Anxiety is a common mental health disorder that affects over 40 million adults in the United States each year. It is characterized by excessive and persistent worry or fear about everyday situations. Some level of anxiety is normal, but anxiety disorders interfere with daily activities and cause significant distress. There are several factors that can contribute to anxiety, including brain chemistry, personality, and life experiences. Recently, there has been increased interest in the link between hormones and anxiety. Fluctuations or imbalances in hormones may play a role in the development or exacerbation of anxiety symptoms in some individuals. In this article, we will explore the evidence on hormonal causes of anxiety and provide an overview of the major hormones that have been implicated.
What is anxiety?
Anxiety disorders include generalized anxiety disorder, social anxiety disorder, panic disorder, and phobias. The hallmark of anxiety is excessive fear or worry that is difficult to control and lasts for at least six months. This persistent anxiety impacts daily functioning and causes significant distress. Anxiety often co-occurs with other mental health conditions like depression.
Some common symptoms of anxiety include:
– Feeling restless, on-edge, or tense
– Difficulty concentrating
– Irritability
– Fatigue
– Muscle tension
– Difficulty sleeping
– Racing thoughts
– Avoiding situations that cause anxiety
– Panic attacks
Anxiety disorders typically develop due to a complex interaction of biological and environmental factors. Research suggests that genetics, brain chemistry, personality, and trauma can make someone more vulnerable to anxiety. However, experiencing prolonged or high levels of stress often triggers the onset of anxiety symptoms in predisposed individuals.
How do hormones impact anxiety?
Hormones are chemical messengers that regulate many processes in the body. They are produced by glands like the thyroid, adrenal glands, and ovaries/testes. Hormones travel through the bloodstream to tissues and exert their effects by binding to receptors on cells. The major hormone systems include thyroid hormones, sex hormones (estrogen/progesterone in women and testosterone in men), stress hormones like cortisol, and reproductive hormones.
Hormonal imbalances or fluctuations can develop for various reasons like chronic stress, poor diet, underlying health conditions, or normal life stages like menopause. When hormones are out of balance, it can impact mood and set the stage for anxiety. Here’s an overview of the main ways specific hormones influence anxiety risk:
Thyroid hormones
The thyroid gland secretes hormones like thyroxine (T4) and triiodothyronine (T3) that regulate metabolism. An overactive thyroid (hyperthyroidism) and underactive thyroid (hypothyroidism) can trigger anxiety symptoms.
In hyperthyroidism, excess thyroid hormone production accelerates metabolism and can cause agitation, nervousness, irritability, and rapid heart rate. Up to 90% of people with hyperthyroidism experience anxiety. Treatment to get thyroid levels back to normal often resolves anxiety.
With hypothyroidism, a deficiency in thyroid hormones slows metabolism down. Fatigue caused by low thyroid function can mimic anxiety symptoms. Also, hypothyroidism may worsen underlying anxiety. Treating the thyroid condition through medication helps alleviate anxiety in these cases.
Sex hormones
Estrogen and progesterone naturally fluctuate throughout the menstrual cycle in women. Lower levels of estrogen right before a menstrual period may exacerbate anxiety in some women. On the other hand, high estrogen levels during pregnancy seem to have a protective effect against anxiety.
Menopause onset also causes a major drop in estrogen that can trigger anxiety symptoms. Up to 20% of women going through menopause experience anxiety that seems linked to hormonal changes.
In men, low testosterone levels are associated with increased anxiety. Testosterone acts on brain regions implicated in mood regulation. One study found men with anxiety disorders tend to have lower testosterone.
Stress hormones
Cortisol is known as the primary “stress hormone” and helps regulate the stress response. Long-term stress leads to chronically high cortisol that may enhance anxiety. Cortisol hypersecretion seen in disorders like Cushing’s disease also correlates with higher anxiety prevalence.
On the other hand, low cortisol or blunted stress reactivity can be seen in chronic anxiety. This may reflect dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis that controls cortisol release. Overall, abnormal cortisol signaling whether too high or low seems linked to anxiety risk.
Reproductive hormones
Dramatic fluctuations in reproductive hormones like progesterone, estrogen, and testosterone occur during pregnancy, after giving birth, and perimenopause. These life stages are also associated with increased risk for new onset or recurring anxiety.
Up to 10% of pregnant women experience anxiety during pregnancy. Postpartum anxiety affects around 15% of new mothers. And 10-20% of women going through perimenopause have anxiety symptoms. Rapid declines in progesterone/estrogens after pregnancy and during the menopausal transition may contribute to anxiety in vulnerable women.
Specific hormonal causes of anxiety
While research indicates hormones generally can impact anxiety, certain hormone-related medical conditions seem strongly tied to anxiety. Treatment targeting the underlying hormonal imbalance often helps alleviate accompanying anxiety. Some specific examples include:
PCOS
Polycystic ovarian syndrome (PCOS) results from excess male hormones (androgens) in women that inhibit normal ovulation. Up to 57% of women with PCOS have elevated anxiety levels compared to 15% in the general population. High testosterone associated with PCOS may directly affect mood. Anxiety could also stem from PCOS symptoms like menstrual dysfunction, infertility, and metabolic issues.
