Some women have feelings of depression and anxiety. Ellen, a 49-year-old mother whose grown child recently left home to work, was one. An active community volunteer, she had a stable marriage and home life. When she came in to see me, she said, “My periods are still pretty regular, the only change is that they’re much lighter than they used to be. But my emotions are out of control. I feel like I’m having panic attacks.”

Ellen’s hormone profile suggested that she was menopausal. (Her estradiol level, when measured with a saliva sample, was less than 1 pg/ml.) However, because she still had a relatively regular menstrual cycle, she assumed, correctly, that she couldn’t be menopausal. (Remember that a woman is not considered menopausal until she has stopped menstruating completely.) Ellen was unfamiliar with the term perimenopause, so she was unsure of how she should interpret her symptoms. She wondered if she was crazy. Before she came to see me, she had seen a psychiatrist who prescribed Xanax and someone else who prescribed a low-dose birth control pill after testing her estrogen. Was it confusing? Completely.

Ellen’s panic attacks weren’t the result of having either too much time on her hands or too much to do. In fact, she seemed quite content with the balance of things in her life before they started. In her case, low progesterone levels may have been the driving force behind the panic. The low-dose birth control pills she was taking may have helped address the estrogen decline. (It’s interesting to note that the estrogen in these oral contraceptives is often of a higher amount and greater potency than the estrogen prescribed as part of a hormone replacement therapy regimen specifically for perimenopausal symptoms.) The other important variable in low-dose oral contraceptives is that they contain synthetic progestins. Synthetic progestins suppress the body’s production of progesterone. In some women, synthetic progestins greatly worsen anxiety, which may be because their bodies respond poorly to the shortage of the hormone nature intended for them to have.

Ellen had no family history of either heart disease or osteoporosis. She didn’t necessarily want to use hormone replacement therapy at this time. Her uterine lining was still being stimulated enough to produce monthly periods. (The estrogen in the oral contraceptives may have had this stimulatory effect.) It seemed appropriate to try progesterone therapy, 200 mg of natural micronized progesterone daily for three weeks. Progesterone does not have to be used in conjunction with estrogen, even though estrogen must not be used alone in women who still have a uterus.

Ellen discontinued the birth control pill and felt better within a week. She started using micronized natural progesterone and felt significantly less anxious. This solution may sound too simplistic. But the reality is that in some cases we treat symptoms with different medications and end up treating the side effects of one medication with another drug. In Ellen’s case, it would be important to keep the whole picture straight by following up and monitoring her estrogen level. To do this, we would test her estrogen and progesterone levels again in thirty days. This would tell us more about the ratio of estrogen and progesterone in her body and ensure that the dosage of natural progesterone was appropriate for her.

Mary, one of the perimenopausal women we’ve already met, also chose to try natural progesterone to alleviate her persistent anxiety. I’m not suggesting that natural progesterone is a panacea for anxiety, but I do want to point out that many health providers may not offer it as an option. Although natural progesterone has been used in Europe for decades, it is still something of an “alternative” approach in the United States. More frequently, American women are prescribed an antianxiety or antidepressant medication. If you are feeling persistent anxiety or panic attacks, natural progesterone is among the choices you may want to consider.

Why is progesterone often effective in managing feelings of anxiety? While estrogen appears to have an elevating effect on our moods, progesterone seems to calm or relax us, there really is an exquisite balance between these two hormones in our bodies. Produced in massive amounts in pregnant women, progesterone may be the reason why some women feel peaceful and serene when they are expecting. In fact, antianxiety medications like Valium act on similar sites in the brain as progesterone. Progesterone is sometimes used to treat PMS, based on the theory that inadequate levels of this hormone in the second half of the menstrual cycle contribute to premenstrual anxiety. An out-of-kilter ratio between estrogen and progesterone may also account in part for anxiety or depression during perimenopause.

I say “in part” because some scientists believe that women who become depressed during perimenopause are predisposed toward this depression for other reasons, and that women with perimenopausal depression are likely to have been depressed before their reproductive hormones begin to change. I don’t totally agree with this. I see too many women for whom life had been moving along smoothly before they reached the perimenopausal phase, and who then found themselves feeling depressed for the first time.

Sadness and worry in our forties may have a hormonal component, but these feelings can also be heightened by our circumstances. Reaching our forties can have a sobering effect, as we realize we are not Immortal. Many women face losses during their forties: their marriage may end, their children leave home, their parents may become ill or die. I don’t want to give the impression that perimenopausal depression or anxiety is an “either-or” situation, we can’t say that hormones either have everything or nothing to do with the way we feel. We are neither ruled by our hormones nor exempt from their effects. Rather, I’m suggesting that we should look carefully at hormonal influences on our moods and be prepared to take an inventory of other personal issues that can contribute to our feelings of unhappiness or tension.

Related posts:

1. The Basics of Hormones For Perimenopause – Natural versus Synthetic

2. The Basics of Perimenopause – language barriers during hormone replacement therapy

3. What Do Female Sex Hormones Do For The Female Body?

4. The Basics of Perimenopause – Progesterone and Mood

5. The Basics of Signs of Perimenopause – Depression and Loss of Libido

6. The Basics of the Subtle Connections About Daily-Life Things When Going Through Perimenopause

7. The Basics of HRT Issues – Pill, patch, or Cream?

8. The Basics of the Relationship Between Progesterone and Perimenopause

9. The Basics of Hormone Testing During Perimenopause – Old and New

10. Differences between Progesterone and Progestin