Related Topics: Depression, Menopause

Bioidentical Hormones For Anxiety and Depression

Low mood is common at menopause and it is not just one hormone, but two, that can help relieve it as bioidentical expert Jeffrey Dach explains.

Dr Jeffrey Dach

56 year old Susan suffered from anxiety and panic attacks, and had been prescribed Valium, Effexor and Wellbutrin by her primary care doctor.  The drugs had adverse side effects and didn’t seem to be helping, so she stopped taking them.

After further discussion, she told me that symptoms started a few years ago after monthly cycles stopped and the onset of menopausal hot flashes. She noticed that the anxiety and panic attack seems to precede an episode of hot flashes.

We sent Susan to the lab for a hormone panel, and sure enough, Susan’s estrogen level was low. Susan’s symptoms were caused by menopausal estrogen deficiency, a finding commonly seen in the post menopausal age group.

Symptoms are promptly relieved with bioidentical estradiol applied as a topical cream twice a day.  Additionally, Susan’s tests revealed vitamin and mineral deficiencies which were, no doubt, aggravating the anxiety attacks.

Susan was started on her bioidentical hormone program which included estradiol and progesterone as a balanced topical cream. She was also started on vitamin B12 and Magnesium supplements.  Six weeks later, Susan reported that her anxiety and panic attacks had improved and were almost gone.  She also noticed better sleep and more clarity of mind, and her night sweats and hot flashes had resolved as well.

Anxiety is Associated with Hot Flashes

A study published in 2005 Menopause reported that anxiety is strongly associated with menopausal hot flashes, and usually precedes the hot flash episode. Hot flashes are caused by estrogen deficiency, and are treated with bioidentical estradiol, which virtually eliminates them. Numerous articles summarize the medical literature showing that low estrogen levels cause anxiety and depression in humans and animals. Estrogen treatment relieves anxiety and depression as well as virtually eliminates the hot flashes.

What is the Mechanism of Action Of Estrogen in Eliminating Anxiety and Depression?

Estrogen receptors have been found in the brain, and estrogen increases the expression of an enzyme in the brain called tryptophan hydroxylase-2 (TPH2).  This enzyme converts tryptophan to serotonin, an important neurotransmitter responsible for an anti-anxiety and calming effect in the brain.  These estrogen receptors have been isolated to specific areas of the brain call the DRN, or the dorsal raphe nuclei.

A study published in the 2001 Archives of General Psychiatry evaluated bioidentical estrogen as treatment for peri-menopausal depression. They evaluated fifty women ages 40-55 years, suffering from a depressive disorder and irregular menstrual periods (FSH >25 IU/L).  These women were treated with bioidentical estrogen or placebo over 12-weeks. Remission of depression was observed in 17 (68%) women treated with bioidentical estradiol compared with only 5 (20%) in the placebo group.  The authors concluded,  “Transdermal estradiol is an effective treatment of depression for perimenopausal women.”

To read more on Dr Dach’s work please visit his website at

If you have any questions or comments on his article you can contact him via his website.

Helpful information:

Many women see their moods plummet at menopause for a a variety of reasons: increased stress, anxiety over hot flushes, sleepless nights and emotional challenges. Maintaining good hormone balance is essential, and a combination cream such as 20-1 with both progesterone and two natural oestrogen can be more effective at helping with anxiety and depression than progesterone alone.

With the increasing number of menopausal women being put on antidepressants to help menopause symptoms, this natural approach can be more effective for them and for any related anxiety and depression.

Stress And Hormones – Keep Calm And Follow My Top 3 Practical Tips

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Comments 5
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AnnA Rushton | 12:47 pm, November 27th, 2017

Taylor you need to speak to whoever prescribed your estrogel as it may need increasing but may also be an issue with application. You can check that below for progesterone cream or you may find 20-1, which is a combination cream with the majority ingredient of bioidentical progesterone plus a small amount of two natural oestrogens in a well-balanced formula, would be better more effective:

Taylor ryan ryan | 8:47 am, November 27th, 2017

Hi been using same dose of progesterone cream and estrogel for about 2 years now hot flushes and anxiety returned do I need more estrogen please help

căn hộ hưng phát | 2:08 pm, July 20th, 2012

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Mimi | 5:10 pm, June 29th, 2012

I am 47 and I woke up one morning feeling so tired and out of it with panic and anxiety attacks. After coming home from ER. Was diagnosed with anxiety attack and prescribed Ativan. It helps but now depression has set in. I take elavil 10 mg at night and apply my biest cream every morning and progesterone at night. It has been a life changing experience due to menopause. I have been battling this for 3 years now and just coming to terms with it. It turns your world upside down. But you just have to be strong and keep smiling. Not that I did any of that. But it helps to meditate this thought and really focus on positive. God bless us all. Mimi

relaxation techniques for panic attacks | 5:44 pm, April 15th, 2012

Sometimes I get them but I would also like to know if other people get them too. I know that people do but very few people are ever candid about it. I also get mild anxiety attacks when I’m in a very large crowd of people. Not that I am scared of people but I just feel very closed in around a bunch of people. I would like not hear about taking medication or seeing a doctor. Because what if there were no doctors or medications that you can take for it, Thank you and good advice is helpful..

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