Estrogen’s Impact on Women’s Mental Health, According to a Doctor

Estrogen plays a major role in women’s health, including mental health. Estrogen is a sex hormone and therefore is responsible for regulating things like breast development and menstrual cycles, but it's also linked to women’s emotional well-being. The endocrine system is charged with regulating estrogen's ebb and flow.

Estrogen’s impact on mood is complex because there are so many other factors that come into play. Still, we know that beginning in puberty, estrogen has a big impact on women's emotional health.

In this article we’ll go through what happens when you have low estrogen and high estrogen, estrogen’s impact on the brain, and estrogen’s impact on mood at several different times throughout a woman's life. Then we’ll wrap up by discussing treatment and lifestyle habits one can explore if they suspect an imbalance in estrogen levels.

What Happens If Estrogen Is Low?

Estrogen becomes low naturally at various points during a woman’s life. This happens for many reasons, according to Kirti Patel, MD, MHL, Gynecology and Women’s Health at UMass Memorial Healthcare-Harrington and Chief Medical Officer of thePOV. For example, postpartum women who are breastfeeding have low estrogen and it’s typically not a concern because the situation is temporary.

On the other hand, Patel says, “if you have anorexia and you're underweight, your sex hormone levels can drop, and your periods can stop. You can have very low estrogen levels, and that can be very dangerous because during this time, for example, you bones can thin out [because] estrogen helps maintain the strength of your bones.”

When it comes to changes in mood, while Patel says there are often multiple causes, low estrogen often plays a role. You can have mood swings, and feel sad, anxious, or frustrated. You may also experience sleep disruptions and consequently experience fatigue, which in turn, may make your mood swings worse. "Brain fog" and other cognitive issues are associated with low estrogen too.

Although these things can have other causes, estrogen is one major factor that could come into play.

What Happens When Estrogen Is High?

Just like with low estrogen, high estrogen can cause issues too. High estrogen levels relative to progesterone are known as estrogen dominance in the naturopathic community. Some clinicians feel this can contribute to mood changes. 

Although high estrogen can play a role in making endometriosis worse, cause fibroids to grow, lead to heavier periods, and increase the risk of endometrial polyps and uterine cancer, Dr. Patel says that a high estrogen level does not have a significant direct impact on mood, as much as the fluctuation of levels does. 

What Is Estrogen’s Impact on the Brain?

Estrogen may be known for working in the reproductive system, but it also works elsewhere, including the brain. One of estrogen’s main impacts in the brain is to “help to increase and improve the function of your feel-good hormones, serotonin and dopamine,” says Patel. In addition, estrogen can modify the production and effect of endorphins and even have neuroprotective effects.

On the other hand, estrogen may also be responsible for brain fog, especially around the time of perimenopause or menopause but, as Patel says, estrogen isn’t solely responsible.

Estrogen and Mood

We’ve already gone over how estrogen impacts mood in general. Now let’s look at some specific syndromes and disorders.

Premenstrual Syndrome

Premenstrual syndrome (PMS) is present when women consistently have physical and emotional symptoms that occur a few days before their period but go away afterwards. These symptoms are usually significant enough to impact school, work, or other daily activities.

Patel says that in addition to physical symptoms like bloating, pelvic discomfort and cramping, there are many mood issues that can occur because of PMS. These can include feeling blue, feeling irritable, feeling depressed, and feeling an increase in one’s anxiety.

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is, according to Patel, a more severe form of PMS. However, in PMDD, the emotional symptoms are more severe and often eclipse any physical symptoms you may have.

No one knows exactly why some people have PMS, some people have PMDD, and some people coast by with no symptoms at all, but Patel says some people believe women who have a history of trauma are more prone to have PMDD.

On the other hand, PMDD may run in the family. Either way, it’s clear estrogen levels play a role in PMS and PMDD, but it may have less to do with how low the levels get during this time and more to do with the role estrogen plays in the brain at this time of the month in some people.

Postpartum Depression

Postpartum depression is an official diagnosis in the DSM, known as major depressive disorder with peripartum onset. “We know that estrogen levels decline postpartum, especially with breastfeeding,” Patel notes. And while decline in estrogen can be linked to that decline in mood, Patel says that there are other potential contributions including certain psychosocial stressors, other hormonal changes and a previous history of psychiatric disorders.

One signal that postpartum depression isn’t solely estrogen’s fault is that the treatment— antidepressants and/or therapy—is the same as for other forms of depression (rather than something that would alter estrogen levels).

Depression That Occurs During Perimenopause

Perimenopause happens during the years leading up to menopause. “During this time you’ll know you’re in it when your periods change, perhaps the interval [between them] is longer… or you skip a couple months… [or] your periods get lighter.” These hormonal shifts can be associated with fluctuations in mood too.

Depression That Occurs After Menopause

Women who are postmenopausal have stopped having their periods and, consequently, have very low estrogen. “Once you’ve gone through the initial years following menopause and you adjust to a new normal lower estrogen level,” Patel says, “your risk of mood problems and depression decrease.”

Treatment and Lifestyle Changes

If you suspect an imbalance in estrogen levels, there are a few treatments and lifestyle changes you can explore. On the treatment end of the spectrum, Patel recommends evaluation for low-dose estrogen and progesterone birth control pills, especially during perimenopause. And of course, seeking a mental health professional's care if your symptoms significantly impact your mood is another treatment option that can help.

On the lifestyle end of the spectrum, Patel recommends the following for boosting your mood—whether or not your estrogen levels are irregular:

• Keeping a healthy weight
• Exercising
• Keeping a healthy diet
• Healthy sleep
• Managing stress
  

Estrogen can have an outsized impact on a woman's physical and emotional well-being throughout their lifetime, so if you have concerns about this and need help, don’t hesitate to see your doctor or mental health professional.