More Than Mood Swings: Hormones and Mental Health

Classically, mental health is discussed through the lens of psychology, stress, trauma, or environment, but as I wrote about a couple of months ago, biology also plays a powerful role. This month I want to take a look at how hormones influence our mood, cognition, sleep, emotional regulation, stress tolerance, and how this affects our relationships and daily life.

For both women and men, hormonal shifts can significantly affect mental well-being across the lifespan. Yet many of these experiences remain misunderstood, minimized, or misdiagnosed.

From menstrual cycles and postpartum recovery to perimenopause, thyroid disorders, and age-related hormonal changes, growing research suggests that hormones and mental health are deeply interconnected.

Menstrual Cycles, Pregnancy, and Postpartum Mental Health

Many women experience emotional symptoms associated with menstrual cycles, including irritability, anxiety, sadness, or fatigue. For some, these symptoms become severe enough to interfere with daily functioning, as seen in conditions such as Premenstrual Dysphoric Disorder (PMDD) (Johns Hopkins Medicine, n.d.).

Pregnancy and the postpartum period represent another major hormonal transition. During pregnancy, estrogen and progesterone rise dramatically, followed by a rapid drop after childbirth. This abrupt hormonal shift, combined with sleep deprivation, physical recovery, identity changes, and caregiving demands, can contribute to postpartum depression and anxiety. Importantly, postpartum mental health struggles are not simply emotional reactions to parenthood. They are increasingly understood as the result of a complex interaction between hormones, brain chemistry, physical stress, and environmental factors (University of Florida Department of Physiology and Aging, 2025).

Researchers have noted that women who experience PMDD, or postpartum depression and/or anxiety may be more susceptible too mental health struggles during perimenopause. Suggesting a broader pattern of hormonal sensitivity across the lifespan (Behrman & Crockett, 2023).

Perimenopause

Perimenopause, which is the years leading up to menopause, is increasingly being recognized as a significant neurological and emotional transition, not simply a reproductive one. During this period, estrogen and progesterone levels fluctuate unpredictably, affecting neurotransmitters such as serotonin, dopamine, and GABA, all of which play important roles in mood regulation (Harvard Health Publishing, 2020).

While hot flashes and irregular menstrual cycles are the symptoms most commonly associated with perimenopause, many women experience a whole host of emotional and cognitive symptoms that can be disruptive to daily life, including anxiety, depression, irritability, mood swings, sleep disruption, brain fog, difficulty concentrating, and reduced stress tolerance (Harvard Health Publishing, 2020).

Researchers believe it is often the hormonal fluctuation itself, rather than simply declining estrogen, that contributes to increased vulnerability to anxiety and depression during this stage of life. And as mentioned above, women with a history of postpartum depression, PMDD, or prior anxiety and depression may be particularly sensitive to these shifts (Behrman & Crockett, 2023).

Physical symptoms can also compound emotional distress. Chronic sleep disruption from night sweats and insomnia can intensify anxiety, low mood, and cognitive difficulties, creating a cycle that is difficult to break (Harvard Health Publishing, 2020).

Despite how common these experiences are, many women report feeling dismissed or unprepared for the mental health effects of perimenopause. Symptoms are often attributed solely to stress, aging, or burnout rather than recognized as part of a significant hormonal transition (Harvard Health Publishing, 2020).

Chronic Conditions

Hormonal health is not only shaped by life stages, but also by chronic medical conditions that affect the endocrine system. Conditions such as Polyendocrine metabolic ovarian syndrome (PMOS), thyroid disorders, and other metabolic or hormonal conditions are associated with significantly higher rates of anxiety, depression, and emotional distress (Gorbis, 2023).

PMOS has been in the news lately as it was renamed earlier this month (previously known as polycystic ovary syndrome) with the hope that it is now considered a more “whole-body” condition, versus a reproductive one (Barnes, 2026). PMOS is one of the most common hormonal disorders affecting women and can influence insulin regulation, androgen levels, ovulation, metabolism, and inflammation. Women with PMOS experience higher rates of depression and anxiety than the general population, likely due to a combination of biological, metabolic, and psychosocial factors. Symptoms such as infertility, weight changes, acne, fatigue, and body image distress can further affect self-esteem and emotional well-being (Mayo Clinic, 2026).

The thyroid gland plays a critical role in regulating metabolism, energy, and mood. Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can produce psychiatric symptoms that are sometimes mistaken for primary mental health conditions. Hypothyroidism may contribute to a number of symptoms including depression, fatigue, brain fog, and slowed cognition. While hyperthyroidism may contribute to anxiety, panic symptoms, irritability, and insomnia. Because symptoms can develop gradually, thyroid-related mental health issues may go unrecognized for long periods of time (Mayo Clinic, n.d.).

These conditions highlight the importance of viewing mental health holistically. Emotional symptoms are not always purely psychological, sometimes they are signals of broader physiological changes occurring throughout the body.

Hormones and Men’s Mental Health

Hormonal influences on mental health are not exclusive to women. Men also experience age-related hormonal changes that can affect mood, cognition, energy, and emotional regulation, although these changes are often discussed far less openly (Verano, 2026).

Unlike the relatively abrupt hormonal fluctuations of being postpartum or in perimenopause, testosterone decline in men tends to occur gradually over decades. This slower progression can make hormonal changes more difficult to recognize and diagnose (Verano, 2026).

Some researchers and clinicians have used the term “Irritable Male Syndrome” to describe a cluster of symptoms potentially associated with declining testosterone and chronic stress, including irritability, anger, low motivation, fatigue, reduced libido, mood changes, and social withdrawal. Because these symptoms emerge slowly and can overlap with stress, aging, work burnout, or depression, hormonal contributions are often overlooked. Men are also less likely to seek support for emotional changes, particularly when symptoms present as irritability or emotional withdrawal rather than sadness (Verano, 2026).

Moving Toward a More Integrated Understanding of Mental Health

Historically, physical health and mental health have often been treated as separate systems. Yet hormones operate at the intersection of the brain and body, influencing both emotional and physical functioning simultaneously. Increasing awareness of hormonal mental health effects has the potential to reduce stigma, improve diagnosis, and help people better understand experiences that may otherwise feel confusing or isolating (Gorbis, 2023).

Recognizing the role hormones can play expands the conversation around mental health and wellbeing by acknowledging that mental health is shaped by a complex interaction between biology, lived experience, stress, relationships, and overall physical health.

Bibliography

Barnes, G. (2026). PCOS name change ‘more representative of condition’. BBC

Behrman, S., & Crockett, C. (2023). Severe mental illness and the perimenopause. BJPsych bulletin, 48(6), 1–7. Advance online publication. https://doi.org/10.1192/bjb.2023.89

Gorbis, E. (2023). Hormones, mental health, and the mind/body connection. Anxiety & Depression Association of America

Harvard Health Publishing. (2020). Menopause and mental health. Harvard Health Publishing

Johns Hopkins Medicine. (n.d.). Premenstrual dysphoric disorder (PMDD). Johns Hopkins Medicine Health Library

Mayo Clinic. (2026). Polyendocrine metabolic ovarian syndrome (PMOS): Symptoms and causes. Mayo Clinic

Mayo Clinic. (n.d.). Thyroid disease: Can it affect a person’s mood? Mayo Clinic

University of Florida Department of Physiology and Aging. (2025). How hormonal changes affect emotions, mood & mental health in women. University of Florida Department of Physiology and Aging

Verano, M. (2026). From grumpy old man to “irritable male syndrome”. Psychology Today