Sex hormone imbalances

Low estrogen can manifest in the following mental health symptoms:

• DepressionTurek, J. and Gąsior, Ł. (2023) ‘Estrogen fluctuations during the menopausal transition are a risk factor for depressive disorders’, Pharmacological Reports, 75(1), pp. 32–43.
  • Dr. Sara Gottfried calls estrogen “nature’s Prozac” Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 151. because it regulates the availability of serotonin our feel-good neurotransmitterBendis, P.C., Zimmerman, S., Onisiforou, A., Zanos, P. and Georgiou, P. (2024) ‘The impact of estradiol on serotonin, glutamate, and dopamine systems’, Frontiers in Neuroscience, 18, 1348551.
  • It has been proven that estrogen can help with depression and has a role in mood disorders in women over forty Han, Y., Gu, S., Li, Y., Qian, X., Wang, F. and Huang, J.H. (2023) ‘Neuroendocrine pathogenesis of perimenopausal depression’, Frontiers in Psychiatry, 14, 1162501.
• Loss of pleasure and motivation
  • Estrogen also plays a role in regulating dopamine, the neurotransmitter for pleasure and motivationBendis, P.C., Zimmerman, S., Onisiforou, A., Zanos, P. and Georgiou, P. (2024) ‘The impact of estradiol on serotonin, glutamate, and dopamine systems’, Frontiers in Neuroscience, 18, 1348551.
• Poor sleepHabibzadeh, A., Boroon, M. and Shalbafan, M. (2025) ‘Exploring the efficacy of intranasal oxytocin (OXT) for anxiety and stress-related disorders through functional magnetic resonance imaging (fMRI) study: a systematic review’, BMC Pharmacology and Toxicology, 26, 162.
• Poor cognitive function, brain fog and poor memoryRuehr, L., Hoffmann, K., May, E., Münch, M.L., Schlögl, H. and Sacher, J. (2025) ‘Estrogens and human brain networks: a systematic review of structural and functional neuroimaging studies’, Frontiers in Neuroendocrinology, 77, 101174.
  • In part due to its vasodilating effect on the brain, estrogen can improve cognition and memory Ruehr, L., Hoffmann, K., May, E., Münch, M.L., Schlögl, H. and Sacher, J. (2025) ‘Estrogens and human brain networks: a systematic review of structural and functional neuroimaging studies’, Frontiers in Neuroendocrinology, 77, 101174.
  • Estrogen is linked to brain-derived neurotrophic factor (BDNF), a protein which promotes brain plasticity by increasing nerve cells and maintaining neurons, especially in the parts of the brain which deal with higher thinking, learning, and long term memory Zhang, Z., He, Z., Pan, J., Yuan, M., Lang, Y., Wei, X. and Zhang, C. (2024) ‘The interaction of BDNF with estrogen in the development of hypertension and obesity, particularly during menopause’, Frontiers in Endocrinology, 15, 1384159.
  • BDNF is increased by estrogen and exercise, and reduced by cortisol Zhang, Z., He, Z., Pan, J., Yuan, M., Lang, Y., Wei, X. and Zhang, C. (2024) ‘The interaction of BDNF with estrogen in the development of hypertension and obesity, particularly during menopause’, Frontiers in Endocrinology, 15, 1384159.
  • BDNF and estrogen also work in tandem to support serotonin, dopamine and glutamine neurotransmitters
  • Estrogen has a neuro-protective effect, and issues with the interactions between estrogen and BDNF are linked to schizophrenia and mood disorders

    Zhang, Z., He, Z., Pan, J., Yuan, M., Lang, Y., Wei, X. and Zhang, C. (2024) ‘The interaction of BDNF with estrogen in the development of hypertension and obesity, particularly during menopause’, Frontiers in Endocrinology, 15, 1384159.

• Anxiety and panicWieczorek, K., Targonskaya, A. and Maslowski, K. (2023) ‘Reproductive hormones and female mental wellbeing’, Women, 3(3), pp. 432–444.
• Low libidoWieczorek, K., Targonskaya, A. and Maslowski, K. (2023) ‘Reproductive hormones and female mental wellbeing’, Women, 3(3), pp. 432–444.
• Unpredictable moodsTurek, J. and Gąsior, Ł. (2023) ‘Estrogen fluctuations during the menopausal transition are a risk factor for depressive disorders’, Pharmacological Reports, 75(1), pp. 32–43.

• Night sweats
• Hot flushes
• Weakening of muscles including leaky bladder or incontinence – estrogen controls the strength of your urinary tract
• Vaginal dryness
• Thinning and dry skin
• Shrinking or sagging breasts

The effects of high estrogen on mental health can mimic those of low estrogen, making diagnosis from symptoms confusing. Using a combination of symptoms and lab results (blood, urine) can help with an accurate diagnosis.

