When Hormones Stir the Mind: Navigating Hormonal Transitions (Part 2)

Finding the Right Treatment

While these transitions are all expected and, with the exception of pregnancy, will happen to all of us, there is no need to go through it unsupported. A multimodal and comprehensive approach can help you find a targeted treatment that will allow you to show up for yourself, your loved ones, and your goals. There is no one-size-fits-all approach, but some guiding principles can help you get started.

• Understand that Hormonal shifts Have Complex Meaning

  • For some women, there is a strong desire to move through these transitions without the aid of pharmaceutical or hormonal interventions. This is a completely normal and legitimate choice. Choosing to experience the full range of symptoms, sensations, and shifts without suppression or external support can be deeply meaningful. In these cases, lifestyle-centered approaches, like nourishing the body, mind, and spirit with whole foods, movement, therapy or spiritual guidance, slowing down, and leaning into community may offer the type of support that feels most aligned. This path is not about “doing it the hard way,” but about honoring a desire to stay close to the body’s natural rhythms. 

    
    

  • At the same time, it’s equally valid, and sometimes essential, to seek pharmaceutical or hormonal treatment. These transitions can bring not only discomfort, but also profound distress. Symptoms like depression, anxiety, mania, psychosis, or suicidal ideation are real, and they occur more often than we tend to talk about. In such cases, medical intervention is not a weakness or a failure, it’s a wise and life-affirming choice. For some women, hormonal therapy or medication offers a bridge back to stability and safety. 

    
    

  • Sometimes treatment is necessary, but the necessary treatments can be deeply invalidating to identity, especially when treatments might include hormones that will not be affirming to one’s gender. For example, when a cis-woman needs testosterone, or a trans-man who needs estrogen or progesterone. Not only are these decisions deeply personal, but they can stir up deep rooted conflicts with one’s identity. 

No treatment, whether natural, pharmaceutical, or hormonal, is without its benefits and risks. Every individual is different. Every transition is different. And each woman deserves the right to assess what kind of support she needs, in connection with her values, her intuition, her lived experience, with the support of her medical provider.

• Consider underlying conditions

  • Women represent 63% of all autoimmune diagnoses. (Conrad et. al, 2023) Disorders like Hashimotos, POTS, MCAS, and more will destabilize under the pressures of rapid hormonal shifts. (Cutolo et. al, 2003)

    
    

  • Underlying mental health conditions are most likely to destabilize during these times. Previously managed ADHD, mood disorders, and anxiety will often exacerbate during times of hormonal shift and pruning. Or, often more unsettling, compensated but undiagnosed mental health conditions may emerge in the setting of these rapid shifts. This is partly due to the synaptic pruning previously mentioned, but also due to the effect that estrogens, progesterone, and androgens have a direct effect on neurotransmitters. (Barth et al. 2015)

• Available Treatment Options

We are living in an exciting time of exploding research around women’s health. As a consequence, the recommendations are evolving rapidly and new treatments are becoming available every day. It’s hard to list all the possible available options because every person’s approach is going to be different based on underlying conditions, preferences, and unique life situations. But here are a few of the possibilities.

• Antidepressants like SSRIs or SNRIs, which are considered first-line treatments for PMDD and related disorders

• Non-stimulant alpha2 and mildly dopaminergic medications like atomoxetine, guanfacine, or clonidine may be used to help with issues like brain fog, executive dysfunction, sleep, anxiety, or mood dysregulation of SSRIs fail or are inappropriate. 

• Medications that modulate glutamate and gaba can be used to help down regulate inflammation, help with vasomotor symptoms, and treat anxiety or depression. 

• Non-pharmaceutical options can be offered to gently raise or indirectly effect levels of serotonin, gaba, or dopamine such as saffron, rhodiola, magnesium, and vitamin D

• Optimizing thyroid function, iron levels in women who are regularly bleeding, and vitamin levels will support overall function and health. 

• Hormone replacement or hormonal birth control can be appropriate depending on life stage and desire to prevent pregnancy.

• Lifestyle interventions like improving sleep, movement, nutrition, and reducing life stress. (We all know these are important, but having accountability to stick to them really helps!)

• Therapy approaches such as CBT, mindfulness, DBT, somatic therapies, and more can be especially useful in managing negative thought loops, emotional overwhelm, and somatic symptoms.

  
  

The most important thing to remember is that treatment is not one-size-fits-all. Each woman’s hormonal sensitivity and personal story is unique, so finding the right approach may take some time and partnership with a supportive provider.

Rachel Ward, PMHNP-BC is the medical director and founder of Something Human Mental Health and believes strongly in holistic, well rounded approach to care.

References:

The American College of Obstetricians and Gynecologists. Hormone Therapy for Menopause. (2024) https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause

Barth, C., Villringer, A., Sacher, J. (2015) Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience (9) DOI=10.3389/fnins.2015.00037

Crandall CJ, et al. JAMA 2023;329:405-420. doi: 10.1001/jama.2022.24140; Santoro N, et al. J Clin Endocrinol Metab 2021;106:1-15. doi: 10.1210/clinem/dgaa764; “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. Menopause 2022;129:767-794. doi: 10.1097/GME.0000000000002028

Conrad, Nathalie et al. (2023) Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK The Lancet 401:1878-1890.Cutolo, M., Capellino, S., Sulli, A., Serioli, B., Secchi, M., Villaggio, B., Straub, R. (2006) Estrogens and Autoimmune Diseases. Annals of the New York Academy of Sciences (I)1089:538-547

Haraguchi, S., Sasahara, K., Shikimi, H., Honda, S., Harada, N., and Tsutsui, K. (2012). Estradiol promotes purkinje dendritic growth, spinogenesis, and synaptogenesis during neonatal life by inducing the expression of BDNF. Cerebellum 11, 416–417. doi: 10.1007/s12311-011-0342-6