Hormones & Anxiety

Anxiety can be triggered by psychological stress, environmental situations, physical mechanisms of the body, or hormones.¹ Examples of situational triggers include social gatherings and crowded or small spaces, which can lead to anxiety. Psychological stress triggers may include food or meal times, testing, public speaking, performance pressure, and separation for younger children. These triggers all share one thing: a perception of personal endangerment where your survival is at risk.¹ This feeling of risk sets off our fight or flight mode in a false alarm, which is the basis of anxiety.

Nutritional deficits, biological predispositions, epigenetics, personal environmental factors, and even learned behavior can increase someone’s risk for anxiety. Hormone imbalances can also play a role in anxious response patterns.^2,3 Melatonin, estrogen, and cortisol may be three important hormones when it comes to anxious responses.²

What Hormones Do in Our Bodies

Hormones regulate systems within the body such as physiological development, emotional regulation, reproduction, and metabolism.⁴ They impact individuals’ moods and mental health.^2,4 Even digestion is regulated by hormones and has a clinically demonstrated impact on physical and mental well-being.^1,2

Some common processes hormones regulate include:

• Mood
• Growth
• Metabolism
• Reproduction
• Sleep
• Digestion

Hormonal Imbalances & Anxiety

Fluctuating estrogen, progesterone, and testosterone can impact anxiety,^2,5 and current treatment considerations for anxiety include hormone therapy.⁵ Hormonal imbalances of stress hormones like cortisol, adrenal hormones, and reproductive hormones can exacerbate anxiety symptoms.

Stress Hormones & Anxiety

When an individual perceives they are in danger, the amygdala is activated and signals the hypothalamus⁶ to release cortisol. The stress response originates in the brain and results in a physiological response including increased heart rate from contracted blood vessels as the body prepares to utilize muscle. Blood flow is averted from the brain to muscles for optimum flight or fight.

Possible symptoms of elevated cortisol levels include:

• Anxiety
• Depression
• Headaches
• Weight gain
• Sleep issues
• Elevated heart rate
• Lowered oxygen levels in the blood
• Tingling or numbness in the extremities
• Digestion difficulties
• Decreased energy
• Changes to menstrual cycles

Thyroid Hormones & Their Impact on Anxiety

Thyroid imbalances can also affect anxiety.  Whether elevated (hyperthyroidism) or lowered (hypothyroidism), anxiety and other comorbid mental health diagnoses like depression result from the imbalance in 20-40% of patients with thyroid disorders.¹ Greater thyroid issues result in more severe symptoms of anxiety.

Estrogen & Testosterone

Testosterone lowers anxiety.⁷ Both men and women have testosterone levels though women have an amount approximately 10% lower than males.⁷ Data demonstrates anxiety rates increase in male subjects when their testosterone levels are reduced. Similarly, women with lowered testosterone levels are more likely to experience anxiety.⁷

There is some conflicting and limited research on estrogen and its connection to anxiety.⁷ Estrogen lowers anxiety,^3,8 however, some research shows higher levels of both estrogen and separately, testosterone, were related to anxiety symptoms. Statistically, more women are affected by anxiety than men.

Hormonal Changes Across Life Stages

Hormone changes are one way that the body works to maintain “a constant internal environment.”⁸ Hormones are one of the communication means for the body and changes occur naturally throughout life stages.⁸ Hormonal changes play a large role in women’s mental health. For individuals affected by anxiety symptoms, a change in hormones may elicit a response.

Menstrual Cycle & Hormone Fluctuations

The menstrual cycle creates a variance in estrogen and progesterone levels.³ This can impact anxiety levels for those with anxiety symptoms, before and post-menses onset. Anxiety levels increase before a period and during the menstrual cycle for women who have clinical psychiatric disorders.⁹

Some studies show that as estrogen levels decrease, such as with menopause, anxiety may increase. Consideration of anxiety-related symptoms before menopause is essential to determine the relationship between menopause and anxiety. For women who have strong stress hormones and stress response, menopause can exacerbate this response pattern. Mitigating negative response habits through coping skills, stress reduction, and other strategies may prove helpful in navigating this season for women.

Identifying & Diagnosing Hormone-Related Anxiety

Medical consultation is important when considering the role of hormones and anxiety management. A baseline understanding of your particular hormone levels and needs can benefit you with the holistic treatment for anxiety and other mental health-related disorders. There are hormone-related treatments that obstetricians and gynecologists can offer. Endocrinologists or primary care providers can also support identifying and diagnosing hormone-related anxiety.

