The Darkest Side of Hormone Imbalance
12 Jan 2017

The Darkest Side of Hormone Imbalance

Janet was in her late 40’s when we first began working together. She had just split up with her husband of one year and was a financially strapped single mom to 2 teenage boys. Janet had a long history of issues with depression, which culminated at age 42 with 2 hospitalizations for suicide attempts.

While any suicide attempt is cause for alarm, what is even more remarkable is that her severe depressive issues were not related to a chemical imbalance in her brain—it was a hormone imbalance and her depression completely lifted once she started on bio-identical hormone replacement therapy (BHRT).

Suicide risk in midlife is not something that is frequently talked about, but studies have shown that suicide rates are increasing. Middle-aged women, between 45 and 64, had the highest suicide rate among women in both 1999 and 2014. This age group also had the largest increase in suicide rate: 63%, from 6 to 9.8 per 100,000. It’s probably no coincidence that those high numbers reflect the transition of vibrant baby boomers into middle and older age.

What’s the Root Cause?

Depression, anxiety, mood swings and panic attacks are very common in perimenopause and menopause and are often be related to an imbalance between progesterone and estrogen. Menopause affects not only our bodies but our emotions and brain functionality.

Hormones impact endorphin levels and neurotransmitters like serotonin, dopamine and GABA, so when your brain neuromodulators of estrogen and progesterone are up and down, so is your sense of well-being. Add to that life changes such as divorce, caring for aging parents, changing feelings about body image and role in life or substance abuse and you have a recipe for disaster.

Gut health also plays a major role since most of the body’s neurotransmitters are made in the “gut brain.”

Signs of depression can include one or more of the following: sadness, loss of energy, feelings of hopelessness or worthlessness, loss of enjoyment, difficulty concentrating, uncontrollable crying, difficulty making decisions, irritability, increased need for sleep, insomnia or excessive sleep, a change in appetite causing weight loss or gain, and thoughts of death or suicide or attempting suicide.

Hormone Testing and Treatment

Feeling down sometimes is common (especially if you’re experiencing an acute stressor), but if you’re continually feeling hopelessness, emptiness, and persistent anxiety, it is time to locate a good menopause specialist.  Testing can uncover imbalances which can then be directly addressed.

Each method of testing (blood, saliva and urine) has their plusses and minuses, but my preference is the DUTCH urine test. This test not only gives levels of sex hormones and cortisol, but also gives information about how your body is breaking down those hormones. This allows your metabolic pathways to be optimized in addition to balancing hormones. If you’re considering any testing, here are important tests to include:

  • DHEAS: DHEA sulfate is a hormone that converts into other hormones, including estrogen and testosterone. DHEA contributes to optimal adrenal function and your feeling of overall well-being. The ratio of DHEAS to cortisol can give information about stress-related effects on adrenal function.
  • Estradiol: Estradiol is the main type of estrogen produced in the body, secreted by the ovaries and to a lesser extent in the adrenals. Low levels can cause memory lapses resulting in sticky notes aplenty, anxiety, depression, uncontrollable bursts of anger, sleeplessness, night sweats and much more.
  • Testosterone: In women, the ovaries’ production of testosterone maintains a healthy libido, strong bones, muscle mass and mental stability.
  • Progesterone: Progesterone is a hormone that stimulates the uterus and prepares it for pregnancy. It also regulates the menstrual cycle, and low levels of progesterone can cause insomnia, irritability, anxiety and heart palpitations. Ideally, this test should be done on day 19-21 of your cycle (if still regular).
  • Thyroid: This includes checking your TSH (thyroid-stimulating hormone), free T3, free T4 and thyroid antibodies. Symptoms of perimenopause and menopause and a thyroid disorder can be very similar.

Suicide Danger Signs

The best way to minimize the risk of suicide is to know the risk factors and to recognize the warning signs of suicide. Take these signs seriously. Know how to respond to them. It could save someone’s life.

Warning signs that someone is considering suicide include:

  • A person who says they want to die or kill themselves.
  • Having a plan for killing themselves.
  • Describing feelings of hopelessness and having no reason to live.
  • Talking about feeling trapped or having an unbearable pain.
  • Talking about being a burden to others.
  • Increased use of alcohol or drugs.
  • Reckless behavior or acting anxious or agitated.
  • Sleeping too much or too little.
  • Isolating themselves.
  • Displaying extreme mood swings.

A suicidal person may not ask for help, but that doesn’t mean that help isn’t wanted. People who take their lives don’t want to die—they just want to stop hurting. Suicide prevention starts with recognizing the warning signs and taking them seriously. If you think a friend or family member is considering suicide, you might be afraid to bring up the subject. But talking openly about suicidal thoughts and feelings can save a life.

While Janet’s case was extreme, it highlights the importance of making sure that hormones are at least considered as a contributor to emotional problems in midlife.

Tweet: Menopause affects not only our bodies but our emotions and brain functionality.

Seventy percent of women have no one to talk to about menopause.

It’s important for all of us to bring this issue out of the shadows and have open conversations about this transition and the link to mental illness. Let’s give women permission to stop suffering in silence.

