Anxiety and Depression: Do Hormones Have a Role?

Written by Kristina Calligan
Woman anxiously holding her head in front of a mauve backdrop.

“Mood changes in perimenopause are real. The goal is not to blame everything on hormones, but to understand how hormone shifts, sleep, stress, and life changes may be working together.”

— Arcadia Women’s Wellness

Anxiety and depression can feel confusing at any age, but they can feel especially disorienting during perimenopause and menopause. A woman who has always felt steady may suddenly feel irritable, tearful, panicky, flat, overwhelmed, or unlike herself. She may also be sleeping poorly, waking with night sweats, noticing brain fog, or feeling less resilient than she used to feel.

So, do hormones have a role? Sometimes, yes. Hormones are not the only cause of anxiety or depression, but the hormonal shifts of perimenopause and menopause can absolutely influence mood, sleep, stress tolerance, and emotional regulation.

Why mood can change in perimenopause

Perimenopause is not a slow, smooth decline in hormones. It is often a phase of fluctuation. Estrogen may rise, drop, and swing unpredictably. Progesterone may become less consistent as ovulation becomes more irregular. These changes can affect brain chemicals involved in mood, motivation, sleep, temperature regulation, and anxiety response.

This is one reason some women describe perimenopause as feeling like emotional whiplash. The same person may feel fine one week and deeply overwhelmed the next. Symptoms may worsen before a period, during skipped or irregular cycles, or during seasons of poor sleep and high stress.

Estrogen, sleep, and the mood connection

Estrogen interacts with several systems in the brain that help regulate mood. When estrogen shifts quickly, some women become more vulnerable to irritability, anxiety, low mood, panic symptoms, or depressive symptoms. Estrogen changes can also contribute to hot flashes and night sweats, which may disrupt sleep. Poor sleep can then make anxiety and depression worse, creating a frustrating cycle.

For some women, systemic estrogen therapy may help mood indirectly by improving hot flashes, night sweats, sleep, and overall quality of life. In some perimenopausal women, estrogen may also have a more direct mood benefit. However, hormone therapy is not a stand-alone treatment for every type of anxiety or depression, and estrogen is not specifically approved as a treatment for major depressive disorder.

It is also important to understand that localized vaginal estrogen is different from systemic estrogen. Localized estrogen is used mainly for vaginal dryness, painful intercourse, urinary symptoms, and recurrent urinary discomfort related to low-estrogen tissues. It is not intended to treat mood symptoms.

What about progesterone and testosterone?

Progesterone also matters. Progesterone and its metabolites can influence sleep and calmness for some women, which is why some patients feel more relaxed or sleepier when using certain forms of progesterone. Other women feel more moody, bloated, or emotionally sensitive with progesterone exposure. This is one reason the type, dose, timing, and route of hormone therapy should be individualized.

Testosterone may play a role in libido, motivation, energy, and sexual response for some women, but it is not considered a primary treatment for anxiety or depression. If low desire, fatigue, or loss of motivation are part of the picture, testosterone may be discussed as one piece of a broader evaluation, not as a quick fix.

When it is not only hormones

The phrase “it might be hormones” should not become another way of dismissing women. Mood symptoms deserve a thoughtful evaluation. Anxiety and depression can be related to hormone shifts, but they can also be influenced by thyroid disease, anemia, vitamin deficiencies, medication side effects, alcohol use, grief, relationship stress, caregiving, work burnout, trauma, sleep apnea, chronic pain, or a prior history of depression or anxiety.

A careful visit may include a discussion of symptom timing, menstrual changes, hot flashes, sleep quality, panic symptoms, appetite, alcohol and caffeine use, libido, life stressors, medications, safety concerns, and personal or family mental health history. Screening tools for anxiety and depression may be helpful. Labs may be considered when symptoms suggest thyroid changes, iron deficiency, vitamin deficiencies, or other medical contributors.

What can help?

Treatment should match the cause and severity of symptoms. Some women benefit from lifestyle foundations such as consistent sleep, morning light, movement, strength training, reduced alcohol, balanced nutrition, stress reduction, and nervous-system regulation. These strategies are not “just lifestyle”; they can be meaningful supports for the brain and body.

Therapy can also be very helpful. Cognitive behavioral therapy, mindfulness-based approaches, trauma-informed therapy, and counseling can support coping skills, sleep, anxiety, grief, and the identity changes that sometimes show up in midlife.

Medication may be appropriate too. SSRIs, SNRIs, and other mental health medications can be effective for anxiety and depression, and some may also help hot flashes. For some women, hormone therapy may be part of the plan, especially when mood symptoms are occurring alongside hot flashes, night sweats, sleep disruption, irregular cycles, or other menopause-related symptoms. The best plan depends on your symptoms, risks, health history, and goals.

When to seek urgent help

If you are having thoughts of harming yourself, feel unsafe, or are worried you may act on those thoughts, call or text 988 in the United States, call 911, or go to the nearest emergency department. Severe depression, new manic symptoms, hallucinations, severe panic, or inability to function should be evaluated urgently.

The bottom line

Hormones can play a real role in anxiety and depression during perimenopause and menopause, but they are only one part of the story. You do not have to choose between “it is hormones” and “it is mental health.” Often, the answer is both. At Arcadia Women’s Wellness, we help patients look at the full picture so they can understand what is happening and build a care plan that feels thoughtful, safe, and personalized. You can schedule a visit with Arcadia Women’s Wellness here.

Want more patient-friendly women’s health education? Join the Arcadia Women’s Health Library for weekly articles on hormones, menopause, periods, prevention, sexual health, and whole-person wellness.

Medical disclaimer: This article is for education only and does not replace individualized medical advice.


 

Sources:

Kristina Calligan
Next

Sign Up for the Arcadia Women's Health Library: Why Weekly Education Matters