Anxiety and panic attacks can appear suddenly without any warning. One day you feel normal, and the next day, out of the blue, you experience anxiety with racing heart, palpitations. Your mind may also race with obsessive thinking, and simple everyday activities may seem overwhelming. If these symptoms of anxiety and panic coincide with the menstrual cycle, hormone imbalance is suspected. Symptoms may also be related to PMS, perimenopause, or menopause. Thus you might suspect hormone imbalance causing anxiety.
Yes, of course, fluctuating or imbalanced hormones can influence mood, stress responses, sleep, and brain function. However, anxiety and panic attacks can have many causes. A full evaluation can sort things out.
How Hormones and Anxiety Are Connected
Hormones act as chemical messengers throughout the body, and function as neurosteroids in the brain. This means that estrogen, progesterone, thyroid, cortisol, and other hormone levels in the brain determine our emotional state, mood, alertness or calmness, anxiety and other parameters of brain function. Adrenal hormones such as cortisol, epinephrine and norepinephrine activate the body’s stress response, and may cause anxiety and panic attacks.
When hormone levels fluctuate, we may experience mood disturbances, anxiety, panic attack and loss of emotional well-being. Anxiety and panic attacks may include a sudden feeling of intense fear, racing heart, sweating, trembling, shortness of breath, dizziness, or a sense of losing control. A tell-tale sign these symptoms are caused by hormonal fluctuations, is temporal association with the menstrual cycle, PMS episodes, peri-menopause, menopause and reproductive transitions. These are times in life when hormone levels are shifting. Of course, there are other non-hormonal causes of anxiety and panic attacks, and integrative medicine is useful to sort this out. However, hormonal fluctuations are commonly the usual suspects.
Hormonal Changes That May Affect Anxiety
Estrogen and progesterone
Estrogen and progesterone fluctuate throughout the menstrual cycle and change substantially during perimenopause and menopause. These shifts may influence neurotransmitter activity, sleep, and emotional regulation. We may notice increased nervousness, irritability, or emotional sensitivity on certain days of the menstrual cycle. We may experience new or worsening anxiety during perimenopause.
If you are wondering if hormonal imbalance is causing your panic attacks, then notice if the anxiety episodes follow a recurring pattern associated with a particular day of the menstrual cycle. This recurrence with the menstrual cycle suggests a hormonal imbalance issue.
Thyroid hormones
Thyroid hormone levels control metabolic rate and mitochondrial energy production. Excess thyroid can cause anxiety. Excess thyroid symptoms are nervousness, restlessness, rapid heartbeat, and difficulty sleeping. Low thyroid or low thyroid function does the opposite, causing brain fog, slowed metabolic rate, fatigue and weight gain. Various psychiatric syndromes have been associated with Hashimotos thyroiditis, including depression, anxiety, manic-depression, bipolar, acute psychosis, dementia, loss of cognitive function etc. Most of these recover after treatment of Hashimoto’s thyroiditis with thyroid medication and other measures. Thyroid excess symptoms may be indistinguishable from the anxiety of hormonal imbalance. Evaluation of thyroid function with a complete laboratory panel is useful to distinguish the two, especially when there are signs or symptoms of a thyroid disorder.
Cortisol and the stress response
Cortisol is made by the adrenal glands and regulates the stress response. Ongoing stress can affect sleep, energy, mood, and other aspects of health, creating a cycle in which physical and emotional symptoms reinforce each other. Dr. Hans Selye was an endocrinologist working with stress in mice in 1936. He was first to describe the three stages of stress adaptation, initial brief alarm reaction, followed by a prolonged period of resistance and a terminal stage of exhaustion and death. Over his 80-year career devoted to the endocrinology of stress, Dr. Hans Selye wrote over 1500 scientific articles, 32 books, and trained 40 PhD students, one of whom won a Nobel Prize. Dr. Hans Selye’s animal studies on restraint stress defined the field for over 80 years. These studies show that chronic stress powerfully activates the HPA axis (hypothalamic pituriary axis) with robust corticosterone (cortisol) elevation. Note: HPA is Hypothalamic Pituitary Axis. Thus, chronic stress and cortisol elevation causes of anxiety and panic attacks. This possibility should not be overlooked. Laboratory testing of early morning cortisol or a 4-sample salivary cortisol test provides useful information to sort this out.
