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Hormones and mental health

Veronica Ridpath, DO

Throughout life, women are at risk of developing mental health concerns directly related to hormonal changes in their bodies. Women are more often affected by some mental health concerns and display symptoms differently than men.

Unfortunately, there isn’t a great track record of recognizing and treating women’s disorders and issues. Some, like endometriosis, have taken an average of seven doctors and 10 years of symptoms to diagnose!

Thankfully we have greater awareness now, and those trends are changing. Women’s mental health has come a long way from the days of blaming “hysteria” and turning a blind eye to the impact of the unique pressures of being a woman. We now have a greater understanding of not only the impact of gender roles and expectations but also the unique changes in the body that influence mental health.

Three of the most common issues impacting women are:

Premenstrual Dysphoric Disorder:

Premenstrual dysphoric disorder (PMDD) is a severe version of premenstrual syndrome (PMS) that significantly impacts day-to-day living. Emotional symptoms of PMDD include severe depression, anxiety or paranoia, mood swings, anger and rage episodes, and even suicidal thoughts. Physical symptoms include the common PMS symptoms of bloating, fatigue, and intense food cravings that can develop into binge eating. Symptoms tend to flare the week before menstruation and resolve almost immediately during the week of menstruation. The culprit is thought to be a drop in estrogen. Once estrogen levels start to rise again, the symptoms are gone until the next month.

I suggest any woman who notices a change in mood during the month keep a journal of symptoms. There are great, free cycle-tracking apps for smartphones that help track physical and emotional symptoms. This information can help your doctor with the right diagnosis and treatment plan.


In the second trimester most women will experience an improvement in mood due to increased serotonin, a “feel-good” chemical in the brain. Others will experience a worsening of mental health from the life change compounded with the hormonal roller coaster. It is often chalked up to “baby blues” or a lack of sleep, but women can have severe symptoms that are missed.

For those who do experience postpartum depression or anxiety, each pregnancy tends to have more severe symptoms if not treated. Some women avoid medication because of the concern about the effects on the baby. Studies show that a happy mom equals a healthy baby, and there are safe options available. For women who develop bipolar disorder, the first episode often happens after pregnancy and can be mistaken for postpartum depression or anxiety. Paranoia, intrusive or racing thoughts, hearing or seeing things that aren’t there, or a decreased need for sleep should receive urgent evaluation.

Menopause:  Contrary to the name, menopause is a process rather than an event. Hormone levels start to decline and lead to symptoms such as hot flashes, sleep difficulty, fatigue, decreased sex drive, and decreased mental clarity. Menopause also increases the risk of developing a depressive or anxiety disorder. While estrogen replacement improves many of these symptoms, it is not without risks such as blood clots and an increase in some types of cancer. Improving cardiovascular health and increased physical activity can help with symptom control but many women benefit from therapy or medication.

More than 20 percent of women in the United States experienced a mental health concern in the last year. If you experience mood fluctuations, speak with your primary care provider and ask for help. Treatment is available, and the one thing my patients consistently tell me is, “I wish I had asked for help sooner!”

Dr. Veronica Ridpath serves behavioral health patients at the HopeHealth Medical Plaza in Florence. A lifelong resident of the Carolinas, Dr. Ridpath is a member of the North Carolina Psychiatric Association, the American Academy of Addiction Psychiatrists, and the American Psychiatric Association. She has special interest in LGBT mental health and inclusion, improving access to psychiatry services, and patient-centered care.



HopeHealth educates its patients on the importance of having a health care home. As a primary care facility, HopeHealth’s medical team works to prevent and detect illness and the early onset of disease, provide routine physical examinations and promote overall healthy lifestyles.

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