Your Life With Estrogen:
A Connection between Mood and Mental Health
In December of 2018, New York Magazine published an article titled, “Listening to Estrogen” as their cover story. I was immediately intrigued and thrilled that a publication of that stature chose to feature an article that explores the axis where mood, behavior, and female hormones meet. However, I was deeply moved to read personal accounts of women- highly intelligent, healthy, high achieving professionals and mothers experiencing symptoms of psychosis in their 40s. Over two decades, private researchers and organizations like the National Institute of Mental Health developed an idea linking late-onset schizophrenia to menopause-related hormone fluctuations with “the estrogen hypothesis”. In addition to menopause, there are several times during a woman’s life cycle where her estrogen levels my dramatically elevate and drop. What other implications does this phenomenon have on other female mental health issues such as Premenstrual Dysphoric Disorder and Borderline Personality Disorder? It seems that the medical community is waking up to striking connections between these disorders and hormone response more than ever before.
As the article discusses, the estrogen theory suggests that estrogen is protective to cognition as well as mental stability and function. In cases where some women may be genetically or chemically more prone to mental illness, a dramatic drop in estrogen can open a window to vulnerability. This can be supported by comparing schizophrenia and it’s manifestations between men and women. Simply put, testosterone, a dominant male hormone, is the opposite of estrogen, a dominant female hormone. Men are typically diagnosed a bit earlier than women between the ages of 16-22, have more severe symptoms overall, and tend to experience improvements in symptoms after 40 as testosterone levels drop off. Women are diagnosed with schizophrenia most commonly at 25-30, tend to experience less negative symptoms and need less medication than their male counterparts to manage symptoms, but can have more difficulty after menopause. In other words, there seems to be a relationship between high testosterone levels and or low estrogen levels and the severity of symptoms in individuals with schizophrenia.
Borderline Personality Disorder is a chronic mood disorder where individuals experience intense emotions and are unable to self-regulate them which leads to poor self-image, impulsivity, and difficulty maintaining healthy relationships. Yes, it is what Susanna suffered with in the novel (or movie starring Winona and Angelina), Girl Interrupted. About four million Americans live with BPD and seventy-five percent of them are teenage and young adult females. Symptomatic episodes can manifest in behaviors such as dramatic mood swings, impulsive spending, risky sexual activity, disassociation, guilt, self-harm, substance abuse, and suicidal thoughts. A study from the University of Illinois at Chicago found that symptoms worsened at a rate of thirty percent during the time of pre-menstruation and the onset of menstruation when estrogen and progesterone levels plummet.
In 2012, Premenstrual Dysphoric Disorder or PMDD, was officially recolonized and included in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association. PMDD is a collection of symptoms that occur three to four days before menstruation such as irritability, mood swings, tearfulness, depressed mood, fatigue, anxiety, changes to eating and sleeping patterns, feelings of hopelessness or loss of control, as well as physical symptoms. Although some of these signs sound similar to PMS, PMDD’s distinction is symptoms so severe and chronic that they interfere with everyday life and directly causes impairment. About five percent of menstruating women experience PMDD and some are even misdiagnosed with Borderline Personality Disorder or even bipolar disorder. The difficulty with a diagnosis may be due to the interconnectivity between the disorders and the functions of estrogen. Estrogen impacts multiple neurotransmitter systems involved in the regulation of mood, reasoning, eating and sleep cycles, and other aspects of behavior in relation to serotonin and dopamine interactions. It is possible that women with PMDD are more sensitive to these effects of estrogens on serotonergic function. Women with PMDD display specific serotonin abnormalities that are particularly apparent in the late luteal phase when estrogen levels have declined.
Collectively, these disorders affect over ten-million American women each year. It is important that we establish a dialogue around the connection between hormones and mental health so those who are suffering can get the help they need. With more and more information and evidence coming forward, the hope is that hormone response will be a determining factor for how we shape health care and mental health care in the future. Long term research efforts such as the KEEPs study is as a window into more opportunities to explore the potential of treating and even preventing disorders with hormones as a possible solution. Obviously, more research is necessary in order to push progress forward.