By Dr. Nicole Sundene, NMD
Female Hormone Specialist
Over the years I have noticed how different hormonal imbalance patterns in women can translate to anxiety, depression, and mental health issues. My female hormone patients with mental health conditions are a lot like snowflakes. While the mental health condition looks very similar from the outside, we cannot apply a "One size fits all" approach to women struggling with their mental health because the ROOT CAUSE of the mental health condition is often triggered by the many different flavors and types of hormone imbalance. One thing that always amazes me as a hormone doctor is how thyroid and adrenal conditions causing anxiety can look very similar, just like in the picture above, yet they require completely different treatments for the patient to improve. Neither improves with antidepressants.
Anxiety, depression, ADHD and trouble concentrating for women are often the result of unique hormone deficiencies or imbalances. Especially in my women’s health practice. I believe women experience more mental health challenges due to their fluctuating hormones every month with PMS and also throughout life. While men tend to experience a gradual slow decline in testosterone as a natural part of the aging process, women experience a sudden drastic decline in hormones with menopause, perimenopause, and also each month with their menstrual cycle.
The #1 sign that a woman’s depression or anxiety is related to their female hormones is fluctuation. When we see symptoms constantly fluctuating each month then we know there is likely a female hormone imbalance to blame. If a woman suddenly develops anxiety or depression in their 40's or 50's and don't have any situational triggers it is also very likely a hormonal mental health condition.
Just like a snowflake mental health challenges caused by hormone imbalance can look very similar in women from a distance. However, when we zoom in closer we can see the subtle hormonal fluctuations triggering each different type of mental health pattern. As a women’s health doctor, I have noticed many fascinating patterns with mental health and hormone imbalance I would like to share today to educate women on this important topic. Especially while I am seeing so many women, especially moms struggling right now with their mental health! If you are struggling with your mental health, please know you are not alone, and that it is okay to seek professional help.
Thank you for sharing my posts even if you don't have mental health issues. As a doctor I am seeing epidemic levels of Depression and Anxiety in our communities and we need to make it socially acceptable to discuss these issues so patients are receiving enough support whether related to menopause or not. Which is why I have been blogging heavily about mental health.
Imbalance with thyroid, adrenals, and female hormones can cause a variety of annoying mental health symptoms that do not typically respond to standard anti-depressants and anti-anxiety medications. Leaving both women and their doctors frustrated. Many women with hormone imbalance as the underlying cause tend to only receive the side effects of these medications such as weight gain and stomach aches with little relief of their anxiety and depression.
I am writing this PSA today on Hormone Imbalance and Mental Health for women to read and share so they can become educated about the symptom patterns I see when mental health disorders are being caused by hormone imbalance. With so many women struggling to parent through the Pandemic please keep an eye out for one another….many women are struggling and also are experiencing mood disorders that can be improved by balancing their hormones.
If you are a woman and struggling with anxiety or depression the first line of defense should be having hormones tested. Fluctuating hormones through menopause, perimenopause and the monthly menstrual cycle can negatively impact women’s moods. Hormone testing often can help identify the root cause of depression rather than prescribing medications like zoloft, prozac, amitriptyline, cymbalta, effexor, xanax, clonazepam, wellbutrin or propranol, we should be testing women’s hormones as the first line of defense. With hormonal mood disturbance none of these aforementioned medications work, and women are made even more miserable on an antidepressant or anxiety med.
Next, when the antidepressant does not work, what I commonly hear happens is that the psychiatrist decides that everything wrong with the woman is emotional and sends her to weekly counseling to figure out why she is so unhappy. The counselor then determines there is a lot of turmoil and fighting at home and that she needs additional marriage counseling with her husband to resolve the issues at hand. Meanwhile, the woman's weight just continues to balloon up, she feels more and more bloated, more frustrated, more angry, and the hot flashes and night sweats are getting worse and nobody knows what is wrong with her. Even worse nothing she is doing is helping the situation!
So many women with hormone imbalance get trapped in this vicious mental health cycle!
I have seen many marriages almost end, and completely fail due to untreated hormone imbalance. Women and their husbands deserve better awareness and education around hormonal causes of anxiety, depression, and mental health disorders. Especially when PMDD, a severe form of PMS can potentially result in suicide. I have had many husbands call my office at wits end wanting to know if their wife has a hormone imbalance as I shared in my "#1 PMS Doctor" blog.
