Reviewed by Dr. Rasheedah Adewumi, DNP, PMHNP-BC — Board-Certified Psychiatric-Mental Health Nurse Practitioner, Rayzi Women’s Center.
Disclaimer: For informational purposes only. Not a substitute for professional medical advice.
Feeling off without knowing why is frustrating. You might snap at little things. You get anxious over things that used to come so easily, or a great sadness appears from nowhere.
On a bad week, it is easy just to blame burnout. However, if you observe when these slumps occur, such as the week leading up to your period, during pregnancy and in the postpartum period or in a woman’s 40s, it is generally hormones that are responsible.
Sex hormones are in continuous communication with brain neurotransmitters that regulate mood, stress, sleep & attention. Just as hormone levels rise and fall, so does the brain biochemistry.
1. How Do Sex Hormones Alter Brain Pathways
Your primary sex hormones run a daily dialogue with key brain chemicals:
- Estrogen. This influences serotonin, dopamine and norepinephrine directly to keep your mood steadied! It also soothes GABA receptors as well to keep anxiety at bay. What it means: Mood tends to dip when estrogen goes down fast.
- Progesterone. Decomposes into a compound called allopregnanolone, which binds with GABAA receptors to smooth things down in your system. This is acceptable for the majority of us. Yet, for those with a system sensitive to fluctuations in hormones, an immediate drop-off of progesterone before your period or post-partum is panic-inducing and low-mood-inducing.
- Testosterone. Testosterone is a hormone which is present at lower levels in women than men, but it still plays an important role in stamina, motivation and mental focus. At low levels, you become lethargic and constantly tired.
2. Hormonal Changes Over Time
PMDD vs. Standard PMS
After you ovulate, estrogen and progesterone rise and decrease rapidly.
Normal (at least for many women) drop, however, triggers Premenstrual Dysphoric Disorder (PMDD) in 3% to 8% of females. PMDD is not basic PMS.
It is so debilitating a clinical problem that it causes extreme depression, anxiety, rage, and thinking confusion, which all lift after your period starts.
Managing it takes real medical intervention: ongoing or luteal-phase SSRIs or ovulation-suppressing medications.
Pregnancy
Estrogen jumps around 1,000% in pregnancy.
Most women do fine, but any history of mood problems is always a risk factor for antenatal depression and/or anxiety (affecting 10%-15% of pregnancies).
The latter leads to real risks, such as low birth weight or preterm birth, leaving this unmonitored so it is essential that screening of pregnant women for these risk factors is done effectively.
The Postpartum Crash
Right after birth, estrogen and progesterone plunge within hours. It is the fastest, steepest hormone drop your body will ever go through.
| Condition | Prevalence | Onset / Duration | Key Characteristics |
| Baby Blues | Up to 80% | First 1–2 weeks | Mild emotional swings and tearfulness that resolve on their own. |
| Postpartum Depression (PPD) | ~15% | Anytime in year 1 | Lasting depression, severe anxiety, and exhaustion. Needs medical treatment. |
| Postpartum Psychosis | 0.1%–0.2% | First 2 weeks | Medical Emergency: Disorganized thinking, hallucinations, and rapid mood swings. |
Perimenopause
Perimenopause typically begins in your mid-40s and can last as long as a decade. This is not a simple drop in estrogen.
Rising and falling like an irrational mood swing, it creates hot flashes, ambushed sleep, and brain fog that feels like you might be coming down with the flu, anxiety and depression.
It can bring back an old depression or create a first episode in those with no history of mental illness.
3. Thyroid and Cortisol Impact
Not all mood changes come from the ovaries:
Thyroid Issues
- Hypothyroidism (underactive). Mimics major depression. Can cause heavy fatigue, slow thinking, weight gain and low mood.
- Hyperthyroidism (overactive). Mimics panic disorders. Can cause a racing heart, physical restlessness, anxiety and insomnia.
Chronic Stress
Constant stress keeps your body’s panic button stuck on high – that just keeps cortisol elevated.
But over time, high cortisol depletes serotonin, ruins deep sleep, causes systemic inflammation and raises your risk for mood disorders.
4. Accurate Evaluation
An underlying hormone problem is often ignored, meaning someone could experience only partial relief from standard therapy or antidepressants. A good medical evaluation considers physical and psychological aspects hand in hand:
- Test Your Thyroid. When fatigue or mood is the problem, testing TSH, Free T4 and Free T3 can rule out thyroid trouble.
- Day-to-Day Symptoms Tracking. Mood logging over two complete cycles reveals PMDD patterns clearly.
- Perinatal Psychiatrist. Find providers who are experienced at prescribing psych meds safely during pregnancy and breastfeeding
- Consult Perimenopause Care. Visit your doctor to discuss HRT if you can get psychiatric care at the same time.
Rayzi Women’s Center
Dr. Rasheedah Adewumi, DNP, PMHNP-BC, is a board-certified Psychiatric-Mental Health Nurse Practitioner with over 20 years of clinical experience. Her primary focus is on women’s mental wellness throughout all phases of life, such as:
- PMDD
- Perinatal and postpartum mood disorders
- Perimenopause
- Hormone-related mood disturbances
Website – rayzihealthcare.org
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