A woman’s internal world is nothing short of overwhelming. We are constantly processing big emotions and critical tasks, from up-keeping careers, to families, to whatever is left of ourselves–all of which can wreak havoc on our hormones.
The endocrine system, responsible for the regulation of puberty, the menstrual cycle, pregnancy, and menopause, is severely understudied and much more sensitive than we may realize. Those nights of poor quality sleep or long stretches of stress, heartbreak, and grief can throw our hormonal body completely out of whack. Similarly, the incidence of depression is two to three times higher in women than in men,1 and that risk increases with monthly hormonal fluctuations during the reproductive phase of life. During the menopausal transition, drastic fluctuations in estrogen often lead to increased rates of depression and anxiety.2 Conclusively, there’s a direct link between our emotions and our hormones, and it’s time to talk about it.
O Positiv Health got the chance to sit down with board-certified OBGYN and reproductive endocrinologist Dr. Sasha Hakman from our Medical Advisory Board to discuss all things hormones, emotions, and the often misunderstood in between.
O Positiv Health: Starting off, how do emotions interact with the endocrine system? It’s commonly understood that stress and really heavy emotions can throw our hormonal body out of whack, but what's the truth to that?
DR. SASHA HAKMAN: It’s tough to quantify how emotions or chronic stress affect hormones because everyone’s susceptibility varies. Chronic stress often involves the hormone cortisol, produced by the adrenal gland—a small organ above the kidneys. Cortisol is part of the hypothalamic-pituitary-gonadal axis, a communication system between the brain and adrenal gland.
The hypothalamus, the brain’s control center, sends releasing hormones to the pituitary gland, which then releases hormones that act on target organs. The pituitary produces several key hormones, including thyroid-stimulating hormone, reproductive hormones like FSH and LH, and ACTH (adrenocorticotropic hormone). ACTH signals the adrenal gland to make cortisol, which fuels the fight-or-flight response.
When stress—whether emotional, financial, or relational—triggers excess cortisol, it can disrupt the feedback loop between the brain and adrenal gland. Because the pituitary also regulates thyroid and reproductive hormones, elevated cortisol can inadvertently throw those out of balance too.
O Positiv Health: Beyond cortisol as you mentioned, are there any other hormones closely linked to mood and emotional regulation?
SH: Of course cortisol is one of them, but so is estrogen. Estrogen is really highly linked to our emotions, and that's because we have tons of estrogen receptors in the brain. We probably to this day haven't even scratched the surface on the extent of how much hormones affect our emotions, because let's face it, women's health is always understudied, underfunded, and there's a lot of lack of information there.
O Positiv Health: Which is so disappointing, but hopefully we’re walking towards change. With that, are there certain emotional patterns that point to underlying hormonal balances?
SH: If we talk about something like PCOS, which stands for polycystic ovary syndrome, this affects 1 in 10 women. What we do know and what is finally, after so many years, highly recognized, is that there is an incredibly high association with anxiety, depression, and body dysmorphia for women who have PCOS, regardless of their body weight. They still have that higher rate of body dysmorphia, even if they're lean. That is a big problem. If somebody tells me that their periods are kind of irregular, my next question in terms of screening is how bad is your anxiety? Are you battling depression? When we see that, the first thought should be, “Is this because of PCOS?” It’s something that really needs to be more closely screened so that we are not missing a lot of cases of just poorly controlled anxiety, depression, irritability, all of the things.
Then there’s PMDD, a more severe form of PMS marked by intense anxiety, depression, and mood changes around the period. PMDD (premenstrual dysphoric disorder) involves greater emotional and physical symptoms during the luteal phase, just before menstruation, largely due to dropping estrogen levels. Estrogen peaks twice each cycle—once before ovulation and again about a week after—then falls. That decline can cause mood shifts right after ovulation and again a few days before the period. In some cases, it could be through hormonal contraception, like birth control pills to suppress the variation in hormones that is normal for a menstrual cycle, or can even be treated with anxiety meds or antidepressants.
O Positiv Health: That honestly only further validates the significance of being intimately aware of the phases of your cycle and how you feel during each window.
SH: Oh, totally. When you are really aware of how to track your menstrual cycle and you know hormonally where your estrogen is at, you can start to make associations of, you know, I noticed that every single time, two days after ovulation, I am so mean to my family. I always feel so much shame about it and I don't understand, but then you start to realize, oh, well, this is actually physiological. It's a little bit out of my control because when my estrogen drops, it really affects me. Understanding that can at least help you with your relationships and how you interact with people. I know some women who actually will change their plans around those days because they'll say, “I’m just not someone you want to be around during that time.” And as a physician, I say, you don't have to deal with that. There are ways to improve these mood disorders. You don't have to just live with that forever.
O Positiv Health: What are some physical symptoms that could arise when it comes to this sort of emotional and hormonal interplay?
SH: It could be extremely variable. Physical symptoms can sometimes be pain. There's a lot about pain we don't fully understand, but that is what sometimes will explain somatization, which is whatever you're feeling emotionally can manifest physically in the form of pain. Additionally, physical symptoms can be as simple as fatigue, low energy. So we know that estrogen is generally responsible for that euphoric, high-energy feeling.
