Have you found that you’re crying at the drop of a hat? Of course, if you’ve been crying lately for good reasons, i.e. you’re anticipating the empty nest as your kids are going off to school, or you’ve just been laid off after a corporate restructuring at your job, or a friend has been given a scary diagnosis, well, of course you must allow yourself down time to heal and/or grieve. But what I’m referring to, is if you’re just tearing up over everything, a song on the radio, puppies and, yes, tv commercials. If this is happening, your estrogen levels are probably starting to diminish.
What do hormones have to do with thoughts and feelings, you ask? Well, pretty much everything. You know from younger years, that you’d feel crazy during certain times of the month, and everyone just chalks that up to “being hormonal”. Although this is true, I don’t like the dismissal of the experience. A more accurate assessment, would be, “hormonally imbalanced”. In other words, not healthy, out of balance, a true medical condition. It turns out that hormones actually affect the brain in important ways, which changes how we think and feel.
Estrogen is our main female hormone. It has a cyclical pattern every month in young women, then during perimenopause it starts to decrease—you’ll know it’s low because you’ll start skipping periods, getting hot flashes, night sweats and maybe even vaginal dryness. Post menopausally (=after your last period), you stop producing estrogen altogether, and while many of the crazy ups and downs of fluctuating estrogen levels during the perimenopausal transition have subsided, you’re now heading into a deficiency state, where estrogen no longer feeds the body or brain.
Estrogen has been shown to have over 400 effects on various parts of the body, from the breasts, genitals, reproductive tissue, to the bones, heart, and skin. All of these are important, but my favorite thing about studying and treating hormones in women and men, is how they affect the brain. It turns out that they do so in very studied, scientifically measurable ways. Estrogen increases the brain’s production of the neurotransmitter Serotonin. Serotonin is our happy, feel-good neurotransmitter that is probably the one most studied in psychiatry. The majority of antidepressant medications are called SSRI’s or Selective Serotonin Reuptake Inhibitors, which means that they basically recycle the serotonin that is present in the brain where nerve impulses are transmitted. The most common SSRI’s are Prozac, Xoloft, Celexa, Lexapro, Paxil, as well as dozens of other generics. There’s even an SSRI marketed specifically for premenstrual depression, called Sarafem, and it’s basically low-dose Prozac. Although it is just one theory, and there are many other factors, serotonin seems to be a correlative factor in many cases of depression.
The interesting thing about serotonin is that about 80% is actually produced in the gastro-intestinal tract, and there are new researches looking into this gut-brain connection, going so far as to call our gut the “second brain”. Since neurotransmitters are produced in the gut, any inflammation produced there can lead to inflammation in the rest of the body and brain. So a basic first step towards treating depression is to clean up the diet and eliminate all inflammation-causing junk foods and sugar.
What if you’ve done that and you’re engaging in the best depression weapon, that is, regular exercise and adequate sleep, and you’re still crying at the drop of a hat? Does this sound like you?
“I can’t even look at my kids’ baby pictures right now”
“Puppies or butterflies?…floodgates!”
“I can tell my significant other is tiptoeing around me.”
“My kids are constantly rolling their eyes at me, ‘Mom, now don’t start crying again!’”
“During lunch at work, I go sit in my car and have a good cry…..every day.”
“I’ve started listening to Lionel Ritchie songs every day.”
“I cried in the doctor’s office yesterday, and was handed a prescription for Prozac as I checked out.”
“I almost cried in a board meeting last week!”
“What?” sniff sniff.
