Estrogen & Depression: An Unhappy Dance

Estrogen & Depression: An unhappy dance - silhouette of tango dancers

I’ve taken birth control pills for much of my adult life. Sometimes the contraceptive benefit was useful, but much of the time, it was more about keeping estrogen fluctuations associated with PMS at bay. I’ve recently decided to stop taking the pill because there is some indication that oral contraceptives may promote inflammation. The connection isn’t particularly clear, but I want to at least try since my body isn’t very happy currently.

The last time I took an extended break from birth control was a little over three years ago. I was going away on a month-long trip, and by the time I realized I didn’t have refills left on my prescription, it was just too rushed to fit in a trip to the doctor. When I got home from the trip, I figured that I might as well try staying off of it. Maybe I’d feel fine without it.

The first thing that I noticed was that PMS made an appearance again, and the awful cramps during my period that I used to have as a teenager were back. Then several months later I had a relapse of my depression, and all hell broke loose. I was getting lengthy periods ultra-frequently, and my mood was a disaster. It took me a while to realize that I should go back on birth control, but when I did my, body definitely thanked me.

The role of estrogen

So why all of this hormonal craziness? The cycling of estrogen levels causes fluctuations in levels of various neurotransmitters in the brain. Depression rates among women are highest during the childbearing years, when estrogen levels are high and cycling.

During postpartum and peri-menopausal stages, there is a sharp drop-off in estrogen levels, and these times are particularly high risk. In menstruating women, there’s a natural drop-off in estrogen starting after ovulation and lasting until menstruation begins; however, it’s nowhere near as extreme as what happens postpartum or peri-menopausally.


Mood fluctuations are not uncommon with premenstrual syndrome (PMS). Dr. Wikipedia tells us that up to 80% of women experience symptoms of premenstrual syndrome, with 20-30% meeting the full criteria for PMS. Dysmenorrhea (painful periods) affects 20-90% of women.  

Premenstrual dysphoric disorder (PMDD) occurs in 3-8% of women, and it’s a mental illness that kicks PMS mood disruption up several notches. It was introduced in the DSM-5, the newest edition of the Diagnostic and Statistical Manual of Mental Disorders. In PMDD, mood symptoms occur in the time between ovulation and the onset of bleeding. Symptoms typically last for around a week, but they may last up to 2 weeks.

Managing the madness

SSRIs are the most common type of medication used for PMDD, and fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro/Cipralex) have been approved by the U.S. Food and Drug Administration (FDA) specifically for use in PMDD. Unlike in depression and bipolar, response to SSRIs is rapid in women with PMDD, occurring within a day or two. Because of this, the SSRI only needs to be taken in the last 2 weeks of the menstrual cycle or during the time when symptoms are occurring.

Another option is birth control pills containing the progestin drospirenone, which is found in Yasmin, among others. Cognitive behavioural therapy (CBT) may be useful in reducing overall impairment by changing behaviour patterns.

Carrying on

I haven’t been off the birth control long enough to really see yet how it’s going to affect me. If my mind and body start to rebel, I plan to restart it. Maybe I’ll end up taking birth control until I hit menopause and then switching over to hormone replacement. In theory, it would be nice not to throw hormones into my body, but that can be pretty easily outweighed if my own hormones are getting into a war with my depression. So we shall see. But how has evolution not made all of this a well-oiled machine?

For my female readers, have you noticed a relationship between your hormonal cycles and your mental health?

If you’re looking for an app to keep track of these kinds of things, Me v PMDD and Flo are good options.

book cover: Managing the Depression Puzzle, 2nd Edition, by Ashley L. Peterson

Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.

It’s available on Amazon and Google Play.

19 thoughts on “Estrogen & Depression: An Unhappy Dance”

    1. I am new to this BUT help.
      My doctor has percribed me fleuxatine 20mg fir pmdd im 41. I am on no contraception as the pill i was previously on was discontinued, I have a large fibriod and was taken off it. They have now recommended cerazette but 1 doctor says good other doctor says it will deepen depression?! So now I jave no idea what to do. I am 7 days due to have a period & since sun i have felt really low 🙃

  1. My mental health is better since I’ve been in total hormonal menopause (I didn’t have much in the way of periods for about 10 years prior because of an ablation). I had a setback at the end of 2016 and during 2017 because of a failed romance but I struggled through that and am okay. It would have been so much worse 5+ years ago.

  2. I was on birth control for about 10 years probably. The estrogen would make me so sick to my stomach and give me horrible migraines whenever I would start back on it after having my period. It really sucked. I even tried the kind where you skip periods entirely, but still had some issues. I also gained weight that I lost almost immediately when I went off the stuff. Not my favorite stuff in the world lol.

  3. Interesting! I knew hormones and moods were related but didn’t know how. I still don’t really understand it, but oh well, maybe one day.
    I generally get very depressed before my period, and I also sometimes have very painful and irregular periods. My doctor suggested birth control, but I’m hesitant to try it, and my periods haven’t been as bad recently, so for now at least I’m seeing how it goes and how I can best manage it with diet, sleep, etc.

  4. Thank you for this timely post. I’ve recently had to come off any and all HRT (I took a very mild compounded bioidentical) due to a dysplasic (thick) endometrium (I’m 10+ years post menopausal) let me tell you the mood swings just plain SUCK! I haven’t fought depression and hypersensitivity this bad in many years. It’s kind of reassuring to know I’m not the only person out here with estrogen related depression problems. 😉

  5. Big dip about 3 or 4 days before my period. Horrible depression. Horrible irritability. I just recently had a complete hysterectomy. I was about 3 months without hormones. Nope! Wasn’t happening. I am now on estrogen and I am a much happier person!

  6. I always experience PMS and my periods are so bad with awful cramps. I’m happy I take Naproxen which helps with the cramps. Before my period and also during I experience being nauseous and also being more anxious. It definitely has a connection.

  7. Yes i have noticed… 40 years ago…

    Now i understand ….thank you for writing this…i got some answers

    Hope you are feeling better…i am thinking about you.

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