If you’re looking for support and help in perimenopause and menopause, please join me in the Hormone Harmony Club on Facebook. We’re open 24/7 with answers, support and a friendly community. And of course, if you or a loved one need immediate professional help, please contact your local suicide hotline.

Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.

Find out more about working with her at

Dr. Anna Garrett


  1. I was exactly there, at life worthlessness, a few months ago.

    During the first phase of menopause I had almost manic good feelings in body and mind. Then the next phase was up and down, anxious and occasionally dark. Finally After about 4 years, at 57, I felt spent and absolutely numb… worthless and uninspired, no matter what I tried, and I have ALWAYS been very proactive in life and health. Finally I confided in a friend. She said she had been exactly where I was. She tried pharmaceutical HRT, the lowest dose, and had miraculous results. Another friend told me bioidenticals had helped her, and if seeing is believing I can vouch for seeing her skin come back from dull and sagging to vibrant and smooth.

    When I started with Prempro (lowest dose) It took only a few days for me to feel the difference. Now only two
    Months later I am back, feeling normal, healthy, getting stronger every day. I never want to go back to that black hole. It was devastating.

    I truly hope more doctors recognize how important, possibly life-saving, HRT is. With so many potential impacts from environmental chemicals, I have a feeling we are under assault like no other generation. Keeping women healthy in body and mind could be a much bigger challenge in years to come.

    • I’m so happy you found relief!

    • Its what I feel like Ive been in for the last 5yrs and tired of feeling this way. I’m sick of trying to get my overall health back from what this dam has stolen, I’m just so tired.Iv been supplementing which have helped tremendously but can’t seem to just get back to feeling myself.

  2. Dr. I am from India, my close relative aged 43 died by self hanging was undergoing sever mood swing, first she started with fear that we relatives or closerby going to hurt her she wants to leave her husband and want to take her kids away from husband and at one point she dosen’t even bothered about her kids, she will not be normal, she wont eat, drink water, will not take car of kids, will not watch TV, and will always say is anybody going to hurt her and she wanted to literally leave her house, then we showed her psychiatrists she was tough enough to come to Doctor but was forced to take to doctor and Dr. administered an injection said it will work for a month and asked to take medicines, after 5 days she was discharged again she was in the same mood swing, she will not take medicines, instead she attempted drinking Soap solution, we tried to console her but she kept on telling not interested to live frustrated wit life no interest in anything, she was only wanting an opportunity to suicide and she did, we lost her. after he demise we are not able to digest what pushed her to this state, after net search we are trying to find out the cause, whether it bipolar disorder or anorexia or menopausal problem as she did not hint anything to her husband or to any relative, it is still a mystery. Could it be MENOPAUSAL problem

  3. I’ve been struggling with a lot. My dad was near death, a 4 year relationship is not what i thought it was and going no where. Im VERY lonely, and my boss recently said ” i cant sleep at night i must be going through menopause like you.” Is this what is talked about behind my back? I feel very hurt and insecure now. Im 45 and struggling. Ive dwelled about suicide. This weekend ive planted myself at the “wont commit” mans house because its cold and rainy and i dont want to be alone. Im scared to be alone. So i dont know what to do anymore. Ive struggled with a lot and gotten myself through – divorce 10 years ago, left a religion where i also lost all my lifelong friends and parents due to my decision, but im so tired now i dont see a way through these feelings.

    • I am so sorry you’re struggling. Please know that there is light at the end of this tunnel and there is help. Much of what you described can be helped with hormones, other supplements. Are you working with a therapist?

  4. Jude duncan Says: December 29, 2017 at 7:18 am

    Can you please offer a little advice .. I am suffering debilitating depression and very very low with suicidal ideation . I jam on anti depressants . I believe I have a serious hormone imbalance and the doc says the anti depressants are the best thing for this … I don’t know what to do with myself ! I have been trying hard to get better but nothing much is working

    • Hi Jude,

      Sorry you are having a difficult time. Antidepressants won’t fix a hormone imbalance. I can’t really give you advice without knowing more about your situation and history. I would keep looking for someone who will listen and consider hormone testing. I do offer this virtually in my practice.

  5. Carolyne Shapiro Says: May 12, 2018 at 3:00 pm

    I had two estrogen positive great cancers – chemo- radiation. brutal. The – cervical cancer and a radical hysterectomy. for 16 years i suffered hell. Pure hell – insomnia – hot flashes 40 per day and paralytic anxiety – was given valium and dilaudid and sleeping pills and was a walking drug. no hormones for me. i am 60 and better now but came to find none of the above – none of it was necessary. yes I am very angry but have channeled al that into helping women in meno. What a nightmare and for the one of us up here there are literally thousand out there suffering still and in silence and yes – not unlike my own mother they take their lives and I understand why – IT IS BRUTAL!!!!!!! Personally here in the United States i am really just disgusted with the lack of care or concern. it is bad and we are losing more and more women who have not a clue as to wha tit is happening to them – so much needs to be put out thee it is almost overwhelming.

