Our hormones have long been a kind of taboo. But it could be high time to tune in to what’s inside.
Seven years ago, former model Ema Taylor found herself in London – unhappy, off-balance, and unsure where to turn. “I was irritated, I was cranky, I was really quick to react,” she explains. “I wasn’t feeling good in my body, or like myself.”
The feeling had been tenuous enough to seep in undetected, but soon it was impossible to ignore. Doubting herself and devoid of the right medical advice, Taylor decided, on a hunch, to stop taking the pill.
“I felt a bit more like myself … but then I hadn’t got my period for three-and-a-half years.
“I saw naturopaths, doctors, gynaecologists; everyone just said, ‘you’re fine, it’ll come back’, but knowing what I know now, I wasn’t fine.”
It was around that time that Taylor began studying naturopathy, “and I started to become a bit more inquisitive with what was happening with my body.
“I often joke but it feels like another life now. Being more aware, I think is a huge shift for me.”
Now back in Sydney and a fully accredited naturopath practicing out of Bondi’s Nimbus and Co studios, Taylor spends much of her time guiding other women to heal their bodies and minds. When – as Taylor’s were – their ailments are rooted in hormonal factors, the results are often consecutive.
“Our hormones make us who we are,” asserts Taylor. “They are our chemical messengers, they tell us how to feel each day.” Among them are our sex, or gonadal, hormones – primarily estrogen, progesterone and testosterone in women – which do much more than their moniker suggests. They’re part of a network of variables that influence our emotional landscape, our thought processes, and our resultant actions. But if this isn’t widely known, or regularly acknowledged, we hardly have ourselves to blame. It’s only in the past decade, or so, that the medical literature has reached some kind of consensus on the extent of the mind-body connection. Namely, that it is real and inextricable.
In my case, it took stumbling across research into the links between hormones and mental health to realise just how little I knew about my own. Eight years of the pill, skipped periods and a tendency to look to what my body could do for me, before considering what I might do for it, had rendered my hormonal health somewhat of an afterthought. Soon, though, I began noticing patterns – in my life, and the lives of those around me. I needed to know more. Among the studies in question were those led by Melbourne-based professor of psychiatry Jayashri Kulkarni – a leader in the field working out of The Alfred and Monash University.
When I speak with Kulkarni, she’s just returned from a conference overseas; her expertise has her in high demand, but she’s eager to shed light on this mind-body connection in the hopes of raising awareness.
“There’s the perception that gonadal hormones are all about reproduction [and] nothing much north of that,” she explains.
“In fact there’s quite a lot of evidence that points to the real, tight connection between gonadal hormones like estrogen and progesterone and testosterone on the mental state, particularly in women.”
“… They’re particularly prevalent in all areas of the brain but especially in the cognitive or higher thinking levels of the brain and the limbic system, which is the emotional centre of the brain.”
For Kulkarni, like Taylor, there was a clear catalyst for her work in exploring these implications: a realisation of just how impactful they could be. She was working with female patients in a long-stay psychiatric ward when she met a number of women who had experienced the onset of psychosis or schizophrenia in the setting of post-childbirth – or later in life. “With both groups, the women themselves said, look I think something went wrong with my hormones and then all hell broke loose with my mind, and I’ve been trying to tell people about the connection with hormones and mind but no one’s listening.”
Finally, someone did. Her interest piqued, Kulkarni began looking for further connections and found – among other studies – the ‘estrogen hypothesis’; there were findings to suggest the hormone was protective against the early onset of schizophrenia, but declining levels at menopause could be linked to a relapse or ‘first break’ psychosis in women of middle age – something not seen in men, who are commonly diagnosed with schizophrenia in their late teens or early 20s. Yet the medical literature’s basis in the male body and mind meant the possible pattern had been missed, with female patients dismissed as outliers.
It was a discovery that would come to define Kulkarni’s work as the founder and director of Monash Alfred Psychiatry Research Centre, a clinical psychiatrist and advocate for women’s mental health awareness. “I’ve continued on in a number of different ways looking at estrogen as a treatment modality,” she tells. “And then trying to understand how it works and what happens, not just in a research sense but in real life.”
