Reviewed by Sophia Coveney

In a recent study published in the Women Journal, researchers reviewed existing literature to understand the association between mental health and fluctuations in reproductive hormone levels during menstrual and other major reproductive cycles.

Study: Reproductive Hormones and Female Mental Wellbeing. Image Credit: goffkein.pro/Shutterstock.com

Background

Research indicates that the prevalence of anxiety and mood disorders among women is twice that among men. Social factors such as body image issues, body shaming and unrealistic beauty standards, gender inequality, and discrimination contribute to this skewed prevalence of mental health issues among women.

The fluctuations in reproductive hormones during the menstrual cycle and during the major reproductive cycles in a woman’s life are also believed to play a significant role in developing anxiety and other mental health disorders.

The two major hormones that undergo fluctuations during the menstrual cycle are the luteinizing hormone (LH) and the follicle-stimulating hormone (FSH), with an increase in these two hormones prompting the ovarian follicles to mature.

A gradual rise in the levels of the hormone estradiol causes the levels of FSH and LH to peak, resulting in the production of progesterone in the corpus luteum. These cyclical changes in the level of reproductive hormones have been known to influence moods, and monitoring these fluctuating hormone levels could help predict and monitor mental health conditions.

About the study

In the present study, the researchers searched for all English-language, peer-reviewed articles on studies related to reproductive hormones and women’s mental health.

Studies that were qualitative in nature or based on animal models were excluded. A total of 76 studies were included in the final review, covering various aspects of reproductive and mental health, such as reproductive physiology and its association with moods.

The included papers also comprised studies that looked specifically at fluctuating hormonal levels and a range of mental health conditions such as depression, premenstrual dysphoric disorder (PMDD), anxiety disorders, premenstrual syndrome, bipolar disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, and schizophrenia.

Major findings

The review reported that the fluctuating hormonal levels and the physical discomfort associated with menstruation often result in low self-esteem, psychological distress, reduced social interactions, and enhanced facial-emotional processing. Many of the mental health conditions have been reported to be exacerbated during the early follicular and luteal phases.

Furthermore, the enhanced emotional perceptions have also been found to be linked to high estradiol and low progesterone levels, with the increase in estrogen closer to ovulation improving the feelings of attractiveness.

Three major hypotheses have been proposed to explain the impact of estrogen and progesterone on moods and brain function. These involve the effect of estrogen on dopamine neurotransmitters, serotonin levels, and mitochondrial function.

The influence of progesterone and estrogen on cognition, moods, and emotional processing was also discussed in the context of specific mental health conditions such as depression, premenstrual dysphoric disorder (PMDD), premenstrual syndrome, post-traumatic stress disorder (PTSD), bipolar disorder, anxiety disorders, and schizophrenia.

The findings indicated that the disparity between males and females in the prevalence of depression begins with the onset of puberty and the increase in estrogen levels, but it remains unequal throughout the reproductive period and only begins to equalize after menopause.

Furthermore, high levels of LH and FSH along with a decrease in the levels of estradiol have been documented in women with a history of depressive episodes.

The depression rates are also higher among pregnant women who are known to undergo substantial fluctuations in the levels of reproductive hormones. Rapid changes in the levels of estrogen and progesterone are believed to contribute to the development of post-partum depression.

Furthermore, the onset of anxiety and depression has also been found to be correlated with gestational age, with the second trimester showing the highest onset rates.

Lower levels of progesterone during the luteal phase are also correlated to PMDD and premenstrual syndrome, characterized by irritability and enhanced sensitivity to negative stimuli. The hormonal fluctuations during the luteal phase have also been linked to anxiety disorders such as generalized anxiety disorder and panic disorder.

The coinciding of the onset of bipolar disorder in many cases with puberty strongly indicates the role of fluctuating reproductive hormones in the development of mental health disorders.

Furthermore, while pregnancy is found to alleviate the symptoms, hormonal fluctuations during the post-partum period have often been found to worsen the symptoms of bipolar disorder and bring about post-partum psychosis.

The monitoring of hormonal fluctuations through digital apps and hormonal measurements has been reported to be effective not only in managing reproductive health but also in predicting mood changes and changes in mental state. This has been valuable for women in managing their daily life activities and work.

Conclusions

Overall, the review reported that the fluctuations in reproductive hormone levels during menstrual cycles as well as through the various reproductive stages in life are strongly linked to their mental health status and play a significant role in the development of various mental health disorders.

The use of digital apps and wearables to monitor fluctuating hormone levels could help predict and effectively manage changes in mood and mental state.

Journal reference:

• Wieczorek K, Targonskaya A, & Maslowski K (2023). Reproductive Hormones and Female Mental Wellbeing. Women, 3(3), 432–444. doi:10.3390/women3030033. https://www.mdpi.com/2673-4184/3/3/33