• Depression
• Mood swings
• AnxietyWieczorek, K., Targonskaya, A. and Maslowski, K. (2023) ‘Reproductive hormones and female mental wellbeing’, Women, 3(3), pp. 432–444.
• Brain fog
• Insomnia
• IrritabilityWieczorek, K., Targonskaya, A. and Maslowski, K. (2023) ‘Reproductive hormones and female mental wellbeing’, Women, 3(3), pp. 432–444.
• Memory lapses
• Inability to concentrateRuehr, L., Hoffmann, K., May, E., Münch, M.L., Schlögl, H. and Sacher, J. (2025) ‘Estrogens and human brain networks: a systematic review of structural and functional neuroimaging studies’, Frontiers in Neuroendocrinology, 77, 101174.

• Puffiness
• Craving for carbohydrates
• Heavy Bleeding
• Fibrocystic Breasts
• Weight gain around the hips and difficulty losing weight
• Vaginal/Oral yeast (Thrush)
• Tender breasts
• Hair loss
• Fatigue
• Low libido
• Headaches/Migrainesvan Lohuizen, R., Paungarttner, J., Lampl, C., MaassenVanDenBrink, A. and Al-Hassany, L. (2024) ‘Considerations for hormonal therapy in migraine patients: a critical review of current practice’, Expert Review of Neurotherapeutics, 24(1), pp. 55–75.

For optimal well-being, estrogen and progesterone levels should be balanced, as progesterone tempers estrogen’s effects. However if estrogens are relatively high compared to progesterone, especially during the second half of the cycle when progesterone should be higher than estrogen, this is called estrogen dominance.

Estrogen which is unopposed by progesterone, possibly due to anovulatory cycles, can create mental health symptoms.Han, Y., Gu, S., Li, Y., Qian, X., Wang, F. and Huang, J.H. (2023) ‘Neuroendocrine pathogenesis of perimenopausal depression’, Frontiers in Psychiatry, 14, 1162501.

Mental health effects of estrogen dominance

These are similar to the symptoms of low progesterone, as they are linked with low progesterone.

• Anxiety
• Insomnia
• Irritability
• Mood swings
• Brain fog
• Memory loss
• PMS

Physical effects of estrogen dominance

• Possible endometriosis and painful periods
• Difficulty getting pregnant, poor gestation
• Headaches around your period
• Oedema around your feet and ankles
• Restless legs
• Bloating
• Fatigue
• Low libido

The following factors can contribute to low estrogen levels.

Time of month

Prior to menstruation, estrogen levels are naturally low, which can contribute to PMS.

Time of life

• After giving birth, and during breastfeeding, estrogen levels lower
• Perimenopause and menopause – Estrogen levels can plummet in women around 43/47Spicer, J., Malaspina, D., Blank, S.V. and Goosens, K.A. (2025) ‘Follicle-stimulating hormone: more than a marker for menopause: FSH as a frontier for women’s mental health’, Psychiatry Research, 345, 116239.

Nutritional imbalances

• Certain foods and nutritional deficiencies can decrease estrogen levels (link)
• Eating disorders such as anorexia and bulimia
• Gluten intolerance

Lack of appropriate exercise

Extreme exercise can lead to the over-production of testosterone.Angelidi, A.M., Stefanakis, K., Chou, S.H., Valenzuela-Vallejo, L., Dipla, K., Boutari, C., Ntoskas, K., Tokmakidis, P., Kokkinos, A., Goulis, D.G., Papadaki, H.A. and Mantzoros, C.S. (2024) ‘Relative energy deficiency in sport (REDs): endocrine manifestations, pathophysiology and treatments’, Endocrine Reviews, 45(5), pp. 676–708.

Stress

Chronically high cortisol can reduce estrogen levels.

Ageing

• As you age and approach menopause, your estrogen levels fluctuate more than usual
• As your ovarian reserves diminish with age, your hypothalamus and pituitary encourage the release of more estrogen in order to procreate before it’s too lateSpicer, J., Malaspina, D., Blank, S.V. and Goosens, K.A. (2025) ‘Follicle-stimulating hormone: more than a marker for menopause: FSH as a frontier for women’s mental health’, Psychiatry Research, 345, 116239.

Stress

Anything that lowers progesterone, such as stress and high cortisol levels can also cause symptoms of estrogen dominance.

Toxicity

• A heavy toxic load due to environmental pollution can tax the liver, and hamper its ability to detoxify estrogen
• Chemical pollution and toxins, especially from “endocrine disruptors” such as xenoestrogens
  • Xenoestrogens are synthetic chemicals that mimic estrogen Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 159.
  • Found in plastics, flame retardants, cosmetics, lining of tin cans, mercury, etc.
  • Stored in fatty tissues
• Pesticides/herbicides such as Glyphosates which is an endocrine disruptor and may exhibit estrogenic properties

Poor metabolism and detoxification of estrogen

• In order to maintain healthy estrogen levels, you need to inactivate excess estrogen in the liver
• A healthy liver normally breaks down estrogens, and the inactivated estrogens are then cleared by the kidney in the urine
• Poor liver function can therefore cause elevated blood estrogens
• Furthermore, for the liver to inactivate estrogens, sufficient levels of B-vitamins are neededLim, M.J.S., Parlindungan, E., See, E., Gan, C.H., Yap, R. and Yong, G.J.M. (2026) ‘Diet, the gut microbiome, and estrogen physiology: a review in menopausal health and interventions’, Nutrients, 18(7), 1052.