Beyond major life changes such as puberty, pregnancy, postpartum (another period associated with risk factors for depression, anxiety and in fewer cases, psychosis and schizophrenia) and menopause, females’ sex hormones are known to fluctuate with their monthly cycles.
Sometimes, this feels good. When women ovulate, more estrogen enters the system, improving mood, increasing energy levels and consecutively boosting libido: convenient timing if we assume procreation is the end goal.
On the flipside, well, many of us will be familiar with the effects of premenstrual syndrome. There’s a reason one might not feel perfectly fit for public consumption in the week leading up to a period – and that’s a drop in estrogen associated with this phase of the cycle that can lead to a lack of energy, irritability and / or a flat mood.
Important to our understanding of the chemical reactions happening inside our bodies is that while some women might not have reason to notice them, others appear to be more sensitive to such hormonal fluctuations. Premenstrual Dysphoric Disorder, or PMDD, is associated with severe depressive symptoms, anxiety, feeling ‘out of control’ and even suicidal thoughts in the phase leading up to one’s period – and, according to Kulkarni, it is thought to affect about seven per cent of women. Its cyclical aspects are recognisable, if one is looking for them, which makes evidence to suggest that PMDD is commonly misdiagnosed simply as depression – and sometimes bipolar disorder – all the more disturbing.
“It is about the causality being the hormonal shifts that occur across the menstrual cycle, and particularly premenstrually, there’s a drop in estrogen,” explains Kulkarni of PMDD. “We hypothesise that this impacts adversely and causes the depression … But if you don’t target the treatment by using a hormone treatment, then it means really that the outcomes are not the ones that you want.”
It’s clear proper diagnosis is imperative for this reason alone. But then there is that other fact we already know: knowledge is power. In deepening understanding of self – even pre-treatment – there is opportunity to gain clarity, and a sense of control.
When patients present at Taylor’s treatment rooms with issues to do with their hormones, often the journey begins with a physical manifestation. “Probably the most common is polycystic ovarian syndrome and amenorrhea, which is no period whatsoever,” she says. Next up, are “PMS, hormonal acne, breast tenderness, bloating, severe pain and emotional imbalance; feeling out of sorts, teary, cranky.”
“Libido is huge,” Taylor adds. “Frequently, on my form, people will tick low libido …”
“[Libido] is not just about being sexually active … It’s feeling good … and energised, and balanced.”
A common misconception, she says, is “feeling that it’s just a one road or answer as to why hormones are imbalanced [and] not understanding that it’s a holistic thing. It’s about diet, all those things.”
Stress and its associated hormones, like cortisol, are also major factors. In the short term, stress is linked to infertility and changes in the menstrual cycle. But its impact on the gonadal hormones appears to be so strong that psychiatrists have recorded a link between trauma in early life and conditions like PMDD later on.
And then, of course, there are the hormones we add. While hormonal therapies have potential to produce life-changingly positive effects, not least among trans-identifying individuals who choose to undergo hormonal replacement therapy – it seems, in all instances, careful monitoring is key.
In the case of the contraceptive pill, kinds of synthetic progesterone, present in the pill, have been linked to adverse mental health symptoms like depression and anxiety.
“So this is another important thing for young women to know,” Kulkarni explains. “The pill is fantastic for getting fertility control and therefore fertility freedom for women … but the difficulty is that [the type of] progesterone can be depressive.”
“We see in the clinic, women who go, look, I just don’t feel right. I can’t reach the highs of really enjoying something or laughing out loud or just being happy, and I can’t work out why.”
For me, this description sounds a little too familiar. Actually, it was after discovering Kulkarni’s research that I intuited a connection to a feeling that had been bothering me for some time. A kind of dullness I had put down to lifestyle, or burn-out, or just getting older.
But within a fortnight of taking my last contraceptive pill that greyscale had all but cleared. I felt lighter, younger.
There were some unfamiliar sensations, or lack thereof. But mostly, it felt like coming home.
Despite being monitored for physical risk factors like high blood pressure and migraines I had never had a conversation with my GP about how the medication might affect my mental health. And I’d never made the connection myself.
