Women's Health

Estrogen and Women's Emotions

Estrogen and Premenstrual Dysphoric Disorder (PMDD)

As with PMS, women with premenstrual dysphoric disorder (PMDD) regularly develop negative mood symptoms before their periods. Some experts consider premenstrual dysphoric disorder to be a severe form of PMS.

In PMDD, mood symptoms are more severe and often overshadow physical symptoms. The emotional disturbances are significant enough to cause problems with daily life. From 3% to 9% of women experience premenstrual dysphoric disorder.

Estrogen appears to be involved in these mood disturbances, but exactly how is more of a mystery. Estrogen levels in women with PMS or PMDD are almost always normal. The problem may instead lie in the way estrogen "talks" to the parts of the brain involved in mood. Women with PMS or PMDD may also be more affected by the normal fluctuations of estrogen during the menstrual cycle.

Estrogen and Postpartum Depression

Having "the blues" after childbirth is so common it's considered normal. However, 10% to 25% of women experience a major depression within the first six months after childbirth. The abrupt drop in estrogen after delivery seems like the obvious culprit -- but this link has never been proved.

Postpartum depression is treated like any other depression, with antidepressants, therapy, or both. Some preparations of estrogen do show promise as a potential add-on to these established treatments.

Estrogen and Perimenopausal Depression

In the months or years before menopause (called perimenopause), estrogen levels are erratic and unpredictable. During perimenopause, up to 10% of women experience depression that may be caused by unstable estrogen levels. Some studies suggest that using a transdermal estrogen patch by itself can improve depression during perimenopause. Antidepressants were not given to women in these studies, so giving estrogen likely improved their depression.

Estrogen and Postmenopausal Depression

At menopause, estrogen levels fall to very low levels. Interestingly, taking oral estrogen does not improve depression in women after menopause. In large trials evaluating hormone replacement therapy, women taking estrogen reported the same mental health as women taking placebo. After menopause, women's rates of depression fall, becoming similar to men of the same age.