Emotional Health and Well-Being throughout the Lifecycle of a Woman

Just mention those three little letters ─ PMS ─ and you’re bound to get a reaction! Women nod in sympathy; men cringe at the thought. Admit it… your moods have experienced a “Jekyll and Hyde” type of transformation during that time of the month.

But the emphasis on PMS and its effects on a woman’s moods seems blown out of proportion, especially in light of the fact that a woman’s life is a continuum of hormonal upheavals that affect her disposition. From puberty through postmenopause, women experience a continuous cycle of hormonal fluctuations which affect brain chemistry and, therefore, their moods. This physiological fact of life may partially explain why “depression and anxiety disorders are 2–3 times more common in women than in men,” a worldwide, cross-cultural phenomenon, according to Dr. Elizabeth Lee Vliet. This is a serious issue which demands that we look beyond the all-too-common jokes about PMS to get a better understanding of how hormones affect a woman’s emotional health and well-being throughout her lifetime.

Puberty

Most children exhibit some symptoms of anxiety and moodiness during puberty. As parents of teenagers know, adolescents can be irritable or withdrawn and may have poor concentration and trouble sleeping. However, these changes in behavior are typically more extreme for young girls, especially as they begin to menstruate when their stress is heightened by hormonal changes.

Parents should be especially vigilant of their children’s emotional health during puberty. If not dealt with properly, childhood trauma can become encoded into the brain’s biochemistry and reemerge later as serious depression or inability to cope with stress.

PMS

Premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), is a condition generally described as a noticeable tension just before menstruation, which disappears once menstruation begins. For some, this tension is nearly debilitating, seriously affecting their ability to cope with daily life. In fact, Dr. Katharina Dalton, who pioneered the treatment of PMS over 40 years ago, reports that approximately half of all women’s suicide attempts are made during the four days just prior to menstruation, or during the first four days of menstruation.

PMS typically involves a combination of intense tiredness, irritability, and depression, which is easily aggravated by any other stress factors. During this time, many women become weepy, have difficulty making decisions, feel a drop in their physical and mental abilities, and quickly snap at those around them. In addition, women who already suffer from a mood disorder report that their symptoms worsen just prior to menstruation and, if they are taking any medications for it, effectiveness is decreased or diminished.

Although still not yet fully understood, researchers and medical practitioners now agree that PMS is a very real phenomenon, and that it is the result of a complex biochemical/hormonal fluctuation that affects women on a physical, behavioral, and emotional level.

Birth control pills: A woman’s choice regarding contraception may affect her moods. Dr. Gabriel Cousens reports that “as many as 1-in-3 women on birth control pills suffers from depression.” The hormones in the pills affect the brain’s biochemistry in many ways producing emotional effects as well as the desired physical effects. According to Dr. Cousens, women who take birth control pills also often have nutritional deficiencies that may compound the effects on their mood.

Fertility medications: On the flip side of the contraceptive issue, an increasing number of women are experiencing problems conceiving. In response, powerful medications that stimulate the ovaries to produce an over-abundance of eggs are now available. But these medications can also affect moods and increase anxiety because of their effect on the brain’s biochemistry.

Other prescriptions: Some commonly prescribed medications are also known to have mood disorder side effects, including blood pressure medications as well as many others.

Pregnancy

Hormonally speaking, there is no doubt that pregnancy is one of the most volatile times in a woman’s life. The combination of hormonal and imminent lifestyle changes wreaks havoc on her emotions.

During the first few weeks of pregnancy, both estrogen and progesterone levels rise rapidly and can affect mood stability. By the sixth week, a woman’s estrogen level is approximately three times that of the highest point during the menstrual cycle, and many women become extremely irritable. Because the body often successfully accommodates these fluctuations with its own self-regulating mechanisms, most women report feeling much better by the second trimester, and may even feel a sense of euphoria; but not all women adjust so readily.

Approximately 1-in-10 pregnant women experiences some depression or anxiety, and many of those women will continue to have more serious episodes after delivery. In fact, some women never seem to recover the same emotional stability that they enjoyed prior to having a child. If left untreated, mood disorders during pregnancy can lead to serious repercussions for the baby’s health, as well as the important bonding between mother and child after birth.

Postnatal Depression

For many years people felt that postnatal depression, or the “baby blues,” primarily affected those women who were weak or lacking in self-control. The common advice was to “pull yourself together.” But, with the passage of time, that attitude has slowly faded and postnatal depression has gained credence as a medical phenomenon.

Symptoms differ significantly from those of “clinical” or “normal” depression, according to Dr. Dalton. For example, women with depression typically have difficulty sleeping, while women suffering from postnatal depression usually have a yearning for sleep and can’t seem to get enough of it. Obviously, some of that yearning may be the result of typical newborn- related sleep deprivation, but not to the experienced extent. Other differences typically include weight gain (instead of weight loss) and generally feeling best in the morning (while morning is usually when women with depression feel their worst).

Dr. Dalton believes that, in many cases, postnatal depression can be blamed for the onset of PMS. She states that over 80% of the women who have once suffered from postnatal depression subsequently develop PMS. Both postnatal depression and PMS occur during a hormonal upheaval; specifically when there is a significant drop in progesterone. Both conditions include symptoms of exhaustion, irritability, depression, and mood changes ─ sometimes with violent outbursts and/or suicidal tendencies. And, according to Dr. Dalton, both can be successfully treated with progesterone.

Perimenopause / Menopause

Dr. Phyllis Bronson, a biochemist who has conducted studies of mood disorders, stated that what most women fear as they approach menopause is not hot flashes, night sweats, breast cancer, or heart disease, but losing their mind!