It is worth noting that research in this area is still developing, and studies have disputed the link between depression and certain contraceptions. But until we know more, then public awareness of any potential symptoms seems like a fair compromise.
Kulkarni points to a “siloed” effect between medical professions as to why this may be lacking. “So the people who are interested in the mind are not the ones dealing with the body and vice versa … But the second factor, I think, has just been that it’s only been a decade where there’s been more evidence for the impact of hormones on the brain. So I think up to that point, the science also didn’t allow people to think if she’s feeling dull on the pill, maybe it’s the pill.
“There are many types of pills and contraception that are available for women and that really should make a difference to somebody … If that’s the main cause and effect, then that’s easy to shift.”
With the right research and funding, there’s also potential to develop more hormonal contraceptives that don’t come with the same risks. To get there, Kulkarni says we need to keep having conversations about mental health, and loudly.
“I’m going to show my bias here, but I think women’s health and mental health is at the bottom of everyone’s agenda, so it’s never received the research, funding, or the attention, or the research resources that are required to bring these things up for general discussion.
“I think it’s also about the fact that this is not a life-threatening area per se. We lose patients through suicide so let’s not make light of that,” she adds. “But in comparison we’re talking about quality of life here.”
Within the field of naturopathy, methods of individual cycle tracking are gaining traction. One Taylor teaches is the natural fertility awareness method, which tracks temperature and cervical fluid to determine the timing of ovulation and the corresponding ‘fertile window’. If contraception – or conception – isn’t the objective, explains Taylor, “It’s still important for understanding how your body works … like, I am ovulating now, and I feel really good. Or I’m not fertile now and my mood’s dropped a little bit so I must be premenstrual. Little things like that that can be really beneficial.”
When used for contraception, like most methods, it has its pros and cons, (Family Planning New South Wales rates fertility awareness methods in general as between 76 and 99 per cent effective) and arguably requires greater time and commitment: Taylor advises her patients that it takes about a year to learn and therefore use, and says for many women that she works with, this can be the biggest challenge.
It’s not so surprising, given the speed of modern life, that the interlude required to tap into the body’s intricacies each day would require not just learning – but unlearning too.
Tied into this is a societal propensity to view menstruation and hormonal fluctuations as inconveniences – even causes for shame.
As Kulkarni puts it, “the pejorative use of ‘it’s her time of the month’ – and other such comments are used to keep women down. This is why the older feminists abhor hormone-mental health research and have tried to reframe it as the patriarchy subjugating women and environmental issues – rather than biological issues.” So how to find a balance, rooted in reality? She says it’s important to keep a “biopsychosocial” perspective – that intellect, environment, context and learned behaviours all have a large part to play. Also, to “recognise that women’s biology is different to men’s – not inferior, just different. But that by understanding it we have more control over it. Biology is not destiny … Not all women experience these mental ill health conditions – so it is important to recognise that too.”
There are still many places in the world where mental and reproductive health services are a scarce commodity, where women are isolated during the menstruation phase of their cycle, with impacts on safety, liberation and education, and, even in the West, where lack of access to menstrual products is a very real issue for those living below the poverty line.
For we who are fortunate enough to live with relative affluence and opportunity, this is also a time in which our voices can be heard, and effect change as a result. Perhaps, in some cases, the greater challenge can be tuning into the one inside of us.
In my case, at least, it has helped to remember I am human, and admitting to my body’s needs and vulnerabilities, ebbs and flows, doesn’t erode my strength.
If anything it seems that fluidity presents an opportunity for flexibility, momentum and growth. Also – that the natural remedies for general hormonal health look suspiciously like those that improve our mental and physical states: nutrition, moderate exercise, rest and the occasional pause for reflection.
According to Kulkarni, the best thing we can do for ourselves is to trust our intuition. “And for medicos, or other health practitioners I’d say, listen to that, because the very first introduction I had to this whole thing was based on the women’s intuition that something was wrong with the hormones, and they were right.”
Taylor agrees: “Your body knows what it needs. It’s so tricky, because I know it’s so nice to say, do this and then it will be fixed – but it’s almost not a fix. I think it’s important to think of it as a barometer of your health, and just tune in with balance. To all facets of life.”