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“It’s just in your head!”
We’ve all heard that at one point or another as women. Maybe when you’re expressing health concerns to a medical professional, maybe when you’re opening up about your sources of anxiety, maybe when you tell someone you feel like a different person from one point in your cycle to another.
The reality? It’s probably *not* all in your head. Because the reality is, women have been sold a lot of lies about their bodies, their moods, and so much more.
For example, have you ever heard that there’s a relationship between progesterone and anxiety?
Probably not, and this is a prime example of how women don’t have enough information about their own health.
Progesterone is constantly fluctuating throughout our menstrual cycles (with more dramatic shifts happening during pregnancy, postpartum, and perimenopause), yet we rarely hear about how this can affect our physical and mental state.
Terri Bacow, PhD, a clinical psychologist who specializes in anxiety, is on hand to break down this relationship and address one of the (many) ways women have been denied information about their health.
What’s the relationship between progesterone and anxiety?
According to Dr. Bacow, progesterone is typically considered to have a calming effect on the body thanks to its ability to improve sleep.
Interestingly, progesterone can stimulate calming neurotransmitters in the brain and reduce some of those symptoms associated with anxiety (like racing thoughts, restlessness, and panic). But the research suggests that high levels of progesterone can have the opposite effect.
“While progesterone is often associated with relaxation, some research indicates that high progesterone levels can be linked to increased anxiety,” says Dr. Bacow.
Research from 2018 also found an association between women with higher than average progesterone levels reporting higher levels of attachment anxiety, and a 2021 study points out that anxiety disorders are twice as common in women, thanks in part to the fluctuation of hormones.
Progesterone’s fluctuation during your cycle can affect your mood
No, it’s not just in your head. Your mental health really can change from one point in your cycle to another.
“The constant fluctuation of progesterone during a menstrual cycle can make women feel unsteady as these hormones often very directly impact mood,” says Dr. Bacow. “Paying attention to where you are in your cycle can absolutely make you feel less ‘crazy’.”
The value of this? It’s additional data you have regarding your own body. As Dr. Bacow points out, it’s incredibly reassuring to have an explanation for how you are feeling at any given time.
We talk about the physical symptoms you may experience during each phase of your menstrual cycle, from varying energy levels to appetite changes. What we don’t talk about much is how mood can fluctuate throughout our cycles.
During the luteal phase, for example, progesterone levels rise. Initially, this can help you feel relaxed and calm, but some women may experience PMS symptoms like irritability, anxiety, and depression as progesterone levels fluctuate and eventually decline.
“The same is true of estrogen,” she adds. “During the luteal phase of one's cycle, estrogen drops after ovulation which contributes to depression and mood instability, and it is thought that serotonin (the brain's "happy" chemical) plays a large role in this.”
Progesterone, pregnancy, and postpartum
The most obvious reason for drastic hormonal changes? Pregnancy, of course. Progesterone is higher than ever during pregnancy, which is part of the reason pregnancy fatigue is so real: That increase in progesterone has a sedating effect.
Progesterone not only helps maintain a pregnancy, but it also supports the brain's adaptation to physical and emotional changes, according to Dr. Bacow.
“For some women, this contributes to a sense of emotional resilience,” says Dr. Bacow. “On the other hand, while progesterone can have calming effects, rapid hormonal changes especially in the first trimester can lead to emotional ups and downs, increased irritability or mood swings, along with excessive tiredness and ‘brain fog’.”
After delivery, that abrupt progesterone decline can be incredibly destabilizing. “This hormonal shift contributes to the ‘baby blues,’ affecting 80% of new mothers,” says Dr. Bacow.
Progesterone withdrawal can make a woman more vulnerable to anxiety and depression, especially given that the loss of progesterone may disrupt sleep quality.”
Perimenopause represents another major hormonal shift
Ah, perimenopause. That woefully misunderstood, under-discussed phase of life that’s finally starting to get some mainstream attention. While we’re starting to discuss the physical symptoms of perimenopause, the mental effects are real too.
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Yup, you may experience hot flashes and headaches and irregular periods during perimenopause, but you also may feel some mood changes as well.
“During perimenopause, progesterone levels begin to fluctuate and decline, which can significantly impact mental health and mood,” says Dr. Bacow. “As progesterone declines, its soothing effects decrease, leading to increased irritability, mood swings and emotional sensitivity. Further, progesterone helps regulate the stress hormone cortisol, so lower levels can lead to higher stress reactivity.”
You may experience more anxiety during perimenopause thanks to those hormonal changes… or you may not.
“Some women may experience heightened anxiety, restlessness, or even panic attacks during perimenopause, along with sleep disturbance and fatigue,” adds the expert. “Progesterone promotes deep sleep, so its decline can cause insomnia and night waking, which in turn disrupts mood issues and makes it harder to cope.”
Shifts in mood are normal
As women, sometimes it feels like we’re being gaslit by the entire world. It’s so natural to feel like there’s something wrong with us when we experience these shifts in mood, but part of that can be chalked up to the lack of readily available information about how our bodies actually function.
“There is no question that medical professionals have done women a disservice by not talking enough about how progesterone and anxiety have been linked,” says Dr. Bacow. “Women's health is already understudied and underfunded, and OBGYNs receive almost zero training about menopause in medical school, for example, which is incredibly concerning given the thousands of women naturally going through this transitional point of life.”
It’s key that we get familiar with all the ways our hormones can affect us — because those shifts aren't going anywhere.
“Progesterone affects mental health ACROSS the lifespan, and women are already at risk for being labeled ‘unstable’ or ‘emotionally sensitive’ when there are very real biological shifts occurring in our bodies,” says Dr. Bacow.
Dr. Bacow adds that we typically focus exclusively on estrogen when discussing hormonal mood shifts. But, as she points out, estrogen and progesterone are linked, and we ought to pay attention to how both affect us.
“It would be hugely helpful to have a far more open discourse about how progesterone affects anxiety in both positive and negative ways,” adds Dr. Bacow. “The more we educate ourselves, the more empowered we can be to make decisions that promote our physical and emotional health.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, MarieClaire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.