If you have some sort of hormonal disorder that causes you to have really low estrogen, then you might feel low energy in addition to whatever mood changes you're experiencing. So those tend to be probably the most common ones in terms of physical symptoms.
O Positiv Health: It’s funny because you mentioned 1 in 10 women having PCOS, and within my friend group, there are about four of us, including me. Do you find that there are more cases or more accessibility to getting diagnosed?
SH: It’s definitely increasing in incidence and it's a combination of being more aware, having more clearly outlined diagnostic criteria, but then also the fact that environmental factors are at play. There's a lot in our food. The toxic load we're exposed to from the air we breathe, our water, all of our fabric everywhere, whether it's your car, your bedding, your clothing, all the household cleaning products, fragrances, makeup, deodorant, all of the personal hygiene products. We are getting so many endocrine-disrupting chemicals. They're binding to our receptors, eliciting different actions and behaviors. Environmental factors certainly contribute to the increasing rates of things like PCOS for sure.
O Positiv Health: You can truly feel like a maniac trying to maintain a completely toxic-free environment.
SH: Honestly, you can never eliminate it all. It’s just a matter of reducing exposure to improve quality of life.
O Positiv Health: As someone with PCOS, regulating my period has been the mission of my life, so anytime I have a really stressful month, I'm always like, “Oh no, am I going to get it late now?” Is there truth to that sentiment?
SH: Totally. If we're talking emotional distress or really increasing in stress that is more acute, this throws off your hormonal axis.The hypothalamic-pituitary-adrenal axis will then throw off the hypothalamic-pituitary-gonadal axis. In the case of women, the gonads are the ovaries. What we call the HPO axis, the hypothalamic-pituitary-ovarian axis. So if you have high cortisol, you have a shift in that signaling, which will certainly throw off a lot. There's a lot that happens in a much more complicated, nuanced way in terms of sleep and how much melatonin is being secreted overnight and how that impacts your gonadotropin-releasing hormone. There are so many signaling hormones in the brain that affect each other. So something as simple as stress or your sleep being off in impactful. Emotional distress affects sleep and a lot of our hormones are diurnal, meaning they are mostly secreted at night and again in the morning. If your sleep is thrown off, it affects the way that it is secreted. And so that has this big downstream effect.
O Positiv Health: Can balancing hormones naturally, through nutrition, lifestyle and FLO supplements, actually help our emotional regulation?
SH: It really depends on what we're talking about because there's a lot of misunderstanding around balancing your hormones. For instance, if you have insulin resistance, then through nutrition, lifestyle, and supplementation, particularly with myo-inositol and d-chiro-inositol, that can really help. Insulin is a big player in terms of affecting a lot of reproductive hormones and weight gain and mood etc. So there are certain hormonal disorders that can be improved with lifestyle. If you have a really mild form of PCOS, then yes, lifestyle and supplementation can help, but it's not going to work for everybody. Some people will just continue to have really irregular periods and they will need more medical intervention. The reality is most hormones are constantly fluctuating. But hormones often have pulsatile patterns. If you were to draw a hormone and then redraw it an hour later, it’d be totally different and that's considered normal. But for mild cases of things like PCOS or irregular periods that are sort of more environmental and weight-related, lifestyle changes will certainly help a lot.
O Positiv Health: Given everything that we've discussed, is there any habit, supplement, or change in routine that you would recommend every woman practice when it comes to hormonal and emotional regulation?
SH: As a trained OB/GYN and reproductive specialist, the one supplement that every single woman should be on regardless of what she's trying to do is a prenatal vitamin. The reality is, we're not getting all of our micronutrients from our diet. We should be, but that's just not reality. Nobody has the time or the bandwidth to figure out if they're getting all the right servings of fruits and vegetables to get those micronutrients. We're not getting it in our diet and therefore we need to supplement it. But then, more specifically, if there are women who have PCOS, who have insulin resistance, something like FLO’s Women’s Endocrine Superfood Powder is a really great product. The fact that they have an in-house scientist who has helped develop a lot of this is a really big deal. Not all companies are going to do this.
O Positiv Health: Wait, so even if we’re not on the road to motherhood, we should still take a prenatal?
SH: Yes, even if you're not on the road to motherhood. The whole point of a prenatal is to replenish the micronutrients you're lacking for the sake of a healthy pregnancy. Even if you're not trying to get pregnant, you should still try to replace them. I would also say vitamin D for anyone who is vitamin D deficient, which a lot of people are.
About Dr. Hakman
As a double board-certified OBGYN and fertility specialist, Dr. Hakman brings not only advanced expertise but a deep commitment to compassionate care. She blends the latest innovations in reproductive medicine with a patient-centered approach, ensuring every individual feels supported, understood, and empowered throughout their fertility journey. She proudly support individuals and couples of all backgrounds, including the LGBTQ+ community. Your well-being and success are always her top priorities.
