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Last updated October 3, 2026
If your anxiety seems to come and go with your cycle, there’s a good chance hormones are part of the story. Women are about twice as likely as men to experience an anxiety disorder, and about 23% of women meet the criteria for one in any given year. The hormone shifts across the menstrual cycle, especially in the second half, are a big reason why.
Below: which hormones are most often involved, why anxiety so often spikes after ovulation, and what to test if you think yours is hormonal.
Your menstrual cycle is orchestrated by fluctuating hormones throughout the month. Female menstrual cycles generally occur every 24-35 days. The first half of the menstrual cycle, from your first day of bleeding until you ovulate, is called the follicular phase. This is the estrogen-dominant phase of the cycle, and can cause higher levels of serotonin, the “happiness hormone.” Estrogen levels spike during this phase, triggering the hormones that tell your ovaries to ovulate mid-cycle.
Once we ovulate, the small capsule that releases the egg (the corpus luteum) begins producing progesterone which initiates the progesterone-dominant phase called the luteal phase (from ovulation until your next period starts). If we do not become pregnant during this phase, both progesterone and estrogen levels dramatically drop which triggers your uterine lining to shed and a new menstrual cycle to start.
Estrogen will soon soar again at the beginning of the new cycle, creating recurring fluctuations that cause upwards of 80% of women to experience at least one physical, mood, or anxiety symptom.
Anxiety after ovulation is usually driven by progesterone. Either your body isn’t making enough of it after you ovulate, or your brain is unusually sensitive to normal levels of it.
After ovulation, the empty follicle (the corpus luteum) starts making progesterone. Your body converts some of it into allopregnanolone (a mouthful, I know), which acts on the GABA receptors in your brain. These are the same receptors anti-anxiety medications work on. For most women, that’s where the calmer feel of the second half of the cycle comes from.
That can go wrong in two opposite directions.
Not enough progesterone. This is the one I see most in my practice. If ovulation is weak, late, or doesn’t happen at all, you make less progesterone, and your nervous system loses the brake it’s expecting. The second half of your cycle feels wired instead of calm: trouble falling asleep, waking at 3am, a low hum of dread. It often comes with spotting before your period, or fewer than 10 days from ovulation to bleeding.
A brain that’s sensitive to normal progesterone. Researchers in Sweden have found that in some women, allopregnanolone has the opposite effect at the moderate levels a normal luteal phase produces. They estimate it hits hard in roughly 3 to 8% of women and more mildly in up to a quarter. It’s the leading explanation for PMDD.
Estrogen also dips right after ovulation before rising again, which adds to the shift.
Here’s the tricky part. These two feel identical from the inside, but one needs more progesterone support and the other can be made worse by it. The way to tell them apart is a progesterone test drawn about 7 days after ovulation, not on a random cycle day, read alongside the day your anxiety actually starts.
Yes. Hormones can cause anxiety, and in women they’re one of the most overlooked causes. When a hormone is too high, too low, or shifting at the wrong point in your cycle, your nervous system feels it.
Hormonal imbalances can cause many different types of symptoms, especially anxiety. For many women, they struggle with a multitude of different hormone imbalances resulting from the fluctuations of hormones – either too much, or too little hormones are produced, or hormones are produced at the wrong time in the cycle. This fluctuation can lead to severe anxiety symptoms, as well as a host of other symptoms, like bloating and acne, which can ultimately worsen anxiety.
And that’s just during the menstrual cycle …
Women have a higher risk of developing anxiety disorders during different life stages when hormones fluctuate drastically, such as puberty, pregnancy, postpartum, perimenopause, and postmenopause.
Unfortunately, hormones and anxiety can be a bit of a chicken and an egg situation: hormonal imbalances may cause anxiety in some people or be the result of increased anxiety in others.
Anxiety isn’t the only potential side effect of a hormone imbalance. If you suspect that your anxious feelings might be linked to your hormones, knowing the other possible signs of an imbalance can help you make the connection:
Read more about signs and symptoms of a hormonal imbalance and foundational recommendations to address them here: Top Ten Symptoms of Hormone Imbalance.
