Hormones and Mental Health
- Madeline Kraut, LMSW
- Sep 16
- 9 min read
Article #11
September 16, 2025
Access the podcast format of this article on my Spotify channel here.
"A woman's body is a sacred temple. A work of art, and a life-giving vessel."
Suzy Kassem
It’s long been known (and validated in the research) that we can’t have optimal mental wellness if our biology is suffering. Having a healthy, functioning body is a foundational element of mental well being. We see this in the visual of Maslow’s Hierarchy of Needs, which outlines that basic needs - like shelter, water, and food - must be met before we consider thriving at the next level of human development.
With this in mind - that a healthy body precedes mental wellness - we recognize that the more we know about how our bodies work and what they need, the more we are empowered to live a healthier and happier life.
For this reason, I have been interested for years in the role that hormones play in mental well being, both for men and women. In this article, we explore how hormones in a female body impact a woman’s mental health throughout the lifespan.
From the onset of puberty until perimenopause, through menopause and beyond, women are experiencing the daily effects of their hormones on their mental health. Knowing how hormonal events impact our biology empowers us to be informed about our bodies and mental health and proactive about our unique needs.
This article is aimed at providing a crash course on the hormonal changes a woman experiences throughout her lifespan and how she can use this knowledge to support her body, mental health, and relationships.
Let’s start with the stages of hormonal change across a woman’s life.
Stages of Hormonal Change Across the Lifespan
Menstruation
Averages 35+ years, from the onset of puberty to the start of perimenopause.
Breakdown of the Menstrual Cycle
Menstrual Phase: Days 1-5
The uterine lining sheds, which results in the bleeding of menstruation
Estrogen and progesterone levels are low
“Low levels of estradiol and progesterone during menstruation lead to a decrease in serotonin and allopregnanolone. This reduces GABAergic inhibition and causes problems with the regulation of the HPA axis, which increases vulnerability to anxiety disorders” (Wieczorek et al., 2023, pg. 437).
Follicular Phase: Days 6-14
An egg develops in one of the ovaries
Estrogen levels rise, preparing for possible pregnancy
Ovulatory Phase: Day 14
The egg is released, traveling through the fallopian tube
Estrogen levels peak
Luteal Phase: Days 15-28
Progesterone levels rise, preparing the body for possible pregnancy
If pregnancy does not occur, progesterone and estrogen levels drop significantly
Days 21-28 of the cycle (the last week of the luteal phase) are marked by plummeting levels of progesterone and estrogen, which result in the following:
Increase in challenges with cognition, nutrition intake, emotion regulation and more - “Estrogen receptors are widely distributed in the brain, having important regulatory function on different processes such as cognition, anxiety, body temperature, feeding and sexual behavior” (Zárate, 2017).
Estrogen has been documented as a protective factor which significantly improves one’s ability to cope with psychological stressors; higher levels estrogens have a “positive impact on mood” (Wieczorek et al., 2023, pg. 433). When estrogen levels decline, there is less biological bandwidth to cope with stressors.
Estrogen acts as a neuromodulator, affecting the production, function, and signaling of key neurotransmitters like serotonin, dopamine, and GABA, which are crucial for mood regulation (Garg & Munshi, 2025). When estrogen declines, serotonin and dopamine also decline. This leads to challenges with motivation and mood.
Some females experience the decline of estrogen so severely that they can go into estrogen withdrawal, which can trigger migraines, severe cramping, sleep disturbances and more.
For menstruating females, one quarter of their menstruating years are spent in this biological landscape. If the average female menstruates for 35 years, this means that by the time she begins perimenopause, nearly 9 years of her life has been spent struggling with the effects outlined above.
Pregnancy
Estrogen levels rise steadily throughout pregnancy, peaking at the end of pregnancy. The increase of estrogen is 50-fold compared to non-pregnant levels.
At the end of pregnancy, there is a significant drop in estrogen and progesterone, which is considered a key factor in the development of Post-Partum Depression.
In a study done on women with mood disorders, “the results of the estrogen studies show that women with postpartum psychosis had low levels of estrogen and experienced significant symptom improvement after receiving estrogen treatment” (Wieczorek et al., 2023, pg. 437).
Perimenopause
Begins on average at age 47
Averages 4 years
Estrogen and Progesterone begin to decline without the rebounding effects of the menstrual cycle
Mental illness symptoms can start to worsen during this time due to hormonal changes
Menopause
Averages 7 years
Mental illness symptoms can become exacerbated during this period due to significant hormonal changes
“The positive effects of estrogen on different cellular processes, such as reactive oxygen species (ROS) production and antioxidant defense, cardiovascular protection, immune competence and telomere maintenance have been well recognized to account, at least in part, for women’s longer lifespan” (Zárate et al., 2017, pg. 2).
