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Is Your Anxiety Triggered By Hormonal Imbalance? Here's Exactly What To Do About It

Jolene Brighten, N.D.
Doctor of Naturopathic Medicine
By Jolene Brighten, N.D.
Doctor of Naturopathic Medicine
Dr. Jolene Brighten is a women’s health expert currently based in Portland, Oregon. She received her Doctorate of Naturopathic Medicine at the National University of Natural Medicine and is the best-selling author of Beyond the Pill.
Photo by Artem Zhushman

When I first met Martha, financial worries constantly hounded her, looming layoffs meant she often worked 10-hour (or longer) days, and a near-zero sex drive took its toll on her three-year relationship.

To cope with ever-increasing anxiety levels, Martha popped Xanax throughout the day. She was up to 3 mg ("one and a half bars," as she called it), yet she hated feeling dependent on this popular anti-anxiety drug that often made her feel like a space cadet. At the

same time, Martha considered natural anti-anxiety remedies like yoga, meditation, and supplements like L-theanine (as she called it) "woo-woo medicine."

As a doctor who helps women heal from autoimmune disease and balance their hormones, I’ve seen how, despite numerous medications and meditations, many patients like Martha feel plagued by anxiety. Rather than connect these mood disorders with hormonal imbalances, doctors instantly reach for their prescription pad.

Here's the thing: Stress comes in many flavors.

Someone swerving into your lane, overexercise, eating on the run, airport delays, a fight with your boyfriend, and environmental toxins are among the many overlooked, underacknowledged stressors that inundate our days. Whatever the source, when your body feels stressed, your adrenal glands kick in immediately; anything your body considers potentially unsafe will generate an adrenal response. And this mechanism actually kept you alive thousands of years ago when, say, a saber-tooth tiger decided he wanted you for lunch.

Stress should do its job and then leave you alone, but today’s constant stressors keep your adrenals in overdrive. And in response, your body shuts down fertility to keep you safe. So what, you say; you’re not trying to get pregnant anyway. But even if you don’t want to become a mom, shutting down your fertility (unless you’re post-menopausal) can seriously affect your overall health.

The chronic stress-fertility connection you should know about.

To understand why, you need to understand how fertility works. On the third day of your period, your brain increases communication signals with your ovaries, requesting they get an egg ready for ovulation. Roughly around day 14, you raise luteinizing hormone (LH) and your body temperature, resulting in an egg being released. Once the egg releases, the corpus luteum—responsible for secreting your sex hormone progesterone for about two weeks following ovulation, regardless of whether or not the egg is fertilized—stays within the ovary. Like life itself, balance becomes key with hormones like progesterone.

Progesterone maintains the lining of your uterus, making it possible for a fertilized egg to attach if you’re trying to get pregnant. It also helps maintain healthy cervical mucus, which provides nourishment and helps sperm safely swim toward the egg. Progesterone stays high throughout your pregnancy to ensure survival and overall health of the embryo and then fetus. But even if you’re not trying to get pregnant, you still want optimal progesterone levels. That’s because it also stimulates gamma-aminobutyric acid (GABA) receptors that hit the brakes on your neuro-excitatory neurotransmitters.

In my practice, I see how low progesterone levels affect fertility but also create symptoms like mood swings, anxiety, fatigue, low sex drive, and sleep disturbances. When you’re constantly stressed, your body goes into survival mode. Keeping you alive becomes more important than fertility. After all, if that saber-tooth tiger is chasing you for lunch, being pregnant or having a baby could seriously slow you down.

Progesterone and cortisol are competing for your body's attention.

Constant stress also keeps cortisol ramped up. Ideally, levels of this stress hormone should be highest in the morning and gradually taper until it's lowest at night. When it sticks around after its prime, a process called the progesterone steal occurs. Your body literally hijacks progesterone production to make cortisol. A vicious cycle ensues, keeping your adrenals in overdrive, meaning they’re constantly secreting hormones like cortisol, epinephrine, and norepinephrine; lower progesterone and higher stress-hormone levels tell your brain to freak out.

