Credit: Valdemars Magone, Unsplash
Editor's note: This article was sponsored by THIRA Health.
When it comes to mental health, hormones play an integral role, directly affecting a woman’s brain chemistry and overall mood. Not only is hormonal regulation vital to emotional well-being, but imbalances can worsen existing mental health issues or even cause them, leading to a wide array of symptoms, including insomnia, depression, anxiety and irritability. ParentMap consulted Tuesday Burns, M.D., medical director of THIRA Health, for her expert take on how stress, sex and thyroid hormones impact women’s mental health.
The influence of hormones on mental state
Studies show hormones directly affect mental state, but hormonal dysregulation is often overlooked causally in the diagnosis and treatment of mental health disorders. Burns emphasizes a whole-body approach with her patients. “I always tell people, ‘The head bone is connected to the body bone.’ Things that are happening in our bodies, such as hormonal changes, can impact things north of our neck. Everything going on in our brain modulates mood and our ability to focus, function and maintain a good quality of life,” says Burns.
In Western medicine, there’s a tendency to separate mood and anxiety disorders from biological and physiological systems, yet they are intricately connected, Burns maintains. “As a psychiatrist who specializes in working with women and young girls, I make sure I have a full and broad understanding of where they’re at hormonally and where they’re at from a health standpoint. Many times over, you see cases of folks who have sought out treatment for what appears to be severe depression or anxiety, difficulties with basic functioning such as getting out of bed, showering and eating, and then — lo and behold — you find out their thyroid is not functioning adequately, and that’s something that can be addressed very easily. Or you might go to your primary care doctor and report concerns of low energy or difficulties with irritability and just be prescribed an antidepressant. But ruling out vitamin deficiencies and hormonal imbalances, looking for that underlying etiology and understanding what functionally is going on in your body is super important,” says Burns.
The effects of reproductive hormones on brain chemistry
Women experience periods of vulnerability during which sex hormone levels fluctuate: when menstruation first begins, during pregnancy and again in menopause. “What we know in particular about estrogens is that they cross into the brain through the blood-brain barrier and affect levels of serotonin and the serotonin receptors in our brain. So there’s a huge relationship between estrogen hormones and serotonin, which we believe to be a big contributor to how we regulate mood and anxiety. You can see irritability, dysphoria, anxiety, headaches, migraines, an increase in pain — all kinds of physical and mental symptoms as a result of changing levels in estrogen hormones. I think it’s important for moms to be able to share with kiddos during menarche, their first menstrual cycle that their body is doing its normal thing, that these are normal changes,” notes Burns.
While hormonal fluctuations are normal, they can be hard to tolerate and manage at times. “Because of other stressors, whether it’s living in a pandemic or being prone to depression or genetically vulnerable to anxiety, those added layers make changes in hormones so much more profound in how they impact our mood. I think the trick is to keep things in a healthy balance, because even sex hormones like estrogen and progesterone are going to loop back to the brain and affect things like thyroid function, metabolism, your sleep architecture and melatonin production — all of those are connected. Understanding and listening to your body and not ignoring cues like fatigue and hunger is so important,” says Burns.
The last thing we need when we’re already feeling heightened worry is to be hard on ourselves. . . No one is necessarily the best version of themselves right now, but we’re doing our best.
Signs that your thyroid hormones may be out of whack
Thyroid dysfunction, which is so prevalent after giving birth, should be considered if you’re experiencing postpartum symptoms such as low energy, abnormal weight gain, hair loss or change of hair texture, depression, anxiety and cold or heat intolerance, Burns says.
“Thyroid hormones regulate a number of things: our metabolism, hunger, satiety, our energy levels; even temperature regulation, how quickly our hair or our nails grow and our mood balance. The most common thing we see is hypothyroidism [low thyroid function], and what that looks like is kind of confusing. It’s often mistakenly categorized as a normal variant of being postpartum: Hair will often fall out, you’re tired, you’re stressed. I had a patient recently who was complaining about temperature regulation. She was essentially wearing a down coat to sleep because she couldn’t tolerate a colder room. With further investigation, I found out that she had thyroid dysfunction, and she’s already six months postpartum.”
Burns notes that if a new mother is experiencing such symptoms, she should insist that they be investigated during a two-week or four-week postpartum checkup. Treatment with thyroid hormone is usually short-term, has been used for decades and is well studied, she says.
Sustained stress wreaks hormonal chaos
Stress affects us profoundly, diminishing our ability to think clearly and making it harder to learn or retain new information. “Our body needs stress hormones to survive. If we’re crossing the street and we hear brakes squealing, being able to mobilize quickly and get out of the way of that car is vital as part of our survival; we rely on hormones like adrenaline and cortisol to mobilize our body to action. We need them to go into fight-or-flight mode. Unfortunately, when stress is happening in our life, we get these erroneous cues and our brain thinks it is fight-or-flight time. No body, whether it is a human or an animal, can sustain high levels of stress for long periods of time. When those hormones stay at high levels, it affects the way we sleep. Our sleep is going to be fractured or we might be waking up early because our brain is saying, ‘You need to be awake and alert,’ and obviously that’s not necessarily what our body needs,” says Burns.
When we’re stressed, it’s common for us to crave comfort foods and carbohydrates, and our body holds on to every ounce of energy it can. “Stress hormones send signals to your body that it’s time to store up so you can have the energy you need to run from that tiger that’s not actually chasing you. Stress affects your appetite and your metabolism — in a time of stress and survival, your body is not going to lose weight; it’s going to cling onto every calorie,” says Burns.
Lower your expectations to lower stress
Burns says that in the midst of the COVID-19 pandemic, it’s imperative we give ourselves grace and latitude, acknowledging that we’re doing the best we can and accepting that it’s okay to let go of some things. Focus on nourishing your body, prioritizing sleep and sprinkling activity into your day whenever possible.
“The last thing we need when we’re already feeling heightened worry is to be hard on ourselves. As parents, we tell our kiddos all the time, ‘You’re doing a great job,’ but we don’t often stop to tell ourselves that. No one is necessarily the best version of themselves right now, but we’re doing our best. We often hold ourselves to such high standards, but I think now is the time to really manage those standards a little bit.”
Check in with yourself each day to become aware of inner feelings and needs that might be going unnoticed or unattended. Listening to your body’s internal cues and incorporating stress-reducing activities like deep breathing and meditation will go a long way in achieving mind-body balance, but be sure to seek help from a medical professional if you’re struggling.