Hormone Replacement Therapy (HRT)

If estrogen is given during HRT there can be a resulting increase in cortisol, which then blocks progesterone with the net effect of increasing anxiety.Han, Y., Gu, S., Li, Y., Qian, X., Wang, F. and Huang, J.H. (2023) ‘Neuroendocrine pathogenesis of perimenopausal depression’, Frontiers in Psychiatry, 14, 1162501.

Being overweight

• Fat cells produce estrogen, so people who are overweight tend to produce more estrogen
• Estrogen is 50-100 times greater in overweight menopausal women than in lean women
• Excess weight and lack of exercise can lead to chronically high insulin levels, which increases estrogen levelsSteiner, B.M. and Berry, D.C. (2022) ‘The regulation of adipose tissue health by estrogens’, Frontiers in Endocrinology, 13, 889923.

Nutrition

• High consumption of alcohol and red meat can increase estrogen
• Low consumption of fibre can increase estrogen as fibre is necessary for the detoxification of estrogens

Gut issues

Gut dysbiosis (an imbalance between good and bad gut bacteria), often caused by a diet high in sugar and low in fibre can increase estrogen levels and hamper the body’s ability to detoxify excess estrogen.Lim, M.J.S., Parlindungan, E., See, E., Gan, C.H., Yap, R. and Yong, G.J.M. (2026) ‘Diet, the gut microbiome, and estrogen physiology: a review in menopausal health and interventions’, Nutrients, 18(7), 1052.

When progesterone levels drop and become relatively low, this can lead to the following mental health symptoms:

• Anxiety
• Mood swings
• Sleep issues
• Irritability
• Depression
• Lack of resilience to stress
• PMS

Bencker, C., Gschwandtner, L., Nayman, S., Grikšienė, R., Nguyen, B., Nater, U.M., Guennoun, R., Sundström-Poromaa, I., Pletzer, B., Bixo, M. and Comasco, E. (2025) ‘Progestagens and progesterone receptor modulation: effects on the brain, mood, stress, and cognition in females’, Frontiers in Neuroendocrinology, 76, 101160.

• Fluid retention
• Breast tenderness
• Inability to lose weight
• Headaches
• Heavy menstrual bleeding

Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 122, p. 126. Reiss, U. and Zucker, M. (2001). Natural Hormone Balance for Women. New York: Pocket Books, p. 100.

The following factors can contribute to low progesterone and its symptoms.

Time of month

Progesterone is naturally lower the week before your period and during your period.

Time of life

• After giving birth, progesterone levels drop
• High prolactin (the breastfeeding hormone), lowers progesteroneHantsoo, L., Jagodnik, K.M., Novick, A.M., Baweja, R., Lanza di Scalea, T., Ozerdem, A., McGlade, E.C., Simeonova, D.I., Dekel, S., Kornfield, S.L., Nazareth, M., Weiss, S.J. et al. (2023) ‘The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions’, Frontiers in Endocrinology, 14, 1295261. (and estrogen), which may contribute to post-partum depression and anxiety, though the link is not clear
  • Some studies show an increased risk of post-partum depression with breastfeeding, while others show a decreased risk or no association Borra, C., Iacovou, M. and Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. [online] Maternal and Child Health Journal, 19 (4), pp. 897-907. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353856/ [accessed 9 Oct. 2017].
• Progesterone generally starts to drop dramatically from thirty-five onwards, and especially in the 40sTan, J., Yang, Y.Y., Yin, D.Y., Xin, Q. and Ge, X.C. (2025) ‘Research on the impact of thyroid disorders on reproductive function: a narrative review’, Journal of Clinical Medicine Research, 17(8), pp. 409–422.
  • During peri-menopause and menopause (35-55), women do not ovulate as regularly, and can have anovulatory cycles
  • Since it is during ovulation that the ripe egg releases progesterone, if no egg is released, progesterone will be low

Stress and adrenal dysregulation

• High cortisol, which is produced by the adrenal glands, blocks progesterone, and chronic stress (when cortisol levels are high) can thus lead to chronically low progesteroneDomes, G., Linnig, K. and von Dawans, B. (2024) ‘Gonads under stress: a systematic review and meta-analysis on the effects of acute psychosocial stress on gonadal steroids secretion in humans’, Psychoneuroendocrinology, 164, 107004.
• When under stress, our body may struggle to make sufficient stress hormone cortisol in the adrenals
• Therefore, it will make it from the “mother hormone” pregnenolone, which will make less progesterone in order to make more cortisol
  • This is known as the “pregnenolone steal” Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 129.
  • However the pregnenolone steal theory has been more recently somewhat debunked http://blog.zrtlab.com/reassessing-pregnenolone-steal
• When cortisol levels rise due to stress, this will also block progesterone receptors, as cortisol will be using the progesterone receptor, therefore progesterone cannot get into the cell nucleus
• According to Dr Sara Gottfried high cortisol and low progesterone (and/or low estrogen) is a common hormone imbalance in women under the age of 35

Progesterone resistance

For reasons we don’t totally understand, certain women have more progesterone resistance than others. This is when after ovulation, progesterone affects the GABA receptor so that it can no longer respond to progesterone, creating “progesterone resistance”.Bencker, C., Gschwandtner, L., Nayman, S., Grikšienė, R., Nguyen, B., Nater, U.M., Guennoun, R., Sundström-Poromaa, I., Pletzer, B., Bixo, M. and Comasco, E. (2025) ‘Progestagens and progesterone receptor modulation: effects on the brain, mood, stress, and cognition in females’, Frontiers in Neuroendocrinology, 76, 101160.