Most women report feeling mentally foggy or dull before they sense any of the physical symptoms of menopause. As they begin to experience irregular hormonal fluctuations, they feel tense and moody, have poor concentration and memory, feel an overall loss of well-being, and experience difficulty sleeping. Notice that many of these symptoms overlap those of clinical depression.

During perimenopause, some women struggle with depression-like symptoms for the first time, while others, who have had previous episodes of depression, may find their symptoms reemerging.

Moreover, as with PMS, women with a mood disorder may find that previously successful treatments seem to stop working with the onset of menopause. Mood-related symptoms may reemerge and mood swings may become more pronounced. Especially during this stage of life, women should consider investigating hormone therapy as a key element to treat depression or mood-related symptoms.

Hormones Linked to Moods

Some people may argue that our moods are affected by many factors, including our social and physical environment, diet, exercise, and daily sleep patterns just to name a few. But the reality is that those same factors also significantly affect our hormones which regulate our brain’s response system, and thereby determine our moods.

Research at Rockefeller University reported on by Dr. Vliet indicates that steroid hormones (especially estrogen, testosterone, and progesterone) are the most potent chemicals affecting the brain. Changes in the levels of these ovarian hormones influence neurotransmitters (such as dopamine and serotonin), which in turn affect moods. Dr. Vliet agrees that ovarian steroids play an important regulatory role in a woman’s general sense of well-being. She reports that research suggests there is a “previously unrecognized connection between declining hormone levels in perimenopausal women and the high incidence of depression and anxiety disorders.” She also reported on a Yale study which concluded that hormone therapy over a six-month period appeared to result in an improvement in all categories of perimenopausal symptoms, including depression, anxiety attacks, sleep disturbances, and short-term memory problems.

Estrogen: Aside from estrogen’s many roles in our sexual and developmental health, it is also known to be a neurostimulant with anti-depressive effects. Estrogen levels have a domino effect on brain chemistry and moods. Dr. Bronson states that “high levels of estrogen produce an imbalance in the system that aggravates or causes symptoms of tension and anxiety.” In fact, she says that some women with high estrogen levels may be predisposed to high anxiety or panic attacks. On the other hand, low levels can lead to episodes of depression.

A woman typically tends toward either an estrogen dominance or an estrogen deficiency; yet she still experiences both high and low levels due to normal fluctuations (as in PMS) or irregular fluctuations (as in perimenopause) relative to her “normal” level. During the fluctuation, she may experience mixed symptoms as the balance shifts. Mood changes associated with a woman’s declining estrogen levels tend to respond very well to estrogen therapy, with most women reporting more alertness and energy upon treatment.

Progesterone: Dr. Bronson notes that the estrogen/progesterone ratio is the key to proper treatment of mood disorders. A study by Dr. Bronson found that “a deficiency of progesterone is clearly implicated as a primary factor in mid-life anxiety patterns.” She observed that, when estrogen levels were high and progesterone levels low, patients “would exhibit extreme rage, followed by a conciliatory, self-defeating demeanor.” This is not surprising since the largest concentration of progesterone receptors is in the limbic area of the brain, which is the center of emotion and therefore called the “area of rage and violence” by animal physiologists. Progesterone has a calming effect on the brain, which suggests that a deficiency leads to varying levels of anxiety, depending on the level of the imbalance.

Recall the previous discussion regarding PMS and postnatal depression, both of which can occur with a sudden drop in progesterone and can include considerable anxiety. Dr. Dalton found that both conditions can be effectively treated with progesterone, especially if administered before symptoms develop. For PMS, she suggests supplementing with progesterone from ovulation until menstruation. For preventing postnatal depression, she recommends that progesterone therapy begin immediately after delivery, tapering off until menstruation returns. Dr. Bronson agrees that progesterone can be an effective treatment for anxiety in perimenopausal women; however, she finds the treatment to be most effective at higher doses, specifically 400–600 mg/day, administered on the skin. Most of the women treated reported significant improvements in emotional health. When progesterone therapy is in order, both Dr. Bronson and Dr. Dalton emphasize the importance of using bioidentical progesterone instead of progestin to achieve the best results.

Thyroid: The thyroid gland produces several hormones that have a profound effect on the body and affect every cell in one way or another. The primary thyroid hormones are thyroxine (T4) and triiodothyronine (T3), both of which respond to the pituitary thyroid stimulating hormone (TSH) as part of the body’s complex feedback system that keeps endocrine gland secretions in sync. Thyroid hormones also affect blood glucose levels and the release of stress hormones, which obviously affects moods. A thyroid hormone deficiency inhibits the brain’s neurotransmitters, possibly leading to depression. Thyroid hormone levels may be deficient during and after pregnancy.

Insulin & glucose: Dr. Dalton noticed a correlation between aggressive, emotional outbursts during PMS and patients’ blood sugar levels. When asked about the time of day or circumstances immediately preceding such outbursts, patients frequently reported that they occurred late morning after missing breakfast or while preparing for the evening meal, especially if the latter was occurring later than usual. Incidentally, many of her patients reported confusion or forgetfulness during the time surrounding these outbursts.

Dr. Cousens believes that paying careful attention to what and when you eat is important to your emotional health. He states that eating foods that are “super high” on the glycemic index (such as white flour products, refined and sweetened cereals, and candy bars) cause “wild swings in blood sugar, a high followed by a low,” and should be avoided for that reason. For more information, visit WomensInternational.com.