Hormonal Depression and Anxiety can present differently than typical forms. When Depression or Anxiety is resulting from a hormone imbalance often standard medications are not helpful and the patient receives little benefit while enduring multiple side effects such as dry mouth, weight gain, stomach upset, poor libido, brain fog, grogginess, not feeling like one's self, and fatigue.
#1 "Menopause Anxiety” Presents with trouble sleeping, hot flashes, and cold flashes with severe levels of anxiety the patient has never experienced before. Oftentimes this accompanies Menopause and patients with Anxiety triggered by Menopause are usually exhausted all day in a fog, battling brain fog and poor concentration from lack of sleep, and unable to sleep at night no matter how tired they feel during the day. The cycle progresses until they feel worse and worse lost in a brain fog of fatigue, anxiety, and insomnia.
#2 "Thyroid Anxiety" can cause anxiety when the thyroid is either too high or too low. Patients with autoimmune conditions such as Hashimotos thyroiditis can exhibit mood swings as they go from a hormonal rush of high hormones to a crash/low of fatigue and exhaustion when their symptoms return to hypothyroidism.
#3 “Thyroid Depression” caused by low thyroid function is characterized as feeling blah and apathetic. I often describe this thyroid depression to women as “Feeling Like a Dead Plant Needing to be Watered” as I describe further in my Thyroid Depression Blog, when we finally give the needed hormone T3 that helps make serotonin in our brains, the mood can quickly restore to normal and all depression is basically gone. Serotonin is the neurotransmitter that helps us feel calm, happy, and like everything is okay. If your mood is not good AND you take levothyroxine as T4 monotherapy, it is most likely that your brain is starved of T3 and you need a different medication. It is always fascinating to me as a Hormone Doctor how quickly Thyroid Depression can clear up even with a very low dose of thyroid hormone.
#4 Adrenal Fatigue: Can feel like constant severe anxiety, insomnia, panic attacks, and burnout or depression. Adrenal fatigue is characterized in Naturopathic Medicine as 3 different states with chronic anxiety causing severe burnout or MSS 3= Blah, burnt out, unmotivated, apathetic, and no longer caring about day-to-day life.
This occurs when our adrenal glands have been running on high from constant anxiety or life stressors and then fail to continue to produce high levels of cortisol and adrenal hormones such as DHEA that make us feel perky, happy, and energetic. The early stages of MSS 1 are when our cortisol is high and we are “running from the bear”...as I describe in my "Fight, Flight or Fright" blog. The problem with chronic stress is that after so many days in a row “Running from the bear” our glands cannot continue this high rate of hormone production and shift to MSS 2 which is sputtering. Now the adrenals are making stress responses when we are asleep at night and trying to relax and we are waking up with panic attacks while feeling tired and blah throughout the day. We are “Tired but wired.” All of these scenarios can be tested for via insurance based blood hormone testing, and treated with herbal medicine.
When the adrenals are under constant stress we have a pattern of anxiety that crashes into depression. A classic sign of this with my mental health patients is when something stressful happens, or an uncontrolled bout of anxiety turns into depression after a few days. The patient then crashes with fatigue and depression and feels blah, fatigued, unmotivated, and sometimes achey, inflamed, and in chronic pain.
#5 Insulin Resistance Panic Attacks: Do you have constant low-grade depression, fatigue and anxiety and then get panic attacks that come out of the blue? Do you feel suddenly like you are going to die from a bone crushing level of anxiety yet there is no actual emotional trigger causing the panic attack? Do you feel Hangry aka Hungry + Angry? Do you have emotional meltdowns when you get too hungry? High insulin levels such as in PCOS, translate into frequent low blood sugar. Low blood sugar causes sweating, hot flashes, and frequent panic attacks. The only cure for these panic attacks is to eat more sugar which we appease ourselves with temporarily only to cause more insulin resistance and more panic attacks from low blood sugar.
Yet doctors rarely test for Insulin Resistance despite epidemic levels in the America. A simple insulin test can determine if this is a problem. Normal insulin fasting should be <3-4. If insulin is above that number fasting then women need Naturopathic intervention. Simply telling an Insulin Resistant patient to lose weight without providing them herbs and supplements to address and suppress the high insulin number generally results in failure. Treating Insulin Resistance takes 6-12 months to realistically address and control. The first step for women is to count carbs and ensure you are pairing complex carbohydrates with protein, fiber and good fats. By "Stacking Your Macros" and eating small "Stacked" meals every 3-4 hours in addition to taking supplements and herbs from your Naturopathic Doctor you can take charge of your blood sugar and stop it from running your life.