Luteal phase defect

When women’s ovaries aren’t producing enough progesterone during the luteal (second) phase of the menstrual cycle, which can be due to high stress levels and high cortisol and adrenaline, which can detract from progesterone production.

Hypothyroid

• Low thyroid hormone (hypothyroid) can lower progesterone,Tan, J., Yang, Y.Y., Yin, D.Y., Xin, Q. and Ge, X.C. (2025) ‘Research on the impact of thyroid disorders on reproductive function: a narrative review’, Journal of Clinical Medicine Research, 17(8), pp. 409–422.as low thyroid impacts pregnenolone production, and pregnenolone is the precursor to progesterone.
• Hypothyroidism can decrease progesterone receptor sensitivity, causing progesterone resistanceTan, J., Yang, Y.Y., Yin, D.Y., Xin, Q. and Ge, X.C. (2025) ‘Research on the impact of thyroid disorders on reproductive function: a narrative review’, Journal of Clinical Medicine Research, 17(8), pp. 409–422.
• However low progesterone can also lower thyroid function, triggering a vicious circleTan, J., Yang, Y.Y., Yin, D.Y., Xin, Q. and Ge, X.C. (2025) ‘Research on the impact of thyroid disorders on reproductive function: a narrative review’, Journal of Clinical Medicine Research, 17(8), pp. 409–422.

Too much exercise

• Intense and sustained exercise can lower progesterone and cause luteal phase defect (when the ovaries don’t produce enough progesterone in the luteal/second phase of the cycle)
• As many as 48% of women considered to be recreational athletes (women who exercise at least one hour four times per week) have been shown to have low progesteroneCastellanos-Mendoza, M.C., Galloway, S.D.R. and Witard, O.C. (2023) ‘Free-living competitive racewalkers and runners with energy availability estimates of <35 kcal·kg fat-free mass−1·day−1 exhibit peak serum progesterone concentrations indicative of ovulatory disturbances: a pilot study’, Frontiers in Sports and Active Living, 5, 1279534.

Antidepressants

Anti-depressants can lower progesterone.Costin, J. (2025) ‘Unraveling the cycle: a scoping review exploring the impact of antidepressants on the female reproductive cycle’, Cureus, 17(11), e97360.

Nutritional deficiencies

• Lack of vitamin A, B6, C and zinc, which are required for the production of progesterone, can cause low progesterone
• A diet high in refined sugar can cause low progesterone

Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 102.

Progesterone tends to affect mental health mainly when it is too low and rarely when it is too high as the body does not over-produce progesterone like it does estrogen.Stefaniak, M., Dmoch-Gajzlerska, E., Jankowska, K., Rogowski, A., Kajdy, A. and Maksym, R.B. (2023) ‘Progesterone and its metabolites play a beneficial role in affect regulation in the female brain’, Pharmaceuticals, 16(4), 520.

However the main symptom of high progesterone is fatigue and depression.Stefaniak, M., Dmoch-Gajzlerska, E., Jankowska, K., Rogowski, A., Kajdy, A. and Maksym, R.B. (2023) ‘Progesterone and its metabolites play a beneficial role in affect regulation in the female brain’, Pharmaceuticals, 16(4), 520.

• Indecisiveness
• Low libidoFaucett, K., Giles, L.A. and Sing, E. (2026) ‘Testosterone: vital to female physiology’, Women’s Health, 22.
• Poor body image
• Increased anxiety
• Low mood and depression, especially in menIndirli, R., Lanzi, V., Arosio, M., Mantovani, G. and Ferrante, E. (2023) ‘The association of hypogonadism with depression and its treatments’, Frontiers in Endocrinology, 14, 1198437.
• FatigueFaucett, K., Giles, L.A. and Sing, E. (2026) ‘Testosterone: vital to female physiology’, Women’s Health, 22.
• Insomnia
• Lack of confidence
• Cognitive impairmentMorales Arteaga, J.L. (2026) ‘Psychiatric and cognitive effects of testosterone therapy in adult men: a systematic review of clinical evidence and mechanistic insights’, Cureus, 18(2), e102894.
• Memory issues, including Alzheimer’sMorales Arteaga, J.L. (2026) ‘Psychiatric and cognitive effects of testosterone therapy in adult men: a systematic review of clinical evidence and mechanistic insights’, Cureus, 18(2), e102894.