As we quickly discovered, Martha’s exhausting, debilitating anxiety levels stemmed from hormonal imbalances. Her cortisol was off the charts, and she had low progesterone. Insulin resistance kept her inflamed and set her up for diabetes. Estrogen dominance held her weight hostage and further played into her stress levels. Overall, it was a messed-up hormone parade.

To hit the reset button on hormones and anxiety, start here.

Once I find the root cause of hormonal imbalances that contribute to anxiety, I can help patients nourish their adrenal glands and restore hormonal balance. To do that, I implement these seven strategies:

1. Eat a whole foods diet.

Sugar and food sensitivities like gluten and dairy can increase anxiety, stall weight loss, imbalance insulin and other hormones, and leave you feeling less than fabulous. While she wasn’t eating obvious sugar sources, I found so-called healthy foods like whole grain cereal or agave-sweetened snacks had hijacked Martha’s hormones. Instead, she focused on leafy and cruciferous veggies, low-glycemic starches like quinoa, clean protein sources, and healthy fats from foods like wild-caught salmon and avocado.

2. Step it up.

She was already doing yin yoga to manage anxiety, but I also wanted Martha to add some higher-intensity exercise to her plan. That’s because when you’re anxious, your body wants you to move—fast! Big-muscle movements, including jump squats, walking, lunging, and even kicking can help your body move through anxiety and stress.

3. Focus on your breath.

The key word is focus, not control. Trying to control your breath can make you more anxious. Instead, try noticing your breath without judgment next time you feel anxiety swell. Sometimes being present—even during seemingly trivial moments like when you’re paying at the checkout line rather than getting distracted with magazine covers—can shift your awareness and soothe your nervous system.

4. Nix caffeine.

If you’re constantly stressed, that morning java jolt could be doing more harm than good. Martha was a self-admitted caffeine fiend. I had her gradually taper off morning coffee with half-regular/half-decaf. Eventually she moved to green tea, which provides the calming neurotransmitter L-theanine to balance its small amount of caffeine.

5. Prioritize your morning.

Rather than leap out of bed and check her iPhone or email, Martha started her morning with five deep breaths, 10 minutes of sun salutes, and then 20 minutes of meditation. (She admitted on super-busy days she did only five minutes of meditation, which is still fine.) When her mind wandered to her to-do list, she went back to her breath. Go back to your breath and you can manage almost anything.

6. Consider quitting the pill.

Depression is one of the most common reasons why women quit the pill, yet I find birth control also triggers anxiety-induced symptoms by depleting nutrients1 and disrupting your gut balance. The pill also messes with your thyroid, and anxiety can be a common symptom of hypothyroidism. If your conventional physician isn’t hearing it, talk with a functional medicine or naturopathic doctor about going off the pill.

7. Boost progesterone.

Utilizing herbs and nutrients that balance hormones can help balance progesterone levels. For Martha, that began with a professional-quality multivitamin-mineral, essential fatty acids with omega-3s and the omega-6d (GLA), and calming nutrients like passionflower and L-theanine.

Looking for more ways to bust anxiety? Try medical sound therapy, or work on strengthening your vagus nerve.

Jolene Brighten, N.D. author page.
Jolene Brighten, N.D.
Doctor of Naturopathic Medicine

Jolene Brighten, N.D., is a women’s health expert currently working as the President and Chief Medical Officer at Rubus Health in Portland, Oregon. She received her Doctorate of Naturopathic Medicine at the National University of Natural Medicine and a bachelor’s in Nutrition Science from Cal Poly, San Luis Obispo. She is the best-selling author of Beyond the Pill, in which she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. Dr. Brighten has been featured in the New York Post, Cosmopolitan, Forbes, ABC News, and The Guardian.