Here are the three most common anxiety related symptoms that I see in my private practice:
Extremely heavy flow during your period, especially when you have heavy flow every month, can lead to anemia (iron deficiency in the blood) and one of the symptoms of anemia is, you guessed it, anxiety. Heavy bleeding can be caused by estrogen dominance, a condition in which we have more estrogen in our bodies relative to progesterone. It can also be caused by fibroids, adenomyosis, thyroid issues and bleeding disorders, so it’s worth getting checked. Either way, heavy periods drain your iron stores, and ferritin (your stored iron) can drop long before a standard blood count shows anemia. One large study found iron deficiency anemia came with about a 47% higher risk of developing an anxiety disorder. Addressing estrogen dominance can help correct anemia, and reduce anxiety.
Read more about estrogen dominance here: Balanced Living With a Hormone Imbalance: Estrogen Dominance.
Progesterone is produced by the corpus luteum, the empty egg sac leftover after the egg has been released. If you are not ovulating, then you are not making progesterone. Anovulatory cycles (meaning you are not ovulating) are one of the most common reasons for low progesterone levels.
Studies have found that progesterone helps improve cognitive function and plays a role in the synthesis of GABA, a calming chemical produced in the brain. Not enough progesterone can mean not enough GABA, and that can translate into more anxiety. Several factors can contribute to low levels of progesterone, including not ovulating (common in women with PCOS) or having a luteal phase defect, which is when stress or other hormone imbalances interfere with sufficient progesterone production.
Low progesterone is one of the most common hormonal drivers of anxiety in women of reproductive age. Because progesterone has a direct calming effect on the nervous system through GABA receptors, even a modest drop can trigger noticeable anxiety, insomnia, and restlessness, particularly in the week before your period.
If this sounds like you, see Why Do I Feel Anxious After Ovulation? above for how to tell low progesterone apart from progesterone sensitivity.
Read more about low progesterone here: Balanced Living With a Hormone Imbalance: Low Progesterone.
Insulin is one of the body’s master hormones and when it gets out of balance, thanks to eating too many refined carbs and sugar that wreck your blood sugar, your mood stability can go out of balance with it.
Animal studies suggest that insulin resistance, which is what happens when the body stops responding to the health-sustaining message that insulin sends to cells, is associated with mood and behavior disorders. But you likely already know this, not from the research but from your own life. If you’ve ever eaten something sugary, or gone too long without eating anything, and quickly plunged from feeling great to feeling sad, irritated, and panicky, you’ve experienced the up and down of the blood sugar and insulin roller coaster … and the anxiety that can come along with it.
A good step to take towards minimizing hormone-related anxiety is understanding which hormones in particular can affect your mood and response to stress. These include sex hormones, stress hormones, thyroid hormones, and oxytocin. While each plays a pivotal role in the functioning of your body, too much or too little can cause complications.
Fluctuating levels of estrogen and progesterone may play a role in how much anxiety you experience.
Estrogen is higher during the first 2 weeks of the menstrual cycle, which can create higher levels of serotonin, also known as the feel-good hormone. By contrast, studies show that during the times of the menstrual cycle when estrogen is lower (in the second half of your cycle and right before your period), there is a more significant negative mood response.
Both too much and too little estrogen can trigger anxiety. When estrogen is too high (estrogen dominance), it can overstimulate the nervous system, causing racing thoughts, irritability, and panic-like symptoms. When estrogen drops too low, as it does right before your period or during perimenopause, serotonin production decreases, which can trigger depression and anxiety.
Progesterone levels increase just after ovulation, and in women who are sensitive to it, research has found it increases activity in the amygdala, the part of the brain responsible for fight-or-flight responses. It makes sense that triggering the amygdala might result in feeling more anxious than usual.
Changes in mood or increased anxiety often accompany this fluctuation in the second half of the menstrual cycle. In fact, as many as 80% of reproductive-age women experience at least one physical, mood, or anxiety symptom during this window.
Symptoms of estrogen and progesterone imbalances:
Yes, in some cases. While progesterone is generally calming due to its GABA-supporting activity, some women are particularly sensitive to normal luteal levels of progesterone metabolites. When progesterone rises sharply after ovulation, it can stimulate the amygdala, the brain’s fight-or-flight center, leading to increased anxiety, irritability, or a feeling of being on edge.