• Weak muscles and flabbiness
• Hair loss (which can also be a symptom of high testosterone!)
• Lack of energy and stamina
• Loss of coordination and balance
• Decreased pubic and body hairFaucett, K., Giles, L.A. and Sing, E. (2026) ‘Testosterone: vital to female physiology’, Women’s Health, 22.

The effects of high testosterone on mental health are especially prevalent in women.

• Depression and low mood
  • High testosterone results in lower estrogen levels. Estrogen benefits mood
  • Especially notable during menopauseFaucett, K., Giles, L.A. and Sing, E. (2026) ‘Testosterone: vital to female physiology’, Women’s Health, 22.
• Aggressiveness and irritabilityBushell, A. and Crespi, B.J. (2024) ‘The evolutionary basis of elevated testosterone in women with polycystic ovary syndrome: an overview of systematic reviews of the evidence’, Frontiers in Reproductive Health, 6, 1475132.
• Anxiety
• Bossiness

• Oily skin
• Acne
• Loss of hair on head with growth on face

• Chronic stress
  • Even mild anxiety can increase DHEA, which in turn could lead to an excess production of testosterone, as DHEA is a building block for testosterone, and chronically high stress levels are linked to both high cortisol and high androgen levelsDomes, G., Linnig, K. and von Dawans, B. (2024) ‘Gonads under stress: a systematic review and meta-analysis on the effects of acute psychosocial stress on gonadal steroids secretion in humans’, Psychoneuroendocrinology
• Excess body fat‘Adipose tissue and androgens: the ins and outs’ (2025) Adipocyte, 14(1).
• Toxicity
  • Women with PCOS have higher levels of BPA, a plastic found in plastic linings, bottles, flame retardants, etc. These women also exhibited a correlation between BPA levels and higher androgen levels and insulin resistance‘Association between bisphenol exposure and polycystic ovary syndrome risk: an integrated systematic review and meta-analysis’ (2026) Frontiers in Endocrinology.
• Various diseases such as diabetes, adrenal disease and ovarian tumours
• Medications such as anabolic steroids used by bodybuilders and other athletes for performance enhancement

• Ageing
  • Testosterone levels diminish as we age
• Stress
  • While most testosterone is manufactured by the sex glands (testes for men, ovaries in women) a large amount is also manufactured by the adrenal glands
  • During periods of high stress the adrenals are busy making cortisol, and therefore do not make as much testosterone or DHEADomes, G., Linnig, K. and von Dawans, B. (2024) ‘Gonads under stress: a systematic review and meta-analysis on the effects of acute psychosocial stress on gonadal steroids secretion in humans’, Psychoneuroendocrinology
  • Adrenal or pituitary gland dysfunction
• HRT
  • Estrogen therapy
• Various diseases such as such as renal disease and COPD

DHEA (Dihydroepiandrosterone) also part of androgen family, converts into testosterone, but also into estrogen and progesterone.Nawata, H., Yanase, T., Morohashi, K., Nomura, M. and Muta, K. (2026) ‘Anti-aging effects of the adrenal androgens dehydroepiandrosterone and dehydroepiandrosterone sulfate: mechanisms of action and beneficial effects in older people’, Endocrine Journal, 73(4), pp. 495–516.

It is produced mainly in the adrenal glands, but also a small amount is produced in the testicles

It produces in men and women a feeling of vitality, drive and motivation.Nawata, H., Yanase, T., Morohashi, K., Nomura, M. and Muta, K. (2026) ‘Anti-aging effects of the adrenal androgens dehydroepiandrosterone and dehydroepiandrosterone sulfate: mechanisms of action and beneficial effects in older people’, Endocrine Journal, 73(4), pp. 495–516.

• Depression‘Dehydroepiandrosterone for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials’ (2020) Journal of Neuroscience Research.
  • DHEA levels tend to be lower in people suffering from severe depression than in others‘Dehydroepiandrosterone for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials’ (2020) Journal of Neuroscience Research.
• Memory and cognition issues, including Alzheimer’s
  • DHEA protects brain cells from beta-amyloid protein found in Alzheimer’sSólyomvári, C., Makkai, G., Capelo-Carrasco, N., Svob Strac, D., Zelena, D. and Farkas, S. (2026) ‘Time-dependent histological characterization of amyloid-β induced cholinergic and glial alterations and their modulation by dehydroepiandrosterone sulfate (DHEAS)’, Frontiers in Endocrinology
  • A combination of low DHEA and high cortisol has been found to have a negative impact on memory and cognitionNawata, H., Yanase, T., Morohashi, K., Nomura, M. and Muta, K. (2026) ‘Anti-aging effects of the adrenal androgens dehydroepiandrosterone and dehydroepiandrosterone sulfate: mechanisms of action and beneficial effects in older people’, Endocrine Journal, 73(4), pp. 495–516.
• Since low DHEA can lead to low estrogen and low testosterone, the same mental health effects as low estrogen and low testosterone can be listed (link)

• Chronic stress, which causes excessive cortisol levels and impairs DHEA production
• Ageing
  • Production peaks in our 20s and steadily declines until it reaches very low levels in our 60s

A blood test or a saliva test can show levels of DHEA.

