Journal / Mood, Anxiety, Depression

Mental Health & Hormonal Fluctuations

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Mental Health & Hormonal Fluctuations

You and Your Beautiful Mind – Help During Menopause

Every day millions of women seek help for their depression. Some have been looking for decades, but rarely does the medical profession put together how hormones and mental health are interrelated. We believe that hormonal depression, psychosis, and the interrelation between anxiety and hormones must be openly discussed and appreciated. 

I remember it well. I was driving through a familiar Seattle intersection with a median to separate traffic. Standing on that grassy median was an attractive middle-aged woman flailing her arms and screaming at cars. She was completely unhinged. Ranting and raving about what? I suddenly recognized her from my wedding so many years earlier. She was Dr. Robins’ ex-wife, a long-time friend of my husband’s family. I drove past, slightly ducking in fear that she would recognize me. I didn’t acknowledge that I knew her to my children in the backseat who were asking what that crazy lady was doing. 

When I saw my in-laws a few days later, I mentioned my sighting and they explained to me how Ms. Robins had been such a vital part of their parent community. Wicked smart, a fabulous dresser, and a doting mother. Then, suddenly in her 40’s, she simply lost her mind. She became homeless, was in and out of mental institutions and nobody could help. My physician father-in-law shook his head and explained how her mental instability had cost her everything. She lost her family, her friends, her livelihood, and literally her mind due to “psychosis not otherwise specified.”

That image of Ms. Robins in a full psychotic episode on the Seattle street corner is burned in my mind. What happened?  While I will never know Ms. Robins’ diagnosis, I would venture to guess menopause had a lot to do with it. 

Menopause and Psychological Changes

Anxiety and depression are common symptoms of peri- and menopause. Women seek help in many forms, excessive exercise, alcohol, strong medications, and even denial,  but rarely has anyone put together the pieces of the hormonal puzzle. We believe that hormonal causes and correlations must be incorporated into any meaningful conversation with medical professionals. While women may not be ranting and raving, like Ms. Robins, we deserve to feel happy and joyful. 

As women, we know firsthand how hormonal fluctuations, starting at puberty and then every month thereafter, correlate with mood changes and our mental health.  But rarely does the medical profession recognize this fact. In most cases, female hormones are disregarded, and women’s complaints are met with disbelief. Because people don’t often associate mental health with menopause, proper treatment is rarely offered.

Sadly, too many women share a common story of mental illness as they enter menopause.  While we try not to reinforce old stereotypes — be careful, a woman’s hormones will make them crazy — we need to own the reality that they are interconnected.

It’s Just a ‘Phase’

It is no coincidence that hormone-related psychological disorders often occur around menopause. It is especially true when women are starting to deal with the not imagined ageism of our male-centric society. We are aging and not often considered ‘sexy’, we aren’t able to reproduce any longer, and more than ever before we are treated with negligence. At this point in their lives, most women simply want to be valued, respected, and recognized. It is just not acceptable for a woman to be 46, feel like she’s losing her mind, and have a healthcare professional tell her she’s just going through a phase.

With the stigma around mental health issues, most would prefer to attribute anxiety, mood changes, mental fog, and depression to just a ‘phase’ rather than a true medical condition associated with menopause. Yes, women are going through a phase that is called peri- and menopause, and they should be properly treated.

During peri- and menopause, which can last over 20 years, mental health issues can creep up so slowly. A woman may not realize that she is not functioning properly, or maybe even barely functioning. When the rest of the world is staring at you wondering, “what is WRONG” you can be left wondering why they just don’t understand.

Maybe you are getting through your day, showering, buying groceries, and getting yourself to work every day, but are you living your life to its fullest with joy and focus?

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How to Properly Diagnose Menopausal Depression and Psychosis?

For many women, even if they have never had a serious mental illness before, and no family history of mental illness, they can become overwhelmed by the hormone changes of peri- and menopause. At times those imbalances can lead to very serious mental health disorders including depression, and even schizophrenia. Schizophrenia is a chronic illness that can lead women and their families to feel unhinged, like Ms. Robins. While there is no cure, there are therapies and drugs that can help to control the symptoms. 

