The Real Reason Women Struggle More With Anxiety & Depression Has Finally Been Named
In 26 U.S. states and in the United Kingdom, it is illegal to separate a puppy from its mother before eight weeks of age. There is no equivalent protection for human mothers.
One in four American women return to work within two weeks of giving birth, almost always because of financial pressure, with no federal mandate for paid leave.
A new perspective paper in PNAS Nexus summarizing recommendations from a National Academies of Sciences, Engineering, and Medicine workshop on women's mental health argues that this contrast is not incidental. It is a window into something much larger.
About the study
The paper draws on a workshop convened by the National Academies of Sciences, Engineering, and Medicine (NASEM) titled "Essential Health Care Services Related to Anxiety and Mood Disorders in Women."
The workshop brought together researchers, health care providers, policymakers, insurers, community members, and people with lived experience to advise the U.S. Health Resources and Services Administration (HRSA) on how to improve women's mental health care.
The backdrop is decades of structural neglect. Until the 1993 NIH Revitalization Act, women and female animals were routinely excluded from clinical trials in the United States.
Even after that mandate, women have remained underrepresented in research. In 2020, just 5% of global research and development funding went toward women's health. The paper's recommendations span five themes: fund more women's health research, train clinicians better, widen access to mental health services, enact sensible policies, and aim for outcomes beyond the mere absence of disease.
A disparity that starts at puberty & compounds across a lifetime
Women are at least twice as likely as men to experience anxiety and depression, a gap that begins in puberty and persists through menopause.
The paper is clear that this is not biological destiny. It is the result of underfunded research, undertrained clinicians, and a health care system built largely around men's biology.
Three major hormonal shifts define a woman's life: puberty, pregnancy, and the transition into menopause. Each is a meaningful turning point for mental health risk.
During the monthly cycle, fluctuating estrogen and progesterone levels are linked to two distinct, diagnosable conditions:
- Premenstrual dysphoric disorder (PMDD) involves significant emotional distress in the second half of the cycle that clears within a week of menstruation.
- Premenstrual exacerbation (PME) is where existing mental health disorders worsen before a period.
Pregnancy comes with major shifts
Pregnancy brings a dramatic hormonal rise of it's own, followed by a sharp postpartum drop.
Mental health disorders are the most common complication of pregnancy and childbirth, with 15 to 21% of pregnant and postpartum women experiencing perinatal mood and anxiety disorders (PMADs)—twice the rate of preeclampsia or gestational diabetes—and yet postpartum depression is not routinely screened for.
Then perimenopause rocks us again
The perimenopause and menopause transition brings a significant drop in estrogen, androgens, and progesterone, associated with sleep problems, brain fog, and the onset or worsening of anxiety and depression.
More than 80% of medical residents report feeling unprepared to treat menopausal women, and family practice doctors receive almost no formal training on how hormonal changes affect mental health.
Plus women have more social stress
Biology alone doesn't explain the gap. Women face a compounding set of social stressors (bias and discrimination, disproportionate caregiving burdens, higher rates of sexual and physical violence, greater exposure to poverty) and higher rates of adverse childhood experiences (ACEs).
Women are more likely than men to report four or more ACEs, which raise long-term risk for anxiety, depression, and chronic disease.
In 2025, more than 63 million Americans served as unpaid family caregivers, a 45% increase over the prior decade, with that labor falling disproportionately on older women and women of color.
If compensated, it would be valued at more than $1.1 trillion. Meanwhile, psychiatrists are reimbursed at 13 to 20% lower rates than other specialty doctors for the same services, pushing many providers out of insurance networks entirely.
What this means for your next doctor's appointment
The paper's most direct message for individual readers is this: the system was not designed for you, and knowing that is the first step toward navigating it more effectively.
- Track your cycle in relation to your mood: PMDD and PME are real, diagnosable, and treatable. Knowing when in your cycle you feel most vulnerable is the first step toward getting targeted care rather than a generic depression diagnosis.
- Know that not all hormonal birth control is the same: Emerging research shows meaningful differences in how various formulations affect mood, cognition, and stress. This warrants a real conversation with your provider, or a referral to a reproductive psychiatry specialist.
- Ask about ACE screening: ACEs are a risk factor for nine of the ten leading causes of death in the United States. Screening is now a billable service in California, and the paper's experts argue it should be standard practice, especially at hormonal transition points.
- If your symptoms have been dismissed, the research confirms this is a systemic problem: Providers receive almost no formal training on how hormonal transitions affect mental health. That gap is not a reflection of your symptoms being minor.
The takeaway
Women are twice as likely as men to experience depression and anxiety, and a new National Academies paper makes clear this is not a biological inevitability.
It is the measurable result of underfunded research, undertrained clinicians, and a health care system built around men's biology. The biological drivers are real, the social ones compound the risk, and the system has never been designed to address either.