When levels of pregnenolone are low, other hormones will be low, because pregnenolone is necessary to produce other hormones. Symptoms of low progesterone and low estrogen are similar to symptoms of low pregnenolone.

• Poor memory
• Poor concentration and attention
• Anxiety
• Depression
• Brain fog
• Social phobia

 

• Ageing
• Stress
• Low cholesterol

 

High prolactin levels lead to low progesterone levels. This can result in similar mental health effects of low progesterone such as:

• Anxiety
• Mood swings
• Insomnia
• Irritability
• Depression
• Lack of resilience to stress
• PMS

 

• Pregnancy and birth
• Breastfeeding
• Stress

Often caused by low progesterone leading up to a woman’s period (due to anovulatory cycles, or simply lower progesterone relative to estrogen during the second half of the cycle),Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z. and Waszkiewicz, N. (2024) ‘Premenstrual syndrome: new insights into etiology and review of treatment methods’, Frontiers in Psychiatry PMS can cause such bad mental health symptoms that it is sometimes treated with SSRI antidepressants mid-cycle, as SSRIs can increase the formation of the progesterone derivative allopregnanolone.Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z. and Waszkiewicz, N. (2024) ‘Premenstrual syndrome: new insights into etiology and review of treatment methods’, Frontiers in Psychiatry

When PMS is so severe that it is considered disabling, it has its own psychiatric name: premenstrual dysphoric disorder (PMDD).Reilly, T.J., Patel, S., Unachukwu, I.C., Knox, C.L., Wilson, C.A., Craig, M.C., Schmalenberger, K.M., Eisenlohr-Moul, T.A. and Cullen, A.E. (2024) ‘The prevalence of premenstrual dysphoric disorder: systematic review and meta-analysis’, Journal of Affective Disorders, 349, pp. 534–540.

Dr. Julie Holland attributes PMS to progesterone being too high relative to estrogen as it peaks day 21, and adversely affects mood. Lower estrogen levels cause serotonin levels to drop a few days before menstruation, which can contribute to PMS symptoms.Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z. and Waszkiewicz, N. (2024) ‘Premenstrual syndrome: new insights into etiology and review of treatment methods’, Frontiers in Psychiatry.

60-80% of women experience some kind of PMS.Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z. and Waszkiewicz, N. (2024) ‘Premenstrual syndrome: new insights into etiology and review of treatment methods’, Frontiers in Psychiatry.

PMS is a great indicator of progesterone levels being out of balance. It is a problem between progesterone, GABA and serotonin interaction.Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z. and Waszkiewicz, N. (2024) ‘Premenstrual syndrome: new insights into etiology and review of treatment methods’, Frontiers in Psychiatry.

According to Dr. Amen “PMS is more than just a hormonal issue. It’s actually a brain disorder”, based on seeing the brain scans of a small group of women with PMS which demonstrate an increased activity in brain regions that are in charge of emotional expression emotions.Amen, D. (2013). Unleash the Power of The Female Brain. New York: Harmony Books, p. 102. Protopopescu, X., Pan, H., Altemus, M., Tuescher, O., Polanecsky, M., McEwen, B., Silbersweig, D. and Stern E. (2005). Orbitofrontal cortex activity related to emotional processing changes across the menstrual cycle. [online] Proceedings of the National Academy of Sciences of the United States of America, 102 (44), pp. 16060–5. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16247013 [accessed 11 Oct. 2017].

Mental health symptoms of PMS

As PMS can be caused by low progesterone, it is not surprising that the symptoms of low progesterone and PMS are similar:

• Depression
• Anxiety and panic
• Insomnia
• Irritability
• Anger
• Confusion

Physical symptoms of PMS

• Bloating
• Fluid retention and oedema
• Food cravings, especially salty or sweet foods (in order to replenish the minerals that are depleted due to changes in estrogen and progesterone levels)

Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z. and Waszkiewicz, N. (2024) ‘Premenstrual syndrome: new insights into etiology and review of treatment methods’, Frontiers in Psychiatry.

Causes of PMS

While some mild symptoms of PMS can be normal due to normal fluctuations of hormone levels, more extreme symptoms of PMS can be caused or exacerbated by:

• Oral contraceptives
• Pregnancy
• Miscarriage
• Abortion
• Tubal ligations
• Ageing
• Low magnesium
• Low blood sugar
• Caffeine
• Alcohol
• Nutritional deficiencies

There is a correlation between PCOS and high androgens. Indeed 50-82% of women with polycystic ovarian syndrome (PCOS) have high androgens.

PCOS is linked to an overactive HPA axis, which has been correlated to mood problems.

Mental health symptoms of PCOS (now PMOS*)

• Increased rate of body dissatisfaction
• Depression and low mood
• Anxiety
• Anger
• Diminished sexual satisfaction

Infante-Cano, M., García-Muñoz, C., Matias-Soto, J., Pineda-Escobar, S., Villar-Alises, O. and Martinez-Calderon, J. (2025) ‘The prevalence and risk of anxiety and depression in polycystic ovary syndrome: an overview of systematic reviews with meta-analysis’, Archives of Women’s Mental Health, 28(3), pp. 475–489.