This is especially common in women taking supplemental progesterone (such as during fertility treatments or hormone therapy). If you notice increased anxiety after starting progesterone, don’t stop it on your own. Talk to your practitioner about adjusting the dose or form.
Low testosterone levels have been linked to certain types of anxiety disorders, particularly social anxiety disorder (SAD). Testosterone helps regulate the part of the brain that allows us to assess other people’s emotions to respond to social threats. Low levels can make it challenging to understand what’s happening in social situations or how to react. This uncertainty can easily lead to anxiety in some people.
Symptoms of a testosterone imbalance:
The stress hormones, otherwise known as cortisol and adrenaline, are released when a person experiences a stressful situation, feels threatened, or senses danger. These stress hormones initiate the fight-or-flight response to help cope with the threat and prepare the body to take action.
However, if an event or experience triggers your stress hormones while you’re not actually in danger, like while reading a stressful work email, you won’t use or release those hormones during a fight-or-flight response. This can cause excess levels of cortisol and adrenaline and can leave your body feeling anxious.
What’s more, an increase in stress hormones can cause the body to release even more stress hormones in response, which can leave you feeling stressed and anxious.
Symptoms of cortisol and adrenaline imbalances:
Thyroid hormones can affect your mood, and an imbalance can impact how you feel both physically and mentally. Feelings of anxiety, restlessness, irritability, and nervousness are common symptoms of an overactive thyroid (hyperthyroidism). On the other end of the spectrum, an underactive thyroid can cause symptoms like fatigue and feelings of depression.
What’s more, a 2018 meta-analysis in JAMA Psychiatry found autoimmune thyroiditis (Hashimoto’s) linked to roughly twice the odds of an anxiety disorder, and that link can show up even when thyroid hormone levels look normal. Most standard panels stop at TSH, so ask for TPO and thyroglobulin antibodies too.
Symptoms of thyroid imbalance:
Oxytocin is the hormone emitted when we fall in love or bond with someone. While this hormone is often referred to as the “love hormone,” and it can help reduce anxiety, it has some adverse effects, too. In research, oxytocin was found to strengthen bad memories and increase fear and anxiety.
Oxytocin modulates anxiety, aggression, and the stress/fear response when one is introduced to different types of stimuli. Anxiety and emotional responsiveness to stress may decrease during periods of high oxytocin activity in the body, such as lactation and sexual activity.
An imbalance in oxytocin levels can occur during periods of prolonged stress or trauma, potentially leading to heightened anxiety and difficulty forming positive social connections.
Symptoms of oxytocin imbalance:
If your anxiety follows your cycle, here’s what I’d want to look at:
Here are my favorite five ways to balance your hormones in order to regain your sense of calm and reduce anxiety:
Step one is to stabilize your blood sugar, and the best way to do that is to eat the right carbs at the right time. Start each day with a protein and healthy fat-rich breakfast within 90 minutes of waking up. Aim to include at least 20-30 grams of high quality protein. A nutrient-dense breakfast can help stabilize blood sugar throughout the day and promote healthy hormone balance. A 2013 study found that women with PCOS who ate the majority of their calories at breakfast, and fewer calories at each meal throughout the day, had better hormone balance.
For both lunch and dinner, incorporate high quality protein, healthy fats and real food sources of unrefined carbohydrates, like lentils, beans, starchy root vegetables, and whole non-gluten grains.. Eating some complex carbohydrates, like a sweet potato, at your evening meal can reduce cortisol spikes at night and promote healthy, restorative sleep.
Did you know that tailoring your exercise regime to your menstrual cycle will help you balance your hormones more effectively and efficiently? Seriously.
If you were to do the exact same workout routine every day of the month, you’d notice that some days feel better than others, sometimes you recover quicker than others, and some days you just won’t be able to do the same amount of movement as the day before … that’s because of hormones.
Let’s break this down into phases: the first half of your cycle is the estrogen phase, and the second half of your cycle is the progesterone phase.
Days 1-3: although the estrogen phase (from the first day of bleeding until ovulation) of your cycle is when your energy is boosted, days 1-3 can be tough for some women: you’re bleeding, your body is switching over to a new cycle, and rest and recovery are essential. So, take it easy!
