Understanding the Role of Hormones in Anxiety: Part 2 of 3- Puberty, Post-Partum, and Perimenopause

If you've read part 1 of "Hormones and Anxiety," you now understand how anxiety manifests in the brain.

It's always advisable to undergo a thorough blood work-up with your healthcare practitioner, whether it's your family doctor or a trusted naturopathic doctor. Low levels of iron, vitamin B12, vitamin D, and thyroid hormones may contribute to anxiety and can be easily addressed.

Now, let's explore how hormones can often be an overlooked cause of anxiety, particularly during periods of hormonal change such as puberty, postpartum, and perimenopause. Like everything else in our bodies, hormones require balance to maintain homeostasis. When hormone levels become imbalanced—either too high or too low—the body tries to compensate, leading to anxiety peaks during periods of change or imbalance.

The GAD-7 questionnaire is a commonly used tool in primary medicine for assessing anxiety. Take a look at the questions below, and you may notice a commonality between these symptoms and the experiences of many women with hormonal imbalances. Patients are asked to rate their responses on a scale of 0 to 3:

1. Feeling nervous, anxious, or on edge
2. Inability to stop or control worrying
3. Excessive worrying about different things
4. Trouble relaxing
5. Restlessness that makes it hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid, as if something terrible might happen

A quick reminder about estrogen and progesterone:

During the first 14 days of your menstrual cycle (day 1 being the first day of flow), estrogen is the dominant hormone and is often referred to as the "happy hormone." Most women feel great during the first half of their cycles and tend to be highly productive. In the second half of the cycle, there is a significant drop in estrogen, and progesterone takes over. Changes in mood are common during this phase if the difference between estrogen and progesterone is too pronounced.

High estrogen symptoms may include heavy periods, breast pain, irritability, and can be associated with conditions like uterine fibroids and fibrocystic breasts. On the other hand, low estrogen symptoms may manifest as night sweats and depression.

In early perimenopause, anxiety is frequently observed due to high fluctuations of estrogen (and low progesterone). In later perimenopause and menopause, anxiety is more likely to be caused by low estrogen levels.

Progesterone plays a crucial role in mood regulation. Changes in progesterone levels can affect one's mood and sense of well-being because progesterone converts to allopregnanolone, which binds to GABA receptors. Higher levels of progesterone increase GABA function—a neurotransmitter known for its calming properties.

What happens during perimenopause that can intensify anxiety? Ovulation becomes less regular or less strong, and the stress response weakens. If we don't produce enough progesterone or our response to cortisol is insufficient, anxiety becomes more likely. Adequate thyroid function and insulin sensitivity are also essential for ovulation. We'll delve into this further in part 3.

Moving on to postpartum anxiety: The sudden decrease in estrogen and progesterone levels after childbirth can make individuals more sensitive to cortisol levels, resulting in feelings of being overwhelmed or panicky. Combine this with sleep deprivation, and it becomes the perfect recipe for anxiety. Furthermore, estrogen withdrawal induces oxytocin neuroplasticity in the brain, increasing anxiety-like behavior during the postpartum period. Lastly, dopamine levels drop to allow prolactin to increase for milk production.

Now, let's address puberty—a tumultuous time of fluctuating hormones and social development, often accompanied by anxiety. The two primary sex hormones during puberty are testosterone and estrogen, which surge during adolescence. Testosterone is predominant in males, while estrogen prevails in females. In females, estrogen levels influence the production of serotonin—a neurotransmitter responsible for feelings of well-being. Insufficient levels of serotonin can lead to depression, while imbalances of testosterone or estrogen can cause irritability and anxiety. Poor management of blood sugar levels or insulin sensitivity can exacerbate fluctuations in estrogen and testosterone.

In part 3, we'll explore natural remedies for anxiety once we've identified its root cause.

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