Women, Hormones & Anxiety: Understanding When to Consider Medication or Therapy

September 1, 2025
Menopausal mature woman wearing green dress sitting at the desk in the office, having hot flashes and using hand fan. By Deepika Tanwar, MD It’s no secret that many women experience fluctuations in mood and energy throughout their lives. Hormonal changes during puberty, menstrual cycles, pregnancy, and menopause impact the body’s hormone balance—and these changes can sometimes be upsetting. When estrogen and progesterone levels rise and fall, the brain’s “alarm system” may be triggered, causing anxiety in situations that once felt routine. While some women may recover quickly, others may develop full-blown anxiety disorders. Recognizing when to seek therapy, medication, or a combination of both can help avoid months or even years of unnecessary distress.

How Hormones Turn Up the Alarm

Hormones are essential in helping your body handle stress, with cortisol and adrenaline playing key roles. When estrogen levels suddenly dip before your period or during perimenopause, it can cause cortisol to spike, making you feel on edge, restless, or anxious. Ongoing hormone imbalances might also impact serotonin, the brain chemical that helps regulate your mood. This can make everyday frustrations seem much bigger than they really are, and bedtime might become a time when your thoughts race through worries and worst-case scenarios. Remember, you’re not alone, and understanding these changes can help you feel more in control.

When Normal Worry Becomes an Anxiety Disorder

It’s common to feel anxious before an exam or major work presentation, but repeated symptoms that disrupt sleep, relationships, or career often indicate something more serious. Anxiety disorders include:
  • Generalized anxiety disorder (GAD) – characterized by persistent, free-floating worry that affects multiple aspects of life.
  • Panic disorder – involves experiencing repeated panic attacks that can suddenly happen without warning.
  • Stress disorder – refers to a condition that includes post-traumatic stress, which is associated with past threats or trauma.
Reaching out for a professional evaluation can be a positive step forward if you're struggling with mental health and feeling like it's affecting your daily happiness.

Therapy First: Why Cognitive Behavioral Therapy (CBT) Is Effective as an Initial Approach

Cognitive behavioral therapy (CBT) helps you recognize automatic threat thoughts like “I’m going to faint during this meeting,” and learn to replace them with more balanced perspectives. It also gently guides you to face avoided situations step by step. Studies show that CBT can be very effective in managing anxiety during hormonal changes—from PMS-related fears to worries during perimenopause—since it reprograms how the brain interprets physical sensations. CBT is a versatile treatment that can be provided in both individual and group therapy settings, making it accessible and cost-effective. By engaging in just a few sessions, many clients can develop effective coping skills that help manage distress both in the short term and over time, all without the potential side effects of medication.

Medication’s Role in Treatment: A Key Aspect

Occasionally, hormone fluctuations or severe mood symptoms can be too much for behavioral tools to handle on their own. Medication isn’t a sign of failure; it’s a proven way to calm down and make therapy more effective. Your primary-care physician, OB-GYN, or psychiatrist may explore several treatment options with you:
  1. SSRIs or SNRIs – standard first-line treatments for GAD, panic disorder, and depression, often chosen for their effectiveness and tolerability.
  2. Hormone replacement therapy (HRT) – used during perimenopause or menopause to manage hot flashes, insomnia, and anxiety, while helping stabilize mood by reducing fluctuations in estrogen.
  3. Hormonal therapy – for women of reproductive age experiencing severe premenstrual mood swings (e.g., oral contraceptives that reduce estrogen fluctuations).
It's important to remember that every medication can have side effects, such as nausea or weight changes. Be sure to discuss the benefits and potential risks with your prescriber. Some women find that a lower dose combined with CBT works really well for them, while others might need a full course of medication to find their balance. Your healthcare provider can help decide what's best for you.

Therapy or Medication—Which Should You Try First?

Consider starting therapy if:
  • Anxiety predictably spikes with your cycle.
  • You prefer non-pharmacological methods and can dedicate time to practice skills.
  • Symptoms are bothersome but not disabling.
Consider beginning or adding medication if:
  • Symptoms lead to missed work, social withdrawal, or persistent insomnia.
  • Panic attacks occur unpredictably, restricting driving and exercising.
  • A depressive episode co-occurs, preventing you from doing CBT homework.
Keep in mind, choices are never set in stone. Many clients start medication to help soothe their anxiety, explore CBT to develop lasting skills, and gradually reduce medications with the support of their healthcare provider. It’s all about finding what works best for you on your journey.

Getting the Conversation Started

  1. Track patterns – log anxiety levels, sleep, and cycle days for at least two months.
  2. Consult your primary doctor – to rule out thyroid issues or other underlying physical causes.
  3. Ask for a referral – “Could you refer me to a mental health specialist who treats hormone-related anxiety?”
  4. Bring your data – symptom logs help clinicians tailor plans.

Daily Tips for Managing Hormone Fluctuations

  • Embrace movement: Aerobic exercise helps reduce cortisol spikes and can boost your mood, making you feel happier and more energized.
  • Balance blood sugar: Protein-rich snacks reduce the fluctuations that cause jittery highs and lows resembling anxiety.
  • Limit caffeine and alcohol: Both can increase anxious feelings, especially right before menstruation.
  • Build a calming toolkit: Five-minute breathing apps, progressive muscle relaxation, or guided imagery can quickly reset the nervous system.
These practices complement CBT homework and boost resilience, even with medication.

You Don’t Have to Decide by Yourself

Whether you’re dealing with PMS mood swings, worries during pregnancy, or feelings of panic during perimenopause, getting expert advice can turn feelings of dread into confidence. The Ross Center’s team is here to help with anxiety issues at any stage of life. Schedule a Consultation Today We also provide secure telehealth in DC, Virginia, New York, Maryland, and other PSYPACT states—so quality care is always accessible. Let’s create a plan—therapy, medication, or both—to help you find calm, no matter what your hormones are up to this month.