#6 PMS & PMDD: The most widely accepted women’s hormone imbalance causing mental health disorders. For many women they don’t understand how severely they are being impacted by PMS. The first half of your cycle or “Follicular Phase” you are “Fine” generally days 1-14. But then you ovulate on day 14, the "hormone sprinkler" of estrogen, progesterone, and testosterone is released and your system is now raging with hormones that are about to burn off at different rates causing mental health imbalance in the process. The “Luteal Phase” or “Looney Phase” as I call it to help women laugh and understand that this is somewhat normal is when the mental health issues arise. During the Luteal or Looney phase, women feel agitation, anger, rage followed by depression, sadness and severe fatigue. Physical symptoms can accompany the anxiety and depression such as bloating, headaches, migraines and stomach aches are also common with this form of hormone imbalance causing female mood swings.
The best thing I can do to help you as your hormone doctor is order "Biphasic Mental Health Labs." This means I am testing your hormones when you feel "Fine" in your "Follicular Phase," and then I am testing your hormones days 21-25 of your cycle or when you feel the MOST Looney in your Luteal phase. Using a period tracker app can help us pinpoint the best and worst days to test your hormones. When my mental health patients do this and see the HUGE discrepancies in their hormones it always helps them cope better.
When we can laugh and call it the "Looney Phase," this also helps women feel less pressured that there is something wrong with them mentally, and understand it simply hormone imbalance challenging their mental health. This is an especially important point when women truly feel "Fine" in their Follicular phase and experience zero depression or anxiety. Does this patient actually have a mental health disorder? Do they deserve a permanent diagnosis with a mental health diagnosis code? Do they need the social stigma of being diagnosed with a mental health disorder? Or do they need their hormones tested and balanced?
#7 Perimenopause: As I describe in my "Perimenopause is Permanent PMS" blog, when women are in the ten years prior to menopause they are perimenopausal and dealing with hormonal mood swings from imbalanced estrogen and progesterone. Women in their 40's notice they have fewer and fewer "Happy Days" in their cycle and have more PMS days. Often my perimenopausal patients are complaining of constant anxiety, anger, agitation, rage, depression, and mood swings. Hormone imbalance can often easily be corrected via hormone testing and implementation of herbal medicine, Naturopathy and Bioidentical Hormones. Oftentimes in perimenopause women need more nutritional support for their mood and don't actually need Bioidentical Hormones until they are in menopause. However, it is common for low testosterone and low progesterone to impact mood.
Testosterone and progesterone levels naturally decline around 35 as "Nature's Birth Control." When testosterone is low for women it can cause depression, anxiety, lack of self confidence, "Imposter Syndrome," and physical symptoms such as fatigue, poor exercise recovery, achey joints and muscles, and low libido.
When progesterone is low it causes insomnia, anxiety, nightsweats, brain fog, low libido, vision problems, headaches, migraines, increased autoimmune disease, and vaginal dryness.
#8 Anemic Anxiety: Chronic anxiety, fatigue, depression, brain fog, coupled with a constant worry you cannot get everything done due to fatigue is the pattern to iron deficiency causing mental health disorders as I discuss in my "Depression Diet" blog. While iron is not a hormone, I want to take this important opportunity to remind all women how important it is to simply take iron every single day while you are bleeding every month and losing iron. When iron stores or “Ferritin” drop below 75 women are often depressed, anxious and exhausted. By taking a multivitamin with iron every month this is a simple “Mental Health Fix” for many women. Too many times I have taken on a new mental health patient only to realize the underlying issue is anemia. I hate to ever waste anyone's money on something so simple!
So if you are not feeling well and are tired and feeling run down you take a multivitamin for iron and B vitamins and call my office to schedule an appointment so we can get to the root cause of your anxiety and depression. I would be happy to help you with your hormones and mental health.
