Hormonal Anxiety in Women: Causes & What to Check

There are a hundred and one reasons to be anxious. There’s a lot going on in the world, the pace of life is busy, and people are more isolated than ever. It’s easy for feelings of anxiety to be brushed off as “just a part of life”. More people these days seem to be taking action and working with a therapist to support their anxiety. This is amazing. However, in my opinion, the biological factors that contribute to anxiety are still not getting enough attention–or the attention and advice is coming from not so credible sources. 

Hormones play an important role in mental health. Despite that, most of my patients come to me without having any kind of hormonal assessment for their anxiety. Here are some important considerations that are first on my list when working with patients struggling with anxiety: 

Thyroid Dysfunction and Anxiety

It’s well documented that both hypothyroidism and hyperthyroidism can contribute to feelings of anxiety and mood swings. When assessing the thyroid, it’s sometimes helpful to look at a fuller thyroid panel that includes more than just TSH. Sometimes TSH can be normal but T4, T3 or thyroid antibodies can be abnormal which can impact mental health. Supporting thyroid health is an important pillar of treatment for many of my patients who are struggling with anxiety. 

PMDD and Premenstrual Anxiety

Many women feel major anxiety or mood swings before the period (sometimes up to 2 weeks before the period). In most of these cases, hormone levels are actually normal. Some women just have nervous systems that are highly sensitive to the normal fluctuation of hormones before the period (and even around ovulation). I always make sure that I assess if a patient feels more anxious before their period and I provide a treatment plan to offer support during this specific period of time. 

PCOS and Mental Health

Women with PCOS tend to struggle with insulin resistance and elevated androgens. Various mental health concerns have been linked to PCOS. This could be related to the difficult symptoms and/or to the abnormal hormone levels. Supporting hormone health for these women often improves anxiety. I wrote more about this topic here: https://www.samanthadass.com/resources/pcos-anxiety-and-depression

Perimenopause Anxiety and Hormone Fluctuations

There are a lot of hormonal shifts that happen during perimenopause. These shifts can cause irritability, moodiness, tearfulness and anxiety. Whenever I have an anxious patient who is likely going through perimenopause, it’s important that we are working on strategies to make this transition as smooth as possible.

What I Check

There is no standard set of hormone tests that I run for everyone with anxiety. Depending on symptoms and health history, I may run a full thyroid panel, check for insulin resistance, look into some of the reproductive hormones such as testosterone, estrogen, progesterone etc. Some cases require in depth hormone investigations but that’s not true for every case. Either way, it’s important that your healthcare provider hears your full story and takes the time to listen to all of your symptoms in order to determine what should be tested.

If this resonates and you need help managing your anxiety book a free 15-minute call to learn more.