Hyperparathyroidism
Parathyroid glands control calcium levels via parathyroid hormone (PTH). Hyperparathyroidism from a benign tumor results in overproduction of PTH. Anxiety frequently occurs in hyperparathyroidism along with fatigue, bone loss, and cardiovascular issues. How excess PTH triggers anxiety symptoms requires more research but may involve altering calcium signaling in the brain.
Hyperthyroidism
As mentioned earlier, an overactive thyroid gland secretes excess thyroid hormones leading to hyperthyroidism. Palpitations, tremors, and feeling on-edge from the sped up metabolism manifest as anxiety symptoms. Treating the hyperthyroidism through medication, radioiodine therapy, or surgery typically resolves accompanying anxiety.
Hypothyroidism
In hypothyroidism, the thyroid is underactive and doesn’t make enough thyroid hormone. Debilitating fatigue from low metabolism can mimic anxiety sensations. Also, thyroid hormones act on aspects of brain function that regulate mood when out of balance. Restoring thyroid levels treats anxiety stemming from hypothyroidism.
Menopause
Plummeting estrogen levels during the menopausal transition disrupt stress signaling pathways in the brain. This makes some women in perimenopause vulnerable to new onset anxiety. Hormone replacement therapy may help alleviate anxiety that emerges due to menopause.
Postpartum thyroiditis
Up to 10% of women develop inflammation of the thyroid after pregnancy leading to temporary hyperthyroidism followed by hypothyroidism. These fluctuations in thyroid hormones can manifest as anxiety, irritability, and mood swings in the first year postpartum. Getting diagnosed and treated for postpartum thyroiditis helps stabilize mood.
How are hormone-related anxiety disorders treated?
The main approach in treating anxiety arising from hormonal imbalances involves:
1. Diagnosing and treating the underlying hormonal condition whether it is thyroid disorders, PCOS, menopause, or another issue. This may include medications or surgery to normalize hormone levels.
2. Using anti-anxiety medications like certain SSRIs or benzodiazepines on a short-term basis during the hormonal transition. These help manage anxiety symptoms as hormone levels stabilize.
3. Trying psychotherapy approaches like cognitive behavioral therapy (CBT) to develop constructive coping strategies for anxiety. This can help patients respond to hormone-induced anxiety symptoms in a more positive manner.
4. Adopting lifestyle and dietary changes that assist with hormonal balance like regular exercise, stress management, adequate sleep, and improved nutrition.
While addressing the hormonal imbalance is key, anxiety that develops often needs direct treatment as well. A combination approach helps most patients struggling with anxiety related to hormone fluctuations or disease.
Can hormones alone cause anxiety disorders?
Hormonal abnormalities are rarely the sole cause of clinical anxiety or anxiety disorders. However, they likely contribute to anxiety development by altering brain function in those already vulnerable. Research suggests hormones act as a “trigger” that can unleash anxiety in people predisposed due to their genetics, trauma background, or personality traits like neuroticism.
Studies indicate variables that influence anxiety risk include:
– Family history – Genes inheritance
– Stress levels – trauma, negative life events
– Personality type – neuroticism, introversion
– Brain chemistry – neurotransmitter imbalances
– Comorbid conditions – depression, chronic illness
– Gender and sex hormones
– Overall health and hormonal status
So hormonal problems are one piece of the puzzle when it comes to anxiety disorders, but not necessarily the whole picture. A susceptible individual with trauma history and high stress levels may experience onset of severe anxiety if they develop thyroid disease or get thrown into menopause. Improving the thyroid or menopausal transition symptoms alone without addressing the other mental health and personality components may not resolve their anxiety.
For most patients, anxiety arises out of a web of multiple predispositions that get exacerbated during times of hormonal fluctuations or imbalance. Treatment works best when it approaches anxiety from multiple angles, rather than just isolated hormone therapy.
The takeaway
Hormonal imbalances or shifts can trigger or aggravate anxiety in predisposed individuals. Hyperthyroidism, hypothyroidism, dramatic reproductive hormone changes, abnormal cortisol, low testosterone, and conditions like PCOS seem most tied to anxiety risk. While correcting the hormonal problem is important, complementary medications, therapy, or lifestyle changes are often needed to successfully treat hormone-induced anxiety.
Rather than the sole cause, hormonal dysfunction seems to be an inciting factor for anxiety onset in those already vulnerable. Comprehensive treatment accounting for all contributing factors generally provides the best relief for anxiety related to hormone issues. Anyone experiencing new onset anxiety correlated with major hormonal events like pregnancy, postpartum, or perimenopause should see their doctor to explore whether hormonal imbalance could be at play.