Covid-19 means uncertainty for a lot of people. Combined with stress and racism-related grief, the pandemic can trigger feelings of anxiety in people but more so among women.
Psychiatrist Maureen Sayres Van Niel from the American Psychiatric Association’s Women’s Caucus shared via wellness platform Well+Good that although there are various factors behind such disparity, including discriminatory pay practices and employment, increased everyday stress, and exposure to stigma and racism, hormonal differences also play an important role in making women more vulnerable to depression and anxiety.
She said that everyone, regardless of gender or sex, produces some amount of progesterone, estrogen, and testosterone. However, “people with testes” have different hormonal makeup compared to those with ovaries and uteruses and those differences could impact how they respond to stress. Well+Good editors highlight the use of gender-neutral terminology as much as possible although health researchers are only starting to study the health of transgender and Gender non-conforming (GNC) people.
Women’s reproductive hormones fluctuate throughout the month during their menstrual cycle. On the first day of their period, the progesterone and estrogen levels are both very low. But around 14 days of the cycle or at ovulation, their estrogen levels increase. It is during such time that their progesterone levels also begin to rise to 20-fold as their body prepares for a possible pregnancy. If the woman doesn’t become pregnant, her hormone levels will plummet until before the next period and the cycle will restart. Take note, however, that this applies only for people who are not taking hormonal birth control, which affects their progesterone and estrogen level.
Experts think that the hormones estrogen and progesterone are mainly responsible for variations in anxiety. Other hormones, like thyroid hormones, cortisol, and oxytocin, are also likely to play. Testosterone in men is converted into estrogen in the brain and the levels will remain relatively stable because they do not menstruate.
In women, however, fluctuations of said hormone appear to be linked to mood changes. The study has also shown that about 80% of women experience a physical symptom or mood changes in the last half of their menstrual cycles and about 20% have premenstrual symptoms. Another 5 to 8% experience premenstrual dysphoric disorder (PMDD).
Premenstrual dysphoric disorder (PMDD)
PMDD is a health problem that is the same as premenstrual syndrome (PMS) but is more serious. The former causes severe depression, anxiety, and irritability in a week or two before the period starts. Symptoms then usually go away two to three days after the period starts.
Estrogen and progesterone hormones likewise increase exponentially once the women get pregnant and then drop dramatically after giving birth. This contributes to the “baby blues,” which include irritability, sadness, anxiety, and mood swings. While baby blues often get resolve within a week or so of birth, the symptoms of depression are more intense.
According to Postpartum Support International, approximately 6% of pregnant women and 100% of postpartum women develop anxiety. Sometimes, they develop anxiety alone, and sometimes they experience it in addition to depression. The symptoms of anxiety in postpartum or during pregnancy may include constant worries, racing thoughts, inability to sit still, feeling that something bad is going to happen, and physical symptoms, like nausea, hot flashes, and dizziness.
An estimated 264 million worldwide have an anxiety disorder and the prevalence of any anxiety disorder was higher for females (23.4%) compared to males (14.3%). In the US, for instance, the prevalence of anxiety disorders in 2017 was 4.76% for males and 4.42% for females. In South Korea, the prevalence was 2.55% for males and 5.02 for females, published in the scientific online publication Our World in Data.
Meanwhile, countries with the lowest share of the population with anxiety disorders in the same period were Colombia (2.51%), Venezuela (2.87%), Nigeria (2.895), Russia (2.95%), Kazakhstan (2.61%), and Mongolia (2.58%), among others.
Estrogen level and “fear extinction”
Ten years leading up to menopause, progesterone, and estrogen also fluctuate inconsistently. About 25% of women report experiencing frequent irritability or anxiety during this transition in their life.
NYU Grossman School of Medicine’s professor in the psychiatry department Mohammed Milad, Ph.D., who is also the director of the behavioral neuroscience program research, discovered in both rat and human studies that increased level of estrogen supports a person’s ability to handle feelings of anxiety. This is referred to as the “fear extinction.” Low levels of estrogen, on the other hand, makes an individual more vulnerable to trauma. This could mean that people with higher levels of estrogen essentially handle anxious feelings and fear better although it remains unclear whether the findings will apply to transgender people who are undergoing hormone therapy because such population was not included in the research.
Yet, the study shows that hormone therapy for transgender people may reduce their rates of anxiety. Dr. Milad added that it is not like estrogen gives a person with a superpower by inhibiting fear but the absence of such hormone that seems to be problematic. He highlighted that anxiety disparities cannot all be explained by hormones alone but hormones play an important role that has not yet been studied in the past. He cited a 2012 study on PTSD, wherein it concluded that PTSD and anxiety disorder seems to have the same neural pathways in the brain and both are affected by the fluctuations of hormones.
That small study likewise found that women sexual assault victims who took estrogen hormone therapy as their emergency contraceptive had fewer symptoms of post-traumatic stress disorders in the next three months compared who did not take the therapy. But Dr. Van Niel said that just because one experiences anxiety doesn’t necessarily mean that they have a disorder. In this current situation, everyone feels anxious to a certain extent. If the anxiety symptoms, though, are interfering with a person’s ability to function on an everyday level, then it is best to talk to a medical professional.
Not everyone with anxiety needs medication. What’s most important is knowledge, the experts shared.
Anxiety is our body’s natural response to stress. Just as hormones play a role in why women are more vulnerable to anxiety, there are also hormonal ways to relieve anxiety, such as eating a balanced diet, getting a regular exercise, taking a multivitamin, and cuddling with a loved one.