Estrogen and Progesterone continue to decline, which is linked to the following challenges:
“Estrogens possess potent antioxidant properties and play important roles in maintaining normal reproductive and non-reproductive functions. They exert neuroprotective actions and their loss during aging and natural or surgical menopause is associated with mitochondrial dysfunction, neuroinflammation, synaptic decline, cognitive impairment and increased risk of age-related disorders” (Zárate et al., 2017, pg. 1).
The long-term decline of estrogen in menopause is a key reason for the increased risk of osteoporosis in women; estrogen helps maintain bone density (University Hospitals, n.d.).
“Loss of sex hormones has been suggested to promote an accelerated aging phenotype eventually leading to the development of brain hypometabolism, a feature often observed in menopausal women and prodromal Alzheimer’s disease” (Zárate et al., 2017, pg. 1). Incidence of Parkinson’s Disease and stroke are also demonstrated in the research to increase as sex hormones decline in menopause (Zárate et al., 2017).
Mental Health Diagnoses Most Commonly Affected by Hormonal Challenges
Premenstrual Dysphoric Disorder (PMDD)
Symptoms peak the week before menstruation and can include:
Suicidal ideation
Feelings of worthlessness
Increased interpersonal conflict
Inner feelings of chaos
Physical symptoms, such as breast tenderness and sleep disturbances
50% of females diagnosed with ADHD will also meet criteria for PMDD
One of the defining traits of ADHD is chronically low levels of dopamine, compared to neurotypical baseline measures. Estrogen promotes the production and release of dopamine in the brain, which means that as estrogen levels decline, dopamine declines. This can make the luteal phase a time of significant challenge for female ADHD clients.
Anxiety Disorders
“In women with Panic Disorder, there are reports of an increase in the incidence and severity of panic episodes during the luteal phase, which occurs 5–8 days before menstruation” (Wieczorek et al., 2023, pg. 436).
“There is a well-established link in the literature that shows women with anxiety disorders are more vulnerable to the influence of gonadal hormones” (Wieczorek et al., 2023, pg. 436).
“The withdrawal of estrogen increases the likelihood of developing anxiety-related disorders. This phenomenon is often known as premenstrual exacerbation (PME) and can be observed in both depression and anxiety. During this time, women may experience a worsening of mental health symptoms” (Wieczorek et al., 2023, pg. 436).
Post Traumatic Stress Disorder (PTSD)
“It is yet another mental health condition that has a prevalence twice as high in women compared with men. Studies also demonstrate that women with low estrogen levels and with fear-potentiated startle responses were higher for women with PTSD, when compared with normal and high estrogen groups. This suggests that estrogen levels might have the potential to be used to determine women’s vulnerability to fear conditioning and possibly identify at-risk groups (Wieczorek et al., 2023, pg. 437).
It is also well documented in the literature that many other mental health disorders - mood disorders, depressive disorders, Schizophrenia and more - worsen in women as they experience decreasing estrogen levels.
Management & Intervention
Increased knowledge on one’s biological bandwidth can help people plan and respond to situations in a way that supports their goals.
This is an inexpensive supplement females can take that can help decrease the severity of physical and psychological PMDD symptoms (Verkaik et al., 2017). It is an herb that has been used for hormonal support for females for hundreds of years.
Always consult your doctor before changing any of your medications or supplements; Vitex Fruit has been contraindicated when used in conjunction with hormonal contraceptives. This article is not a substitution for medical advice or intervention.
Saffron (yes, the spice!) has long been validated in the research to promote higher serotonin levels. Serotonin decreases during the luteal phase, to the point it causes significant mood disruption.
When you are taking any supplement or prescribed medication to promote higher serotonin levels, monitor for symptoms of serotonin sickness. Always consult your doctor before changing any of your medications or supplements; Saffron has been contraindicated when used in conjunction with SSRI medications. This article is not a substitution for medical advice or intervention.
Nutrition
High levels of sugar consumption can cause blood sugar spikes and crashes that disrupt hormones and increase inflammation. Decreasing sugar intake can help with this. Consuming healthy fats can reduce inflammation, help to regulate hormones, and improve overall mood.
Exercise
Exercise naturally promotes higher levels of serotonin and endorphins, which help with pain relief and positive mood.
Sleep
Quality sleep has been linked with reduction in mood instability, improved daytime alertness, and regulation of hormones through mechanisms such as enhanced melatonin production and a better circadian rhythm.