Most people are introduced to the idea of schizophrenia in young men, and sometimes women, who are in their late teens and early 20’s. Typically it has been regarded as a disorder of the young—an ‘unraveling of the mind’ if you will.  Men are frequently diagnosed in their teen years but for women, the diagnosis comes years later, if ever. 

As recently as the 1990’s, the easiest way for the medical profession to classify schizophrenia was to use a method they’ve used for hundreds of years, AGE. If a person was over 40, they were not classified as schizophrenic, and in some cases, the cutoff age was as young as 24.1 However, in the early ’90s, a retrospective study evaluated 20 years of men and women’s medical histories to identify when they had their first psychotic episode. They found that many of the people that had their first-onset of schizophrenia after 45 were women.

With this discovery, you would think that women would start to be properly diagnosed with psychosis as they enter menopause. But it has been more than 20 years since the study was published, and very few healthcare providers discuss the reality of why women may be experiencing their first breakdowns later in life, or how best to treat them. Instead, women who become suddenly psychotic in middle age are typically given diagnoses like Ms. Robins of “psychosis not otherwise specified” and are often treated with powerful antipsychotics tested in clinical trials on men.1 There is a long history of women committed to mental asylums with symptoms that were labeled “insane from suppressed menses”.1 So, rather than identify the cause of the madness, the women were put away and never properly diagnosed.

The Estrogen Hypothesis

Luckily, a small group of female psychiatrists working in tandem from all over the world has identified the critical role that dramatic fluctuations in hormones with menopause have and that it may trigger schizophrenia. They call the correlation between the drop in hormones and the psychosis, “the estrogen hypothesis”.2

These researchers have pulled back the curtain to reveal the deeply embedded bias in the medical community of overlooking the middle-aged, menopausal woman who needs help. Even when presenting psychotic symptoms, because they are in their 40’s, physicians will often ignore a diagnosis of schizophrenia and simply associate it with “the change of life.” The medical profession is still discounting the seriousness of ‘the change of life’ and the severe drop in hormones. These depleted hormones are a serious affliction that must be taken seriously.

Today we read story after story about women who, like Ms. Robins, became ‘unhinged’ with menopause. This is a serious problem, and there is real collateral damage that comes from not recognizing the illness. Without recognition, a woman’s relationships will suffer at a time when she could be enjoying so many of the things she has been working so hard to achieve: friends, family, career, etc.

The importance of estrogen, and the ‘estrogen hypothesis,’ can be used to help explain a large number of mental health concerns related to changing hormones throughout a woman’s life. They include:

  1. Women whose mental health fluctuates with their monthly hormonal cycles.

  2. Women who suffer from postpartum depression (after the birth of a child) and can have a psychotic episode where they are catatonic or suicidal.

  3. Women who have diagnosed and controlled mental illnesses (bipolar disorder, major depression) experience a recurrence when they are perimenopausal or menopausal. 

  4. Women who feel suicidal when others have PMS.

  5. The extreme end of the spectrum – schizophrenic women, who have breakdowns similar to Ms. Robins as they enter menopause.

Summary:

As women, we know that ever since puberty we are constantly dealing with changing hormones and how hormones and mental health are interrelated. Estrogen and progesterone are hormones that cause depression when they are irregular or dropping too low. We also have to acknowledge how hormones can cause anxiety.  

When we enter menopause we are often ignored, but we can use this time as an opportunity to finally level out this rollercoaster of hormones.  We don’t believe that the medical establishment wants to ignore the fact that balanced hormones can save women’s lives by decreasing heart disease, some cancers, diabetes, and suicide, but it is hard to understand why women are not getting the treatment they deserve. That’s why we founded Winona.

Winona finds it outrageous that men can get treatments easily if they can’t get an erection, but women’s treatment for much more serious medical concerns is being pushed aside. Dr. Jeffrey Lieberman puts it more bluntly: “Medicine hasn’t paid much attention to these women. Middle-aged women are low priority, like children used to be.”.1Not at Winona. There is no reason to feel ashamed of the changes that are happening to your body and mind. At Winona, you are not alone.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References:

  1. https://www.magzter.com/stories/Lifestyle/New-York-magazine/Listening-To-Estrogen

  2. https://www.thecut.com/2019/01/estrogen-and-mental-health-women-share-their-stories.html