The Link Between Hormones and Mental Health

Every day, millions of women seek mental health support. In 2022, data from the National Institute of Mental Health revealed that over 26% of women reported experiencing a mental health issue in the last year, compared to approximately 19% of men.⁽¹⁾

Women are generally more prone to anxiety and depression than men, though symptoms may present differently. A study published in the Journal of Affective Disorders found that, compared to men, women diagnosed with depression exhibited higher rates of less common symptoms, such as extreme fatigue or overeating.⁽²⁾ Differences in mental illness prevalence rates between men and women may be partially due to hormonal changes that occur throughout a woman’s life. Understanding the role of hormones in mental health can help women find resources, support, and treatment. 

Can hormonal imbalances cause mental illness?

In addition to genetics, environment, and societal factors, mental health is heavily influenced by hormones and neurotransmitters. Dopamine, serotonin, and norepinephrine are chemical messengers in the brain that act as both neurotransmitters and hormones and are believed to play a role in psychological well-being. When the levels of these chemicals become imbalanced, it can impact mental health. 

An imbalance of serotonin — sometimes called “the happy hormone” — is thought to be associated with depression, while low levels of dopamine, another “happy hormone,” may contribute to the development of attention-deficit/hyperactivity disorder (ADHD). Additionally, imbalances in dopamine, norepinephrine, and other neurotransmitters are believed to play a role in schizophrenia.⁽³⁾

In females, an imbalance of sex steroid hormones has been linked to changes in brain structure and function that may impact mental health. Neuroimaging studies have shown that fluctuating hormone levels during the menstrual cycle are associated with changes in the volume of the hippocampus, a brain region that plays a key role in emotion regulation, particularly in relation to anxiety and depression.⁽⁴⁾

Other Hormones That Affect Mental Health

Several other hormones, in addition to serotonin, dopamine, and norepinephrine, play a significant role in shaping mental health and emotional well-being.

• Cortisol: The release of cortisol, known as the “stress hormone,” is regulated by the hypothalamus-pituitary-adrenal (HPA) axis. Cortisol affects several systems, including the metabolic, immune, cardiovascular, and central nervous systems. Over time, imbalances in cortisol levels, either too much or too little, can cause irritability or depression, increasing vulnerability to psychiatric disorders. Elevated levels of cortisol are seen in about half of patients newly diagnosed with depression. Cortisol levels may also rise during the manic phase of bipolar disorder.⁽⁵⁾

• Thyroid Hormones: Thyroid dysfunction can also be a contributing factor to mental illness. Research suggests that hypothyroidism, in which the body produces insufficient amounts of thyroid hormones, may be linked to depression, sadness, and distress. In contrast, hyperthyroidism, which is characterized by an overproduction of thyroid hormones, is associated with psychosis, agitation, indifference, and mania. A specific thyroid hormone called triiodothyronine (T3) helps regulate levels of serotonin and norepinephrine in the brain. Lower levels of T3 may contribute to the development of depression and anxiety.⁽⁶⁾

• Dehydroepiandrosterone (DHEA): Research findings have been inconclusive, but some studies show that people diagnosed with psychosis have abnormal DHEA levels. DHEA is a steroid precursor to the body’s production of sex steroid hormones like estrogen and testosterone.⁽⁷⁾ Taking DHEA supplements during menopause may help relieve symptoms by increasing the body’s natural testosterone levels.

• Testosterone: Testosterone levels naturally decline with age. While lower testosterone levels are associated with declines in men’s mental health, changes in the hormone can also significantly affect women. Women with low levels of this sex steroid hormone may experience sleep problems, fatigue, mood changes, and an increased risk of depression.⁽⁸⁾ 

• Melatonin: Sleep is critical in mental health management. Some studies have found that people diagnosed with schizophrenia have lower levels of melatonin, a natural hormone that helps regulate the body’s sleep-wake cycle and protects mood-related brain regions from neuroinflammation.^(9)(10)

Mental Health Symptoms Associated with Hormonal Imbalances 

Hormonal imbalances can affect psychological well-being in different ways, particularly during the menopause transition. Common menopause-related mental health symptoms may include the following:

• Anxiety or excessive worry

• Feelings of sadness, hopelessness, or depression

• Lack of emotion

• Stress

• Irritability

• Difficulty sleeping

• Brain fog

• Fatigue

• Trouble concentrating

• Decreased energy

• Loss of enjoyment in activities

Female Hormones and Mental Health

Fluctuations in female hormones begin with puberty and continue throughout life. These natural changes can make women susceptible to different types of hormonal depression:⁽¹¹⁾

• Premenstrual Dysphoric Disorder: This condition is characterized by severe psychological symptoms that begin weeks before menstruation. Symptoms may include irritability, depression, anger, and, in some cases, thoughts of suicide.