Physical symptoms of PCOS (now PMOS*)

• Obesity or high BMI
  • However this is not always the case, and many lean women also have PCOS
• Excessive hair growth on face, chest or back (hirsutism)
• Irregular periods
• Infertility
• Thinning of hair on head
• Acne

 

*Note: In May 2026, PCOS was formally renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS) via a Lancet-published global consensus process — roughly 22,000 stakeholders surveyed over a decade, led by Helena Teede at Monash University — J. The rename reflects evidence that the condition doesn’t actually involve increased ovarian cysts, and reframes it as a multisystem endocrine-metabolic condition affecting weight, metabolic and mental health, skin, and the reproductive system, not just the ovaries. Diagnostic criteria (the Rotterdam criteria) are unchanged for now; full International Guideline implementation of the new name is due in 2028, after a three-year transition period.

Pregnancy and postpartum are times of tremendous hormonal upheaval, and some women are more sensitive to it than others, usually for a combination of biochemical, life circumstance and psycho-behavioural reasons.

The baby blues, or feeling low a few days or weeks is a normal reaction to the drop in hormones (especially the sex hormones estrogen and progesterone) which occurs after giving birth, the psychological adjustment to motherhood, fatigue, etc.Sahebi, A., Kheiry, M., Abdi, K., Qomi, M. and Golitaleb, M. (2024) ‘Postpartum depression during the COVID-19 pandemic: an umbrella review and meta-analyses’, Frontiers in Psychiatry.

However if low mood, and/or other symptoms persist and last for several months or years, this can be postpartum depression.

Postpartum depression

In some women, post-partum hormones take longer to return to their optimal state, possibly due to other biochemical issues (such as nutritional imbalances) or psycho-behavioural issues (anxiety around motherhood) or difficult life circumstances. The resulting hormonal imbalances can cause postpartum depression, and sometimes this state can last for years and recur with subsequent pregnancies.

Post-partum depression affects 8-15% of women in Britain.

Many women are prescribed anti-depressants and tranquilizers, however a more sustainable approach, and one with less side effects would be to examine the causes of postpartum depression in the form of hormonal imbalances (sex, stress and thyroid), nutritional deficiencies, and psychological factors.

Mental health symptoms of postpartum depression

• Depression
• Insomnia
• Anxiety and panic

Some individuals experience all of the symptoms of postpartum depression while others only experience one or two. For example, it is possible to have postpartum depression and suffer from extreme anxiety without experiencing low mood.

Postpartum psychosis

This is an extreme form of postpartum depression. It can be very dangerous for the baby and the mother, and must be treated immediately by a qualified clinician.

Mental health symptoms of postpartum psychosis

• Desire to harm self or others
• Desire to harm the baby

Please seek professional help immediately if you have any of these symptoms. Remember that this can happen to any new mother, and is largely caused by hormonal issues over which you have little control.

Postpartum thyroiditis

7% of women develop postpartum thyroiditis after giving birth. Similar to Hashimoto’s, this is caused by an overactive immune system attacking the thyroid.

Postpartum thyroiditis often lasts several weeks to several months.Buitrago Gómez, N., Aristizabal, N., García, A.F., Mosquera Agudelo, J.L., Jiménez Salazar, S. and Saldarriaga Betancur, S. (2024) ‘Natural history of postpartum thyroiditis: a narrative review’, Revista Colombiana de Endocrinología, Diabetes & Metabolismo.

Many doctors never think to check a woman’s thyroid after she has given birth and too many new mothers suffer from an unrecognized thyroid condition. This is partly due to the fact that postpartum thyroiditis can be difficult to recognize because its symptoms are often mistakenly attributed to the stress of having a newborn and postpartum mood disorders.

Mental health symptoms of postpartum thyroiditis

• Mood swings
• Low libido
• Insomnia
• Anxiety
• Weight fluctuations
• Fatigue

Physical symptoms of postpartum thyroiditis

• Heart palpitations
• Tremors
• Aching joints
• Thinning hair

Causes of postpartum mental health issues

Hormonal imbalances

• Sex hormones
  • During pregnancy, the blood is flooded with very high levels of estrogen and progesterone, but after the birth, the levels of these hormones, especially progesterone, come crashing down to menopausal levels
  • Breastfeeding keeps estrogen and progesterone at menopausal levels
  • Some women are more sensitive to hormonal fluctuations and low hormones than others
• Stress hormones
  • Pregnancy and post partum takes a toll on the adrenals both for bio-chemical, and psychological reasons, and can cause or exacerbate HPA axis dysregulation
  • High stress hormones can further lower sex and thyroid hormones, exacerbating hormonal imbalances and the resulting mental health symptoms (anxiety, panic, low mood, insomnia, cognitive issues, etc.)
• Thyroid hormones
  • Pregnancy and childbirth can lead to postpartum thyroiditis with symptoms of anxiety, depression, insomnia etc.

