecting multiple salivary samples at specific time intervals in a 24-hour period. This test is useful because it provides a pattern of cortisol release throughout the day. With chronic stress, your cortisol could be dipping and peak at unwanted intervals, impacting your hormones. 

Autoimmune Markers

An Anti-Nuclear Antibody (ANA) Screen + 11 ANA Components is a useful test that will reveal if there is an autoimmune process occurring in your body. This test also includes several markers to test for condition-specific antibodies like Lupus, Multiple Sclerosis, and Rheumatoid Arthritis.

Comprehensive Thyroid Panel 

A properly functioning thyroid gland will produce thyroid hormone biomarkers at adequate levels. In order to gather some objective data, you'll want to get a comprehensive Thyroid Panel. This includes Anti-TPO and Anti-Tg, the two pertinent autoimmune thyroid markers. With this full panel and your clinical picture, your doctor should be able to create a unique treatment plan to support thyroid health and hormone balancing.  

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Conventional Treatment for Hormone Imbalances 

Conventional doctors typically rely on hormone replacement or certain medications to treat hormone imbalances. Below are the most commonly prescribed options:

Bioidentical Hormone Replacement Therapy (BHRT)

Conventional doctors may use Hormone Replacement Therapy (HRT) to treat hormone imbalances. Functional medicine practitioners typically opt to use BHRT for a more compatible therapeutic intervention. These hormone analogs are derived from plant extracts or animals. They closely mimic our sex hormones which can support treating hormone deficiencies in menopausal and postmenopausal women. A cohort study looked at the effectiveness of compounded BHRT for menopausal symptoms. In relation to mental health, women in the study had a decrease in emotional lability, irritability, and anxiety within 3 to 6 months of starting BHRT. 

Progesterone Receptor Modulators

Premenstrual dysphoric disorder (PMDD) is theorized to be driven by a progesterone deficiency during the luteal phase of a woman's cycle. This imbalance is what causes a heightened emotional response. An emerging area of science is looking at selective progesterone receptor modulators class drugs, like ulipristal acetate (UPA). The mechanism of action is that this drug binds to the progesterone receptor sites on the brain and inhibits them. A recent study using UPA in a randomized controlled trial saw significant improvements in daily severity of PMDD symptoms when 5mg/day of UPA was taken. The areas of improvement included depression, anger, irritability, and even remission of symptoms in 50% of women in the drug group. While this is a newly emerging drug, it shows promising results for those suffering from PMDD symptoms. 

Low Dose Naltrexone (LDN)

Doctors have been using LDN as an off-label alternative therapy for autoimmune diseases. The concept is that naltrexone interacts with opioid receptors on immune cells which has an agonist effect that modulates the immune system and decreases pain. A study on rheumatoid arthritis and LDN showed a decrease in the need for other harsh medications the participants were on, such as DMARDS, immunosuppressants, NSAIDs, and analgesics. Future studies should focus on the addition of LDN to support these conditions or as a replacement therapy for immunomodulation and pain. 

How to Balance Hormones Naturally with Functional Medicine 

A functional medicine approach to hormone balancing addresses the root cause. Below are some options for restoring hormone balance:

Hormone Balancing Diet

Eating right for hormone health is vital to balance your hormones successfully. Foods can truly be the building blocks to establishing an optimally functioning body. The body thrives off whole foods, including vegetables, fruits, healthy fats, complex carbohydrates, and quality-sourced protein. The Mediterranean Diet has stood the test of time in providing women with essential micro and macronutrients that supports hormone health and overall wellness. 

Botanical Medicine to Balance Hormones for Women 

Vitex is a go-to botanical for addressing hormone imbalances in women, especially in conditions of female reproductive health like PMS, PCOS, and Endometriosis. St. John's Wart is a commonly used botanical option for the treatment of depression. It works similarly to SSRI drugs. While there is more evidence on the use of St. John's Wart for PMS, one published case study on PMDD showed great improvement in using 900mg/day in place of an SSRI. This is something to consider and discuss with your healthcare providers, especially if you are negatively responding to SSRI drugs. Adaptogenic herbs like Ashwagandha, Rhodiola, Lemon Balm, and chamomile all have beneficial effects in reducing cortisol and the ability to cope with stress. 

Seed Cycling to Balance Hormones for Women

Using therapeutic foods is one way to naturally balance your hormones. Seed Cycling is the process of using specific functional foods (seeds) to regulate the follicular and luteal phases of your menstrual cycle. Benefits of the therapy include reduced PMS symptoms, a recalibration of your menses, improved blood sugar, and the inherent incorporation of nutrient-dense foods. 

Probiotics

There is evidence that probiotics can modulate gut dysbiosis, which ultimately supports hormone balancing and fertility. Lactobacillus species have specifically been shown to restore the vaginal flora, which can improve a women's reproductive health. 

Acupuncture

Scientific evidence backs up the use of acupuncture for the regulation of menstrual cycles and hormone balancing. Women with PCOS have seen clinically beneficial results with the use of acupuncture in decreasing LH and testosterone levels. This TCM therapy is also helpful in reducing symptoms of menopause and depression, which are experienced by many women dealing with hormone imbalances. 

Relaxation Practices

Since women's hormones are greatly impacted by stress, women should incorporate some sort of relaxation practice. Yoga and meditation are both beneficial for the mind and body. Some benefits of relaxation practice include a reduction in the stress hormone cortisol, improved mood, less anger and frustration, and improved digestion.   

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Summary

Hormones have a direct impact on your mental health. Understanding the signs and symptoms of hormonal imbalances can potentially help prevent the development of a mental health condition. Often, women experience symptoms that can overlap multiple disorders. If you feel that your reproductive health or hormones are impacting your ability to cope and navigate life, I highly encourage you to seek professional guidance. Addressing this from the onset of symptoms will allow for prompt testing and interventions, saving you time, energy, and additional anguish.