Non-Hormonal Strategies to Cope With Anxiety

There are many non-hormonal strategies to cope with anxiety, including various natural anxiety remedies. Many therapists and doctors may suggest this form of prevention or treatment initially. Utilizing these coping strategies can help some individuals with moderate to mild symptoms. Interestingly, coping skills are both treatment and preventative techniques to stave off anxious response patterns.

Some anxiety coping strategies include:

• Mindfulness and meditation: Meditation for anxiety and exercises aimed at mindfulness for anxiety can help you remain grounded, reduce stress, and potentially prevent chest pain caused by anxiety. These coping strategies connect mind and body.
• Exercise: Exercise helps anxiety and may help reduce anxiety symptoms by reducing cortisol levels.
• Sleep hygiene: Sleep and anxiety are linked and improving sleep hygiene can help reduce anxiety symptoms or their intensity.
• Play and creativity: One method to cope with anxiety is through play and creativity. Allowing oneself spontaneous (unplanned, unstructured) opportunities to tap into inner creativity can help reduce anxious symptomatology.¹⁰
• Journaling: Journaling can be an effective method of processing emotions.¹¹ Use a guided journal like The Balanced Mind to support healthy coping, try an anxiety app, or use a simple notepad with anxiety journaling prompts to express thoughts and feelings.
• Nutrition and health maintenance: Properly caring for your body includes routine check-ups with physicians or primary care doctors. Healthy nutrition and quality caloric habits help with maintaining healthy body mass, which is related to anxiety levels.⁷
• Social support: Caring for oneself through positive social connections and relationships helps minimize and buffer anxiety levels.¹² Offering support to others is equally beneficial for reducing stress and anxiety so consider regular volunteer roles in your community.
• Self-care and stress reduction: Self-care through relaxation and stress reduction methods like massage therapy, and pampering are legitimate ways to cope with and reduce anxiety symptoms.

Hormonal Treatments for Anxiety

Hormone replacement therapy is one option for some women who experience anxiety symptoms related to hormone dips, spikes, and cycles. Potential risks are related to the lack of evidence-based research showing best practices in hormonal therapy treatments.¹³ For women who experience moderate to severe symptoms, the benefits could potentially outweigh negatives, including reduction of anxious response.

Anxiety Treatment Options

Anxiety, while not reversible, is manageable. Whether due to hormonal imbalance, traumatic events, or other factors, anxiety symptoms are treated through a variety of techniques. Treating the anxiety can involve somatic therapy, cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), medication, mindfulness, psychedelic therapy, and other options.

Some common treatment options for anxiety include:

• Somatic therapy: Somatic therapy helps reduce anxiety by supporting the mind and body connection. Therapists skilled in this area recognize that the body needs to be physiologically supported as well. This approach will bring mindfulness and physical activities or exercises into the counseling room.
• Cognitive behavior therapy: CBT for anxiety helps reduce anxiety and is traditionally viewed as the standard for treatment. Psychoeducation is rooted in the conviction that thoughts affect feelings which, in turn, affect behavior. Coping skills generally involve identifying distorted thoughts or automatic negative thoughts. People successfully progress through treatment by learning thought-interrupting and thought-challenging techniques.
• Dialectical behavior therapy: DBT for anxiety helps reduce anxiety similarly in psychoeducation as CBT. Psychoeducation revolves around the identification of instigating thoughts to unwanted behaviors. Coping skills incorporate behavior modification.
• Medication: Anxiety medication may help those who have severe anxiety symptoms. Anxiety medication can be long-term while others choose to seek medication as an immediate, but temporary, support while psychoeducation coping skills are developed.
• Mindfulness: Mindfulness for anxiety treatment combines breathwork and other techniques like grounding. Similar, with some distinctions to somatic therapy, mindfulness is a holistic approach for individuals in tune with their physicality.
• Psychedelic therapy: Healing through the use of psychedelic therapy and ketamine-assisted therapy is one approach to treating anxiety. This approach combines the science of ketamine use with the treatment of anxiety.
• Relaxation: A good dose of R&R or self-care can help with managing anxious symptoms. When anxiety is related to stress, reducing personal stress is a legitimate coping skill for the management of symptoms.

When to Find Professional Help for Anxiety

It’s time to seek professional help for anxiety symptoms when it is interfering with daily life. Ongoing sleep issues, work performance problems, and interpersonal relationship issues can point to the need for professional treatment. Find a therapist by asking for a referral from a trusted doctor and from people you know who may have had similar struggles.

Online therapist directories can also help you navigate a specific search for in-person or online therapy. Directories can be helpful because they will help you narrow and refine a search for the best fit. Basic facts are listed in most online directories to help you compare the options. A mental health app like Noom Mood can support anxiety management in the interim.