Planning Ahead
For many of my clients who have PMDD, they have found that tracking their cycles allows them to plan ahead and make supportive choices. This might look like planning fewer stimulating activities during the luteal phase and bigger tasks or outings when energy is higher, such as during ovulation. Some people have the practice of self-boundaries not to engage in any challenging or conflict-resolution conversations due to having less biological bandwidth to practice distress tolerance when they are at the end of the luteal phase. Often times, these individuals find that pressing pause on these conversations for just a few days allows them to reengage when they are in a better headspace.
Pharmaceutical Intervention
Remember to advocate for yourself and speak with your primary care providers about options for managing hormonal challenges, such as pursuing Bioidentical Hormone Replacement Therapy for peri/menopausal women or coming off of Hormonal Contraception (HC) for menstruating women.
Many women are not informed of the side effects of HC, even though they have a direct impact on a female’s mental health.
“More than 80% of women in the United States report having used hormonal contraceptives (HCs) at some point during their reproductive-aged years” (Mengelkoch et al., 2023, pg. 747).
HCs have been linked with “chronic systemic inflammation” in the body, increased risk for the development of autoimmune disorders, neurodegenerative diseases, cardiovascular disease, and depression (Mengelkoch et al., 2023, pg. 748).
Research has demonstrated that women using HCs “exhibit a dysregulated inflammatory response to acute psychosocial stressors” and took a prolonged period of time to physiologically recover after exposure to a stressor, compared to naturally cycling females (Mengelkoch et al., 2023, pg. 748).
In a research study conducted by Mengelkooch et al. (2023), “women using HCs exhibited a more robust, rather than blunted, cortisol response to the laboratory-based stressor than naturally cycling women” (pg. 753).
“In HC users, similar patterns are associated with a more negative mood after stress, which could indicate that HC use is associated with a biological stress response that may hamper women’s ability to cope effectively with stressors” (Mengelkoch et al., 2023, pg. 754).
Medical Professionals / Researchers to Follow to Learn More
Dr. Hill has been a guest on numerous health-related podcasts, making her research findings digestible and applicable. She is also consistently publishing peer reviewed research on women’s hormones and the implications on women’s overall well being.
Dr. Sims has also been a guest on many podcasts, talking about her work and sharing her knowledge. She is an Olympian and offers programs for women to learn about how to best support their bodies. She works to fill gaps in literature on women-specific research, particularly as it relates to hormones.
Thanks for Reading!
In short, knowing how hormones impact mental health - and how we can support our bodies and brains well using this knowledge - empowers us to live better lives. Women’s health and the role of hormones on mental well being is a significantly neglected topic in the field of research, but the more we bring it into our discourse, the more we advocate for it to receive more attention in the research and medical fields.
After all - when women live better lives, it elevates society as a whole.
References
Garg, R., & Munshi, A. (2025). Menopause and mental health. Journal of Mid-Life Health, 16(2), 119–123. https://doi.org/10.4103/jmh.jmh_61_25
Mengelkoch, S., Gassen, J., Slavich, G. M., & Hill, S. E. (2023). Hormonal contraceptive use is associated with differences in women’s inflammatory and psychological reactivity to an acute social stressor. Brain, Behavior, and Immunity, 115, 747–757. https://doi.org/10.1016/j.bbi.2023.10.033
Schmalbach, I., Albani, C., Petrowski, K., & Brähler, E. (2022). Client-therapist Dyads and therapy outcome: Does sex matching matters? A cross-sectional study. BMC Psychology, 10(1). https://doi.org/10.1186/s40359-022-00761-4
University Hospitals. (n.d.). Low estrogen levels in Menopause. Estrogen’s Effects on the Female Body | University Hospitals. https://www.uhhospitals.org/health-information/health-and-wellness-library/article/adult-diseases-and-conditions-v0/estrogens-effects-on-the-female-body
Verkaik, S., Kamperman, A. M., van Westrhenen, R., & Schulte, P. F. J. (2017). The treatment of premenstrual syndrome with preparations of Vitex Agnus Castus: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 217(2), 150–166. https://doi.org/10.1016/j.ajog.2017.02.028
Wieczorek, K., Targonskaya, A., & Maslowski, K. (2023). Reproductive hormones and female mental wellbeing. Women, 3(3), 432–444. https://doi.org/10.3390/women3030033
Zárate, S., Stevnsner, T., & Gredilla, R. (2017). Role of estrogen and other sex hormones in brain aging. neuroprotection and DNA repair. Frontiers in Aging Neuroscience, 9. https://doi.org/10.3389/fnagi.2017.00430
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