Women’s mental health is deeply influenced by the dynamic interplay between sex hormones—particularly estrogen, progesterone (and its neurosteroid form, allopregnanolone), and testosterone—and neurotransmitters such as serotonin, dopamine, GABA, and acetylcholine.

 

These hormones not only modulate neurotransmitter activity, but their fluctuations across different stages of life—puberty, the menstrual cycle, pregnancy/postpartum, perimenopause, and menopause—can significantly affect mood, cognition, and emotional regulation. For example, estrogen enhances serotonin and dopamine signaling and supports acetylcholine-driven cognition, while progesterone and allopregnanolone influence GABAergic pathways to regulate anxiety and calm. When these hormones fluctuate or drop abruptly, as seen in premenstrual dysphoric disorder (PMDD), postpartum depression, or perimenopausal mood changes, the resulting imbalance in neurotransmitters can lead to emotional and cognitive symptoms.

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Hormonal-neurotransmitter shifts make perimenopausal women more vulnerable to new or worsening mental health symptoms, even in the absence of a prior psychiatric history. When clinically appropriate, evidence supports targeted hormonal and psychiatric interventions to address this neuroendocrine transition.​​

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