The National Institute for Health (NIH) runs a public research website, and if you enter “estrogen” and “depression” in the search box, 3371 research studies appear in the results. While the point of this blog is not a scientific review of all the literature on estrogen and depression, it is important to point out that there is a proven increase in depressive symptoms during perimenopause and menopause. Let’s just look at 5 quotes from recent studies:
“Estrogen deficiency is involved in the development of depression”1
“The women who underwent oopherectomy (=removal of the ovaries) had a statistically significantly higher score in Hamilton Depression Scale…and Hamilton Anxiety Scale…compared to the control perimenopausal women. There was a significant reduction of depressive and anxiety symptoms during hormone replacement therapy.”2
“Additionally, women with higher estradiol levels also had less subjective distress in response to (psychosocial stress) than women with lower estradiol levels.”3
“Women with a history of PMD (=perimenopausal depression) should be alert to the risk of recurrent depression when discontinuing hormone therapy”4
“The rate of major depressive disorder and clinically meaningful elevations in depressive symptoms increases two- to threefold during the menopause transition.”5
So how does this affect you? The most important conclusion for you to make, is that you’re not crazy, and just writing off your symptoms as “hormonal” is not helpful. Yes, you’re hormonal, or more importantly, you’re hormonally deficient, meaning that your brain does not have the right ingredients to make the correct neurotransmitters to help you think happy, healthy thoughts. You’re probably going to live 30, 40, even 50 more years, and if you’re deficient now, it’s only going to get worse.
What action steps can you take?
Track your symptoms, if you’re perimenopausal, these crying episodes are probably occurring during those months when you’ve skipped periods. If you’re menopausal, are they happening with more frequency?
If you’re also having hot flashes, night sweats or vaginal dryness, this is further evidence that your estrogen levels are low.
Take a deep sigh of relief. Your thoughts are triggered by hormonal deficiency. Label your thoughts, “Oh, I’m having those horrid, low-estrogen thoughts again!”
DO NOT TAKE ACTION on your feelings right now. Label the feelings, but do not listen to the content of those feelings. Do not go down the rabbit hole of “I should quit my job”, “I don’t care anymore”, “I should file for divorce”. If your symptoms are mild, then take a deep breath, do something bandaid-like: take a nap, read a book, call a friend, go to the gym.
If your symptoms are severe, seek medical help NOW. While I prefer to manage these symptoms by addressing the cause—the hormone deficiency itself—you may need an antidepressant or a treatment facility to get you through your emotional state until your hormones are well balanced.
Make an appointment with your Ob/Gyn, Primary Care Physician or Psychiatrist to discuss your hormonally-induced mood changes. Make sure you’ve investigated whether they are aware of the abundant research regarding hormones and mood, and are willing to address your hormone levels when choosing treatment options.
Please share! Tell me your thoughts in the comments below.
1. Inflammation and increased IDO in hippocampus contribute to depression -like behavior induced by estrogen deficiency.Xu Y, Sheng H, Tang Z, Lu J, Ni X. Behav Brain Res. 2015 Jul 15;288:71-8. doi: 10.1016/j.bbr.2015.04.017. Epub 2015 Apr 20.
2. Effects of hormone replacement therapy on depressive and anxiety symptoms after oophorectomy. Ðoković DD, Jović
JJ, Ðoković JD, Knežević MŽ, Djukić-Dejanović S, Ristić-Ignjatović DI. Med Glas (Zenica). 2015 Feb;12(1):79-85.
3. Estradiol levels modulate brain activity and negative responses to psychosocial stress across the menstrual cycle. Albert K, Pruessner J, Newhouse P. Psychoneuroendocrinology. 2015 Sep;59:14-24. doi: 10.1016/j.psyneuen.2015.04.022. Epub 2015 May 7.
4. Effects of Estradiol Withdrawal on Mood in Women With Past Perimenopausal Depression: A Randomized Clinical Trial. Schmidt PJ, Ben Dor R, Martinez PE, Guerrieri GM, Harsh VL, Thompson K, Koziol DE, Nieman LK, Rubinow DR. JAMA Psychiatry. 2015 Jul 1;72(7):714-26. doi: 10.1001/jamapsychiatry.2015.0111.
5. Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausaldepression: a novel heuristic model. Gordon JL, Girdler SS, Meltzer-Brody SE, Stika CS, Thurston RC, Clark CT, Prairie BA, Moses-Kolko E, Joffe H, Wisner KL. Am J Psychiatry. 2015 Mar 1;172(3):227-36. doi:
10.1176/appi.ajp.2014.14070918. Epub 2015 Jan 13. Review.