• Perinatal Depression: This refers to feelings of heightened anxiety or sadness that develop during pregnancy or after childbirth.

• Perimenopausal Depression: Many women experience hot flashes, sleep disturbances, and mood changes during menopause. However, in cases of perimenopausal depression, symptoms can be more severe during this phase of the menopause transition. These may include anxiety, increased irritability, or a loss of interest in activities that once brought joy.

Estrogen, the primary female sex steroid hormone, is believed to play the most significant role in the development of mental health issues related to hormonal changes, as it influences neurotransmitters in the brain that are involved in emotion regulation, mood, reward processing, and cognition. However, the relationship between hormones and mental health is multifaceted, with changes in progesterone and androgen levels also believed to contribute. 

Psychological Changes During Menopause 

Women may be more prone to psychological disorders during menopause. Along with declines in progesterone and testosterone, decreasing estrogen levels — sometimes referred to as estrogen withdrawal — can increase the risk of anxiety and depression during this phase of life. Depressive episodes are typically seen during the later phases of the menopause transition and in the first year of postmenopause.⁽⁴⁾

Hormonal fluctuations during the menopause transition can also lead to increased stress, which in turn raises the risk of mental illness. Stress has been linked to a reduction in the size of the hippocampus, a brain region associated with psychological health. Perimenopause, in particular, has been linked to decreases in hippocampal volume. However, this brain region appears to return to normal size during postmenopause.⁽⁴⁾

Common Mental Health Problems Related to Hormonal Changes During Menopause

Even without a previous diagnosis or family history of mental illness, hormonal changes during menopause can increase the risk of various mental health problems:

Hormonal Depression

Research shows that the risk of major depressive disorder (MDD) is two to five times higher during perimenopause compared to late premenopause. Changes in endocrine activity during this stage of life may trigger new-onset depression or recurrent episodes of MDD. During women’s 40s and 50s, a time rife with hormone fluctuations, those with psychological characteristics such as neuroticism, pessimism, and rumination may be more vulnerable to MDD.⁽¹²⁾ 

Hormonal Anxiety

Increased anxiety is common during the menopause transition. Changes in levels of sex steroid hormones are considered a significant biological risk factor for anxiety disorders in women compared to men.⁽⁴⁾ These disorders may include generalized anxiety disorder, social anxiety disorder, and panic disorder.

Hormonal Psychosis

Decreasing levels of estrogen during the menopause transition may increase the risk of psychosis during midlife, a condition known as menopause-associated psychosis (MAP). This form of hormonal psychosis can lead to schizoaffective disorder or late-onset schizophrenia, which develops after the age of 40. While psychotic episodes typically first occur in early adulthood for men, women make up the majority of midlife-onset cases of schizophrenia.⁽¹³⁾

Menopausal Schizophrenia

Research suggests a potential two-way relationship between menopause and schizophrenia-spectrum disorders. Studies indicate that menopause can worsen existing schizophrenia symptoms, while schizophrenia may intensify symptoms of menopause. Estrogen appears to possess protective propert

ies against schizophrenia, so as hormone levels drop during the menopause transition, the risk of developing schizophrenia increases.⁽¹⁴⁾

Seeking Mental Health Help During Menopause 

Mood changes during the menopause transition are common, but if psychological symptoms are interfering with daily life, women should speak with a healthcare provider about mental health treatment options. Recommendations may include behavioral health counseling, lifestyle modifications, mindfulness practices, or prescription medications like antidepressants or anti-anxiety drugs to help address hormone imbalances. 

Bioidentical hormone replacement therapy (HRT) can help address mood changes associated with menopause. Using plant-derived hormones that resemble the chemical structure of the body’s natural hormones, bioidentical HRT can restore declining estrogen and progesterone levels. While supplementation may improve mood, it should not be considered a direct treatment method for mental health conditions. Patients are encouraged to follow their doctor’s specific treatment plan for issues related to mental health.