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STDWatch
Hannah Kingston

Sep 19, 20227 min read

Estrogen and Anxiety

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Anxiety is far more common in women than in men. Because women also have higher estrogen levels than men, this has led some people to wonder whether estrogen causes anxiety. 

Is there a link between estrogen and anxiety? Can estradiol cause anxiety?

Is there a connection between anxiety and hormones?

Many different hormones in the body can influence mood. Imbalances in hormones have the potential to lead to anxiety. For example, hyperthyroidism (high thyroid hormone) commonly leads to anxiety, while hypothyroidism (low thyroid hormone) can be associated with depression. High levels of cortisol, a stress hormone, can also lead to anxiety.

There is also a connection between sex hormones, such as estrogen, and anxiety. However, the specifics of this connection are somewhat surprising. It would be easy to assume that high estrogen causes anxiety because anxiety is more common in women, but this doesn’t necessarily turn out to be true.

Can high estrogen cause anxiety?

Estrogen is actually believed to be protective against anxiety. This is why women tend to feel less anxious in the first half of their menstrual cycle. During this time, levels of estrogen are high, while levels of progesterone are low. 

Estrogen has been found to calm the stress response in women. Higher estrogen levels lead to higher levels of serotonin in the brain. Serotonin is a neurotransmitter, which is a chemical used by nerve cells to communicate with each other. It’s sometimes referred to as the “happiness chemical” in the brain, because higher levels are associated with feeling happy and peaceful, while lower levels are associated with both anxiety and depression.

Can low estrogen cause anxiety?

Higher estrogen levels can protect against anxiety, and lower levels of estrogen are associated with increased anxiety. Women are more likely to feel anxiety around the time of their period, when estrogen levels are very low. In addition, many women feel anxiety during perimenopause, which is the period of time before menopause occurs. During perimenopause, estrogen levels tend to fluctuate dramatically, which can lead to anxiety.

In addition, drops in estrogen levels can cause disrupted sleep patterns. During perimenopause, hot flashes are common, and these can also disrupt a woman’s sleep. A lack of sleep is associated with mood disorders like anxiety and depression, so the lack of sleep caused by drops in estrogen can also contribute to anxiety. There is some evidence that taking hormone replacement therapy (HRT) can help with mood symptoms like anxiety, although it’s generally not enough to address a serious mental health problem on its own.

Stress is associated with anxiety, but can stress cause low estrogen? Stress has been found to cause greater fluctuations of estrogen levels in premenopausal women. In women who are stressed, estrogen levels will rise higher and drop lower. The changes in estrogen levels may contribute to causing anxiety.

Can low testosterone cause anxiety?

Besides estrogen, testosterone has also been found to have effects on mood. Lower levels of testosterone are linked with mood disorders, like anxiety. Since men generally have a much higher level of testosterone than women do, they’re somewhat protected against anxiety.

Interestingly, the reason that men seem to be protected against anxiety may also be related to estrogen. Through an enzyme called aromatase, testosterone is converted into estrogen. Because a man has a relatively consistent level of testosterone, he will also have a fairly consistent level of estrogen in his brain. For women, the levels of estrogen fluctuate dramatically, and this can make anxiety more likely in women.

How do you know if hormones are causing your anxiety?

If you suffer from anxiety and are wondering whether your hormones, including estrogen and testosterone, may be contributing to the issue, then you may want to consider testing your hormone levels. You can ask your doctor to order the tests for you, or you can order them yourself through an online service. You will then either go to a lab to have your blood drawn, or you will draw it yourself at home using a fingerprick.

Sources

Borrow AP, Handa RJ. Estrogen Receptors Modulation of Anxiety-Like Behavior. Vitam Horm. 2017; 103: 27–52. doi: 10.1016/bs.vh.2016.08.004.

Can Menopause Cause Anxiety, Depression or Panic Attacks? Cleveland Clinic. https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/. Accessed 25 July 2022.

Domonkos E, Hodosy J, et al. On the Role of Testosterone in Anxiety-Like Behavior Across Life in Experimental Rodents. Front Endocrinol (Lausanne). 2018; 9: 441. doi: 10.3389/fendo.2018.00441. 

Estrogen and female anxiety. Harvard Gazette. https://news.harvard.edu/gazette/story/2012/08/estrogen-and-female-anxiety/. Accessed 25 July 2022.

Maeng LY, Milad MR. Sex Differences in Anxiety Disorders: Interactions between Fear, Stress, and Gonadal Hormones. Horm Behav. 2015 Nov; 76: 106–117. doi: 10.1016/j.yhbeh.2015.04.002.

McLean CP, Asnaani A, et al. Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of Illness. J Psychiatr Res. 2011 Aug; 45(8): 1027–1035. doi: 10.1016/j.jpsychires.2011.03.006.

Muacevic A, Adler JR. Role of Sex Hormone Levels and Psychological Stress in the Pathogenesis of Autoimmune Diseases. Cureus. 2017 Jun; 9(6): e1315. doi: 10.7759/cureus.1315.

Shafir T, Love T, et al. Postmenopausal Hormone Use Impact on Emotion Processing Circuitry. Behav Brain Res. 2012 Jan 1; 226(1): 147–153. doi: 10.1016/j.bbr.2011.09.012.


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