Day 4-ovulation: the rest of your estrogen phase is an incredible time to build muscle, making it a great time to do more lifting and strength training! During this phase, I’d recommend lifting heavier weights and doing HIIT workouts. The best part? Shorter recovery times.
Ovulation-menstruation: after ovulation, your body starts to shift and change. The same things that work in the estrogen phase can now slow you down, making you feel a little sluggish. You can still workout in this phase, but take it down a notch: lift lighter weights and focus on slower, but longer endurance cardio. You will need more recovery time, so it’s important to listen to your body and rest when needed.
Reducing caffeine can be very helpful for reducing anxiety. When it comes to giving up caffeine, you don’t need to take my word for it: you’ve likely experienced the manic heartracing that comes after too much coffee … and the less frantic feeling that follows a cup of herbal tea. If anxiety is a problem for you, don’t make it worse by jacking up your heart rate with three cups of coffee. Opt for half caf, or limit your consumption to one cup per day. Always with food. Never after 12pm.
While research on the link between hormonal birth control and mood and anxiety has been inconclusive over the past half century, enough research (and anecdotal evidence) has linked hormonal birth control with depression and other mood disorders. Hormonal birth control has also been shown to deplete mood-supporting vitamins and minerals like vitamin B6, zinc, and magnesium.
If your anxiety started or got worse after you began hormonal birth control, that’s worth raising with your provider. And if you stay on it, make sure B6, zinc and magnesium are covered.
Read more about the long term side effects of hormonal birth control here: Hormonal Birth Control & Long Term Side Effects and how to quit hormonal birth control here: How to Quit The Pill Without Side Effects
The body makes progesterone from a precursor compound called pregnenolone, and pregnenolone is derived from cholesterol. So to produce enough progesterone, we need to have enough healthy cholesterol food sources in your meals: organic grass-fed butter and ghee, coconut oil, and organic grass-fed meats.
The most important dietary change you can make to optimize progesterone levels is to keep your blood sugar nice and steady, which keeps your adrenal glands happy and hormone levels in check. This means including high quality protein, healthy fats, and real food carbohydrates sources (like vegetables) at every meal and snack. Stay away from refined carbohydrates, sugar, and ultra-processed foods.
It’s also important to focus on eating foods containing magnesium, zinc, vitamins B6 and C, all shown to boost progesterone levels. Here are some foods you can add to your diet to naturally support your body’s progesterone levels:
Another option to boost progesterone naturally is a bioidentical progesterone cream. Test first and work with a practitioner, though, because for women who are sensitive to progesterone, adding more can make anxiety worse. Read more here: Using Bioidentical to Naturally Increase Progesterone Levels.
Hormonal changes throughout the menstrual cycle are one of the leading causes of anxiety among women. Understanding how your menstrual cycle works, the hormones at play, and symptoms to look out for can help you determine if a hormone imbalance is the root cause of your anxiety.
Thyroid disease: How does it affect your mood?
Estrogen, Stress, and Depression: Cognitive and Biological Interactions
Sex Differences in Anxiety Disorders: Interactions between Fear, Stress, and Gonadal Hormones
Anxiety Disorders Among Women: A Female Lifespan Approach
Sex Differences in Anxiety and Depression: Role of Testosterone
Hormonal Imbalance: Causes, Symptoms & Treatment
Nutrient and Stress Management
Effects of contraceptives on serum trace elements, calcium and phosphorus levels
If your anxiety follows your cycle, that’s information. It’s worth investigating, not just managing.
If you’re not trying to conceive and want to understand what’s driving your hormones and your anxiety, book a 1:1 hormone assessment with me. We’ll look at your symptoms, the timing, and your labs, and you’ll leave with a plan you can start this cycle.
→ Book a 1:1 Hormone Assessment
If you’re trying to get pregnant, the drivers behind hormonal anxiety (low progesterone, thyroid antibodies, low iron, blood sugar swings) are often the same hidden drivers preventing pregnancy. After nearly 20 years and more than 1,000 women, I’ve found most “unexplained” cases aren’t unexplained. They’re uninvestigated. That’s what we uncover inside The Fertility Code, my 12-week program. Over 90% of the women I work with go on to conceive.
→ Find Out What’s Preventing Pregnancy
Or schedule a free Fertility Strategy Call to see if the program is right for you.
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