Signs That Anxiety May Be Hormone-Related
Symptoms may follow certain patterns that can provide useful clues. For example, anxiety episodes may appear along with irregular periods, hot flashes, night sweats, sleep disruption, changes in menstrual bleeding, or other symptoms associated with hormone fluctuation or imbalance. Symptoms may intensify around menstruation or during perimenopause. Keeping a logbook to write down symptoms, cycle timing, sleep, medications, and major stressors can help identify patterns. If you are wondering if hormone imbalance is causing your anxiety symptoms, remember that fatigue, mood changes, headaches, sleep problems, and weight changes can overlap with thyroid disorders and many other conditions. A full medical evaluation with laboratory panel can usually sort things out.
What Else Can Cause Anxiety and Panic Attacks?
Symptoms of anxiety and panic attacks may include a sudden feeling of intense fear, racing heart, sweating, trembling, shortness of breath, dizziness, or a sense of losing control. Anxiety deserves a broad evaluation because hormonal changes are only one possible contributor. Chronic stress, certain medications, birth control pills, stimulants such as caffeine and amphetamines, sleep deprivation, thyroid disorders, vitamin B12 deficiency, medical conditions, and psychiatric disorders can all be associated with anxiety and panic attacks. Anxiety is a symptom of SSRI antidepressant withdrawal, commonly reported when stopping the drug. Of course, panic attacks can occur without an identifiable hormonal cause.
How Is Hormonal Anxiety Evaluated?
There is no single test for anxiety. Rather a complete evaluation is required beginning with a review of symptoms, medical history, medication and supplement list, menstrual history or menopausal status, sleep patterns, etc. We always do complete laboratory panels. Depending on findings, further testing is sometimes needed. At TruemedMD, our medical director Jeffrey Dach MD, approaches each patient individually. We do not treat a laboratory result in isolation. Rather we integrate all the information together to come up with the most probable diagnosis and the treatment most likely to produce a good outcome. This is called integrative medicine. And this type of evaluation can determine whether hormonal changes are contributing to your symptoms.
When Anxiety Should Not Be Ignored
Occasional worry is part of life, but persistent anxiety that interferes with sleep, relationships, work, or daily activities deserves medical attention. For more serious symptoms, the reader is advised to seek urgent medical care. These more serious symptoms such as severe chest pain, significant breathing problems, fainting, loss of consciousness or anything suggesting a medical emergency requires an urgent visit to your doctor or the Emergency Room. However, for ongoing chronic anxiety, discussing your symptoms with a qualified healthcare professional can help uncover contributing factors and guide appropriate care.
Mainstream Medical Treatment for Anxiety
If you seek care for your anxiety symptoms with your doctor, the gynecologist may give birth control pills if you are premenopausal. Or if you are post menopausal and visit your primary care, they will give you one of two drugs, either an anti-anxiety medication called a benzodiazepine (Valium, Xanax, Ativan, Klonopin, etc.) or an SSRI antidepressant (Prozac, Lexepro, Paxil, Wellbutrin, Zoloft, Effexor, etc.). These drugs are not recommended because they carry adverse side effects and they are addictive with withdrawal effects when people try to stop them. If your symptoms are caused by hormone imbalance, these drugs are the wrong treatment because they do not contain natural progesterone nor do they address hormonal imbalance. Instead, the best approach to address the hormonal imbalance with natural progesterone and supportive natural supplements and botanicals, with good outcomes in most cases. That is our approach at the TruemedMD Clinic in Davie, Florida.
Frequently Asked Questions
Can hormonal changes trigger anxiety?
Hormonal fluctuations may influence mood and stress responses, particularly during menstrual, perimenopausal, and menopausal transitions.
Can low estrogen cause anxiety?
Changes in estrogen may cause anxiety, panic attacks and affect mood and emotional wellbeing. Of course, other causes should also be considered.
Can hormone imbalance cause panic attacks?
Yes, hormonal changes may contribute to anxiety symptoms and panic attacks. It is important to consider other causes as well.
What hormones are linked to anxiety?
Estrogen, progesterone, thyroid hormones, and cortisol can influence systems involved in mood, stress, sleep, and emotional regulation.
Should I get hormone testing for anxiety?
Testing may be appropriate when symptoms suggest underlying hormonal or medical problem, but results require an integrative approach to interpretation of clinical history and laboratory studies.
Use Integrative Medicine to Uncover Causes of Your Symptoms
Anxiety is real, and so are the physical changes that can accompany hormonal transitions. Rather than assuming every symptom reflects a hormone imbalance, we can use integrative medicine approach to reveal the underlying diagnosis and factors affecting your well-being.
If you are experiencing persistent anxiety or panic symptoms alongside hormonal changes, bring your questions, symptoms, and concerns to your consultation with our TruemedMD medical director, Jeffrey Dach, MD, who can help you explore answers through an individualized, integrative approach.
