Women's Hormones and Mental Health: How Cycles Impact Your Brain and Emotions

Kalene Khan
May 20
20 min read

"I don't know if it's perimenopause or not, but I feel off."

"It's been almost a year postpartum and I'm still dealing with..."

"I asked my doctor if it's PCOS, but they ended up just giving me antidepressants."

It can be difficult for women to navigate the complex landscape of hormonal changes and emotional well-being. This week we had the pleasure of interviewing Annalisa Barrett, an LMFT based in southern California. She shares her expertise and insights on how hormone fluctuations influence your mental health, and what you can do to better nurture your mind and body throughout different stages of your cycle, including postpartum and perimenopausal phases. [Video transcript below.]

KALENE: I'm so excited to be able to pass along all of your knowledge and your guidance to our clients. So, I just want to dive right in and give you a chance to share a bit about your background, who you are, and what brought you to having this specialty.

ANNALISA: Yes, sounds good. And thank you, Kalene, for having me and for doing this. Background is, I always start with this because it feels like the most important part of my identity, but I'm a mother of two. Age 13 and almost 15. You just leave a bowl of water out for them and they're good to go pretty much. So, I'm well past the postpartum stage. But, I used to teach prenatal yoga and from there I went on a postpartum doula and then from there I became a licensed therapist. And where I'm at now today as a licensed therapist personally I'm going through the journey of perimenopause. So all of those things combined: My own postpartum experience, taking women through their postpartum experience, and now treating women through all those stages to this space of, I guess, an expert in women's mental health.

And one of the things that drew me to it really was what I probably noticed during my postpartum journey. Our culture, meaning the US, we don't have much of a consideration for women in their postpartum experience or for new mothers and what they're needing emotionally and physically. As you're aware, you got your first doctor visit six weeks post. Whereas baby is coming in weekly. So, they're checking on baby, obviously, they're vulnerable. We want to make sure they're okay, but mom's not even looked in on until she's six weeks post. And we're in an individualistic society, so we don't have the aunties and the grandmas and all of the exchanging of hands. It's pretty much mom--if she's even got a maternity leave and she doesn't have to go back to work right away. And her partner too unless they have to go back to work. So, it's limited. The help and support is quite limited, I think, if you're living in our society.

Then you're sort of in that fourth trimester, I'm not sure if you've heard of that term before, but there's a book and it's called The Fourth Trimester. And that book really woke me up to, 'Oh wow, wait, our bodies do go through so much change after, while pregnant, during birth, post birth...' How is this so overlooked and ignored in what we talk about? You've been through the biggest transition of your life. And really the rhetoric I think it's changing, but at the time that I had given birth it was when are you going to bounce back? And we talked a little about your experience with that expectation of yourself.

KALENE: I think there's a whole healthcare view of what's prioritized for women's health. I've read about how women's health in general has been so... There are so many things that should be prioritized that are not and that's just because that's the way healthcare has gone and that's what makes sense for men too. And so things are still very, 'it's just how we do healthcare.' But there's been so much knowledge we've gained over time, so many things that women have noticed over time that something actually needs to change.

And I've even seen it in the clients who've come to our clinic who are like I've gone to doctor after doctor after doctor and it wasn't until I met like a younger woman doctor who had more recently gone through school that I felt I was really validated or they asked me questions that I hadn't been asked before. So hopefully that is a hope too that things may be changing in the healthcare field. I know it happens slowly, slow changes, but hopefully that will be a thing.

And I'm so glad to hear that you have all of those different roles that you had in the past that brought you now to being a therapist with all of this history and expertise. I am so curious to know what some of the main issues people do come to you for? What are the symptoms they complain about? What are their experiences? Who comes to see you?

ANNALISA: Sure. I will say my specialty is with the perinatal community. So that kind of starts at birth. And I'm so happy to see that women are starting to take care of themselves earlier. As they're starting their pregnancy journey saying, 'I want to set myself up for success so maybe I should talk to someone and just make sure that I'm understanding what I'm going through now before I'm really in it.' So, I'll start there. I'm a linear thinker, so I'm going to start there.

When women come to see me who are expecting, they're struggling with birth fears, competency fears, change of lifestyle concerns, partner contribution, health of the baby. So, that's what's on their mind as they're growing life inside of them and anticipate the next chapter of their life. Women who are postpartum, they're struggling obviously first and foremost with sleep; sleep nutrition. I was mentioning earlier, one of the first questions I ask is do you track your cycle? Also, one of the first things I address with male and female clients is what's your sleep like? Sleep nutrition I think is one of the most important pieces of functionality. So, you're obviously in postpartum dealing with interrupted sleep. Then that can lead to anxiety and depression. For women who are parents, I don't want to just gender it, but for people who are used to maybe having a more type A lifestyle, they're really struggling with that lack of structure and routine. Sometimes there's a struggle with partner contribution, like a care gap and guilt and rage. So that's where the hormones come into play. Postpartum rage is a real thing and it's very much hormonally linked. But all of those other things I explained are linked to it too. Women are really in it during that time.

