Estrogen is the Missing Piece in Women’s Mental Health.
We are in the midst of a much-needed shift in how we understand women’s mental health. For decades, hormonal changes have been sidelined or even dismissed as “emotional” or “irrational.” But what if we’ve been overlooking one of the most powerful regulators of mood, memory, andntal well-being in the female body?
An article from The Cut, titled “Listening to Estrogen - Hormones have always been a third rail in female mental health. They may also be a skeleton key,” brings this conversation to the forefront. Journalist Lisa Miller explores the role of estrogen in shaping the mental health experiences of women—from puberty, through childbirth, and into menopause. It’s a powerful read and a reminder that science, psychiatry, and lived experience must work together.
The Hormone-Mental Health Connection
Estrogen does more than regulate the menstrual cycle—it plays a vital role in the brain. It supports the function of neurotransmitters like dopamine and serotonin, helps modulate stress responses, and even influences neuroplasticity (the brain’s ability to adapt and change). As estrogen levels shift, so too can mood, cognitive function, sleep quality, and emotional regulation.
The article highlights how mental health symptoms can emerge or intensify during times of hormonal fluctuation:
Perimenopause and menopause may trigger anxiety, intrusive thoughts, or depression—even in women with no prior psychiatric history.
Postpartum periods can bring on severe emotional dysregulation, sometimes leading to postpartum depression or psychosis.
Menstruation and PMDD (premenstrual dysphoric disorder) can mirror the symptoms of major depression, yet often go underdiagnosed.
Case Studies That Matter
Miller shares several real-life examples, including women who experienced debilitating psychiatric symptoms during perimenopause—obsessive thoughts, paranoia, even hallucinations—that were initially misdiagnosed as unrelated mental illness. Only when hormone levels were measured and addressed did their symptoms significantly improve.
This points to a deeper systemic issue: most standard psychiatric care does not consider hormonal status as part of mental health assessment, despite the growing body of research linking the two.
A Call to Reframe
This article resonates with what many of us already see in clinical practice: women being treated for mental health symptoms without any inquiry into their hormonal history, cycle patterns, or perimenopausal stage.
We must begin to ask:
Is this a mental illness, or is it a neurochemical response to hormonal changes?
Could this person’s symptoms be eased through hormone-aware interventions rather than solely medication or therapy?
As a therapist with a clinical background in trauma and neuroscience, I believe it's time to bring hormones into the mental health conversation—not as an afterthought, but as an essential piece of the diagnostic puzzle.
What Needs to Change
Medical and Mental Health Integration: Psychiatrists, GPs, and therapists need to work more collaboratively, with shared understanding of hormonal impacts on brain function.
Better Education for Women: Women deserve to understand how their hormones influence their mind, energy, and emotions—especially during transitional life stages.
More Research on Women’s Brains: At the time that the article was written, fewer than 1% of brain-imaging studies include hormonal status as a variable. Hopefully this is changing.
Supportive Conversations: We need to reduce the stigma around talking about hormonal mental health. This isn’t “just hormones”—this is brain health.
Hormones aren't the whole story when it comes to mental health—but they are a crucial chapter we’ve been skipping. By returning estrogen (and other hormones) to the mental health conversation, we give women more accurate, compassionate, and effective care.
If you're currently navigating perimenopause, PMDD, or postpartum changes and feeling like you’re “losing yourself,” you are not alone—and you are not broken. Your body and brain are communicating. The more we understand the science, the better we can support healing.
References:
https://www.thecut.com/2018/12/is-estrogen-the-key-to-understanding-womens-mental-health.html