  6. Carolyne Shapiro Says: May 12, 2018 at 3:05 pm

    Pls excuse my phone typos – we have to do something we do – doit unlike a really serious postpartum depression after giving birth OR experiencing PMS 365 24/7 something has to be done – women do not know about vaginal atrophy or what to do about it so their sex lives are shot though there is a cure – we cry – we cannot move – we cannot function or get out of bed somedays – medicine does not recognize menopause as a medical condition so bio identical therapy women cannot afford – how is that???? I do not know the answers – though yes in nursing I am not a doctor – I can only hole my groups to try to educate and do but i see so so so so so so many women walking around just lost and I ask them, “Have you sen your doctor and had a good hormone panel done?” You know what they say? They say ‘No – what is that?” Are you kidding – we are living in 2018!!!!! Something is terribly terribly wrong here and we need to make it better off we wish to survive – women died at 35 you know not to long ago a biologically speaking they were not needed!!!! We have come a ways since but none of us are feeling really any better than walking dead for far to long and it has to change I know ti does.

  7. Carol Kuehn Says: July 4, 2018 at 12:26 am

    I’m a bit of all the symptoms..where can I get the stuff to balance

  8. Catrine Stothers Says: July 7, 2018 at 7:00 am

    I have been diagnosed with PMDD and under the tip doctors in the U.K. However, I have had a reaction to the gnrh injection (it did not work and sent me psychotic) I bleed all the throughbthe 8 days of injections so they stopped it. They were laying back the hormones with 2 pins of estrodiol oer day and 200 Utrogestan. I have been so ill and suicidal since then and not just mentally but physically. I am bleeding like never before , cramping, boobs sore, bloated, blurry vision, memory loss so bad, I can’t remember where I put thing 5 mins ago. Tired, no appetite, hard to urinatr althogh drinking loads of water. Very suicidal. I had my estrogen levels and the blood test came back on Thursday and was high. 1,298 pmol/L. I have been told to reduce estrogen to 1 pump twice a day and carry on with utregstan. Blood pressure sky high 220:114 and I can’t take bp tablets as they make me more suicidal. This has been confirmed by professor at the Royal Brompton. I feel sick, jittery and don’t know what to do. How long does estrogen dominance last?

  9. Hi,
    I am 37 yrs old.
    3 weeks out of the month I am more depressed, suicidal thoughts increase…at times attempts. I balloon up in weight despite not eating wrong.
    My last ditch effort was to look up if any hormones cause suicidal ideation and found this article.
    Why did I look it up? I have active suicidal thoughts increased in 2 1/2 weeks.. almost tried to act on yesterday…. Whatever reason I didn’t. I just went potty 30 min ago and low n behold, I’ve started my period.
    For years I’ve said it’s around me starting my period more often than not.
    I also lose potassium more around this time too. I should get it checked, but I’m scared to because if it is too low I gotta go inpatient which with my suicidal thoughts they will throw me in lock down unit.
    I have appt tomorrow with the obgyn again. Is there anything she can try to help me reduce my suicidal thoughts. It’s to the extreme. And I’m afraid next time, there won’t be a next time. Something’s gotta give!

    • Hi Carole,

      I am sorry you are experiencing this…and that it took me a couple of days to see this. Have you had your hormones checked (other than by blood tests)? I can’t tell you exactly what to do as I don’t know much about your situation. I hope you shared your suicidal thoughts with your doctor. If you are not in the Hormone Harmony Club on Facebook ( please join us…there are MANY women in there who have been in the same boat. You are not alone. xoxo

  10. FYI I also have hashimotos, diabetes, depression, anxiety…

    I see a therapist and psychiatrist and am on mental health meds for years.

  11. Tara Carter Says: November 7, 2018 at 10:20 pm

    I am 41 and am in early menopause. Prior to this, I was a happy, social and active person. Even with HRT, I now cry all the time, do not want to socialize with others and feel like a disgusting dried up old hag. It is so difficult as none of my friends are near this stage. In fact two are currently naturally pregnant, with surprise later in life babies on the way. I have no children and now know for sure I never will have that oportunity, which adds to the loneliness. The hot flashes, brain fog and night sweats have improved with HRT, but the feelings of worthlessness remain. Counseling has not helped as no one gets how horrifying it is to age prematurely. I never had a need for medications or counseling prior to this horror. Life was good. I had a wonderful sex life, with my husband, prior. However, now I find sex is a reminder of being old, of giving up hope of ever having a family and my vagina being atrophied and dried up. I am not suicidal, but see how menopause could drive someone to that point. This is so much worse than I ever imagined. I am strong and as horrible as this is I know I will survive, however, I would give nearly anything to once again be youthful and healthy.

    • Hi Tara…I am sorry you are struggling. There is so much mindset work that goes into making midlife a time of great possibility while leaving youth behind at the same time. I’d encourage you to continue with counseling and to find positive things to look forward to. Life throws curve balls that knock us off center, but there is always a way back to that center. My thoughts are with you…

  12. Hi Anna, I am 29 years old and going through horrendous hormonal difficulties. Is there a way to speak to you? Where are you based? So you offer Skype/phone? Or can I simply email you a few questions? Many Thanks

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