Nutritional imbalances

Pregnancy and post partum, including breast feeding can take a toll on our nutritional status, as it depletes our reserves of vitamins, minerals and essential fatty acids, especially omega 3s, B vitamins, alpha lipoic acid, coenzyme q10, calcium and magnesium.Raffelock, D. (2008). How Pregnancy Depletes Nutrients. [online] Well Postpartum. Available at: https://momswellness.wordpress.com/2008/12/30/how-pregnancy-depletes-nutrients/ [accessed 11 Oct. 2017].

Difficult life circumstances

• A lack of support from partner, friends or family can take its toll on the new mother, causing stress, unhappiness, and feelings of isolation
• Financial difficulties or concerns can cause stress
• Difficult living conditions can also take their toll on the new mother who is trying to cope with a new baby’s needs as well as her own

Psychological issues

Becoming a mother can bring up many psychological difficulties for some women

• The burden of being responsible for a newborn can create a lot of anxiety
• The loss of one’s identity as a women, and taking on the identity of a mother can raise some profound existential issues which can be painful

Balancing work, motherhood, relationships and self care can be very challenging

While not typically a “syndrome”, menopause and peri-menopause do have their own profile when it comes to mental health, and therefore we will consider them as hormonal syndromes.

Peri-menopause and menopause (ages 35 to 55) are times of hormonal upheaval for women. Both signal a natural stage in the ageing process. As women age, the ovaries produce less progesterone and less estrogen, leading to a gradual decline in sex hormones.

As women age, ovulation becomes less regular; instead of releasing one egg per cycle, the ovaries occasionally skip ovulation, which is called an anovulatory cycle. This leads to a drop in progesterone and estrogen levels. Furthermore as women age, the brain becomes less responsive to the progesterone and estrogen still produced by the ovaries, which may lead to lower production of key neurotransmitters such as serotonin.Teede, H.J., Bahri Khomami, M., Morman, R. et al. (2026) ‘Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process’, The Lancet, published online 12 May 2026.

As a woman goes through perimenopause and menopause, production of sex hormones shifts from the ovaries to the adrenal glands. The health and balance of her HPA axis is essential to her adrenals being able to pick up the slack from her ovaries.

The thyroid usually slows down during perimenopause, which can lead to symptoms of hypothyroidism.

As Dr. Sara Gottfried puts it, peri-menopause is “a perfect neuroendocrine storm: all three hormonal systems – ovaries, thyroid, adrenals – working together to pull the rug out from under you.” Gottfried, S. (2013). The Hormone Cure. New York: Scribner, p. 62.

Meanwhile our liver, the main organ for detoxification, can no longer break down harmful chemicals or estrogens as efficiently, exacerbating estrogen dominance for instance,Lim, M.J.S., Parlindungan, E., See, E., Gan, C.H., Yap, R. and Yong, G.J.M. (2026) ‘Diet, the gut microbiome, and estrogen physiology: a review in menopausal health and interventions’, Nutrients and our digestive systems slow down, which can cause dysbiosis, bloating and slow detoxification of hormones.

Mental health symptoms of perimenopause and menopause

• Exhaustion
• Insomnia
  • Perimenopause and menopause are often accompanied by low levels of cortisol by day (causing feelings of exhaustion) and high cortisol by night (causing insomnia)Tamanna, S., Ullah, M.I., Iftekhar, R. and Shamsuddin, L. (2026) ‘Sleep disturbances in menopause: neuroendocrine mechanisms and clinical implications’, Physiologia
  • Cortisol tends to rise during perimenopause and menopause, which can lead to sleep issues and lower melatoninTamanna, S., Ullah, M.I., Iftekhar, R. and Shamsuddin, L. (2026) ‘Sleep disturbances in menopause: neuroendocrine mechanisms and clinical implications’, Physiologia
• Brain fog and attention issues
  • Rising levels of cortisol and lower levels of estrogen are accompanied by diminishing levels of BDNF (brain-derived neurotrophic factor), the brain chemical which encourages the growth of new nerve cells and neuroplasticity (the brain’s ability to reorganize itself by forming new neural connections), affecting cognition and memoryTamanna, S., Ullah, M.I., Iftekhar, R. and Shamsuddin, L. (2026) ‘Sleep disturbances in menopause: neuroendocrine mechanisms and clinical implications’, Physiologia
• Depression
• Low motivation
• Lack of pleasure
• Anxiety and panic
• Feeling overwhelmed
• Irritability
• Low libido

 

Andropause is the male version of menopause. Like menopause, it is characterised by a gradual decline in adrenal and gonadal androgen hormones such as testosterone and DHEA, and an increase in cortisol.Andersen, M.L., Sanches, J.M., Alvarenga, T.A., Toricelli, M., Vasco, M.B. and Tufik, S. (2026) ‘Late-onset and functional hypogonadism in aging men: an integrated perspective on hormonal, sleep, and metabolic dimensions’, Journal of Endocrinological Investigation.

Mental health symptoms of andropause

• Depression
• Anxiety
• Insomnia
• Mood swings
• Irritability
• Exhaustion
• Poor memory

‘Dehydroepiandrosterone sulfate/cortisol ratio as a biomarker of depressive symptoms in late-onset hypogonadism: an analysis of 3,005 males’, World Journal of Men’s Health.