Kathy, 52, reported having severe PMS throughout her life and revealed that birth control pills had made her “crazy” with agitation in her late twenties. For years Kathy had been diagnosed with chronic fatigue syndrome. In her late forties, she had a hysterectomy. Ever since, she had been using Premarin (estrogens) and vaginal estrogen cream to help with night sweats and reduce pain during sex.

While traveling in Central America shortly before coming to see me, she had developed gastroenteritis and needed her gall bladder removed. After that, she had never gotten back on her feet. Over the next six months, she became increasingly confused, depressed, anxious and irritable.

Wondering if her hormones were affecting her emotional state, she came in for an evaluation. In addition to the Premarin, she was on Wellbutrin (an antidepressant) and Oxycontin (a narcotic for pain). Her cognition was mildly impaired with respect to her attention and speed of thinking.

Kathy’s brain had shown a lifelong sensitivity to the effects of the reproductive hormones estrogen and progesterone. Her history of severe PMS and adverse reaction to birth control pills is evidence of this. Her menopausal transition was bringing predictable hormonal changes and adverse emotional effects.

When she came to me, Kathy was on unopposed estrogen. Because her uterus was gone, there was no risk of uterine cancer from unopposed estrogen and doctors had told her she did not need progesterone. Unfortunately, her brain was feeling the adverse effects of this strategy.

I prescribed a dose of progesterone in a regimen that counterbalanced the estrogen

Kathy quickly calmed down with the new treatment. Over a couple weeks, her anxiety and irritability faded and her thinking normalized. A few months later, she had weaned herself off the antidepressant. She has stayed calm and cheerful since.

This case illustrates how natural reproductive hormonal changes throughout life can wreak havoc on moods and emotions, at least for a sizable subset of women. While estrogen elevates mood and enhances thought processes, it can quickly become anxiety-producing and even seizure-provoking under certain circumstances. Progesterone counteracts the estrogen, exerting anti-anxiety and even anti-seizure effects. It also reduces estrogen receptors on
brain cells.

With the menopausal transition, estrogen levels decline gradually, which can bring about depressive symptoms and mild cognitive changes in many women. Eventually, as periods start skipping, progesterone levels also decline, which can cause anxiety, irritability and mood swings in these women. Judicious replacement and balancing of estrogen and progesterone – with bioidentical forms of these hormones – is a highly effective and safe way to treat
these symptoms.