Female Hormones, Psychiatry & Mental Health
Many OBgyn’s and Family Doctors I know simply do not understand the complexity of these hormones and how they impact mental health. Proper hormone testing for female mental health patients is critical to their long-term optimal function. Many times women think they have had "all their hormones checked" and when I get the actual lab report, then I see that the doctor ordered a TSH, progesterone, and/or estrogen which is about as effective as doing a Mammogram on just one breast every year and assuming the other breast is just fine! Ladies a full hormone panel is not one test or one page of tests. If your hormone lab report is not at least 3-5 pages there is something wrong! You may not actually be "fine" as your doctor said when many tests are likely missing.
While I don't want to sound rude or disrespectful to any of my colleagues that read my blog, I have found from my own experience treating mental health patients as a "Holistic Psychiatrist" for many years that women are lumped in the same mental health categories as men and left judged, misunderstood, under-tested and treated for the wrong issue. Women are labeled as crazy or lazy when they just did not receive the right hormone testing. Neurotransmitters do not always fix depression because they are not always to blame with female mental heatlh!
Women that do not respond to SSRI's, SNRI's, ADHD medications, or anxiety medications need to have their hormones addressed! But who is the doctor to do this? Often my patients are bounced between an Endocrinologist, Psychiatrist and OBgyn to no avail.
The real problem is that many doctors actually don't know how to test hormones, are overwhelmed by the thought of testing hormones, and have limited knowledge on this topic. The reason for this is we are not taught adequate information in medical school and it is of no fault of the doctor. I get text messages every single day from my colleagues not knowing what to do with women's hormones and asking me to help them. So I feel pretty confident in stating that unless you are at an appointment with an official Female Hormone Specialist, such as myself, you likely will not receive the proper hormone testing and help you need. You will not be properly diagnosed and continue to flounder without understanding the exact blueprint for the hormonal triggers for your particular mental health.
I was chosen to work in hormones in 1999 and hand trained by another female hormone specialist as I describe in my blog above. I did not learn what I know about hormones even in Naturopathic school. Although I did learn a great deal about bioidentical hormones and women's health!
So if you are struggling with your mental health and think you have had your hormones tested go check what was done and if it only 1-2 pages it is not sufficient. Especially if you think any of the above scenarios describes your mental health. Please do not go off what your OB said as I usually get a copy of the labs from my patient telling me "My OB just checked all my hormones and they are fine," and instead find grossly inadequate testing done. Also, your hormones can be in the normal range and still not be optimal for mental health.
Most OBgyns I know truly specialize in safely delivering healthy babies and do not always have the training in the complexities of the endocrine system and how it impacts mental health. They lack the time to properly diagnose you, and they lack the time needed to educate you on what you need to do. They also may lack the tools to help you because they don't have herbal medicine and Naturopathy which is superior to just prescribing bioidentical hormones to alleviate hormonal symptoms. Many OBgyn's only know how to correct your hormones via surgery in the form of a hysterectomy removing your uterus and ovaries, or suppressing your cycle with birth control pills that may make your mental health much worse.
Leaving women to feel helpless, hopless and without safe and effective hormone options.
Bioidentical hormone therapy also completely does not work when the anxiety is caused by excessive hormones! There are very few medications that address lowering hormones. This is exactly why as an Integrated Female Hormone Naturopath I am grateful to have herbs in my Toolkit to help mental health patients!
WHAT IS THE WORST-CASE SCENARIO FOR WOMEN'S MENTAL HEALTH?
I recently saw a new mental health patient that was on FIVE psychiatric drugs all because she had low progesterone. She was anxious, suicidal, and unable to concentrate. After testing her hormones I found she was simply progesterone deficient which naturally occurs around age 35 exactly when her symptoms began. I simply gave her progesterone and then gradually she began sleeping no longer requiring Ambien. We began to taper her clonazepam down as she was experiencing less anxiety, and was able to concentrate again without Adderall and Vyvance for her ADHD symptoms.
She was no longer having panic attacks from the ADHD medications and was no longer depressed or suicidal from the anxiety and insomnia. At that point I began to taper her off her antidepressants and replace them with natural antidepressants. Isn't that amazing that just one deficient hormone could cause a woman to need FIVE drugs for their mood? I hope everyone can help me spread awareness for the importance of proper hormone testing for women, especially those challenged by anxiety, depression, and mental health disorders. Thank you for emailing and sharing on social media my mental health blogs to your friends and family that need them right now!
If you need help with your female depression, anxiety, or ADHD I would be happy to help! Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic consultation.
Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum Depression, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!