So the time in between or before after, I have young women who haven't begun that journey yet. I've seen, have you heard of RO OCD? Relationship OCD. But I see, especially women who have treated for a long time, I can see this kind of cyclical nature of around the time that they're in that luteal phase of their cycle, they are questioning their relationship and finding problems within it and it only exists for them during that phase in their cycle. Outside of that phase, everything's just fine. I think that could be hormonally related. The self-critical thoughts increase. I see women coming in dealing with societal expectations, worthiness. Obviously, social media plays a lot within that. Social media has a lot to do with that, mistress men, I'm working with women on that. Like all of these kind of broad range issues I do witness get exacerbated when women are in the luteal phase of their cycle. Like those problems seem heavier, deeper, stronger during that phase. And it's not to minimize that they're not true or not real.

What I believe about this cycle in our life as a woman is it's not meant for us to feel miserable. It's meant for us to have some information about ourselves. It's a time to slow down and take a look at like I'm feeling a lot right now. What does this mean for me? If you're really struggling it's probably because you're fighting against it. Probably because you're going like I have so much anxiety and I don't want to, what do I do to get rid of it? Rather than what is the information about this right now?

KALENE: Or just like dismissing it and ignore like, "It's just because I'm on my period," lI hear that a lot.

ANNALISA: Right. You really kind of learn to go with your cycles and that's where the tracking comes in. Because you look at the calendar and you go, "Oh, I'm kind of due right now." That's why I'm feeling everything so deeply. Okay, what's the opportunity right now? What needs some attention?

KALENE: And so that cyclical pattern of intensity that comes up, I know you're talking about that, that's a really clear sign that this is hormones. This isn't just about, you and your partner have to figure out how to coordinate these new things or adjust to this, or you're losing sleep so you have to handle this. Are there other tells that you think are important for women to know of like, oh, this may be a hormonal issue and not necessarily a something-else issue?

ANNALISA: Yes, definitely. And I want to definitely emphasize that it's not either or. It's not either a mental health issue or a hormonal issue. I think they're very synchronistic. And the external stressors play a real role in that too. They just get exacerbated when we're depleted. So, to answer your question, one of the obvious tells is where am I at in my cycle? Am I in my follicular phase? Am I in my luteal phase? Am I on my cycle or am I ovulating?

I do something called nervous system mapping with my clients. So that's where you are going to start them in a dysregulated state. So have them think about something that puts them in parasympathetic, something kind of anxiety-inducing. The last time they felt like they were in that fight or flight mode. And it's not hard to get our nervous system into that state, just imagining something triggering and then you ask, okay, what is true for you when you're here? What is true for you? What is true about your relationship? What is true about the world? And then you can even talk them into like a freeze state. Okay, remember the last time that you were so stuck that you couldn't make a move, and feeling really down and lethargic. Okay, what's true for you in that?

And then I end with, okay, now let's go into regulation and get ourselves to a more grounded space. You know, when's the last time you felt really connected to your partner and when's the last time you really felt connected to yourself? Okay, what's true for you now? And and every time you know what's true in that regulated state is actually the truth and it's a much kinder story. To kind of tie it back into the cycle, if you know what your truth is when you're in a regulated state, then the other truths when you're in a sympathetic or freeze state are what's coming up most likely around your cycle, around that kind of tender time. Then you can say, "Hey, I'm having these thoughts. I know these are the thoughts that I have when I'm off, or when I'm disregulated."

I think in one of the questions you had asked about the definition of PMDD, so that's like a severe mood or severe physical symptoms, severe mood fluctuations during the premenstrual phase and if it interferes with your daily functioning then it's something to take a look at. So signs would be recurring conflict with loved ones, increase in critical thinking, self-doubt, questioning, increase in depressive symptoms and self-isolation. So, you know, if that's occurring at the time right before you start your period or during, then that could be a sign of a PMDD. I just want to caveat too, it's how you take care of yourself during that time that is going to impact all of those things. So, we're all going to experience that shift to some degree, but if we're pushing past, if we're resisting it, if we're ignoring it and not caring for ourselves during that time, then there is going to be more upheaval emotionally.

KALENE: And to rewind when you talked about how those thought experiments of focusing on where your nervous system is when you're dysregulated and all these different truths you talked about; I love how you worded it of, that regulated state is your truth. That is you. And I think that adds so much. I mean, I felt this self-compassionate energy that can be brought into that experience. I know so many people who are at their worst or struggling and they're looking and comparing themselves to other people and thinking that something's wrong with them. When there are these different versions of ourselves for everybody, but yeah, when you look at your own versions of yourselves, it's like, there's my regulated state and there's the time that I'm really struggling. They're all truths, but I know this is me. I love that it's like an opportunity to have that self-compassion

ANNALISA: You shift lenses, right? You're not always through that clear lens and that's okay. But just kind of recognizing, oh, I have a bit of a filtered lens on right now. How do I want to deal with that? And also it's important to note that if one is having like [suicidal] ideation or you know like immobilizing pain, those are symptoms that need immediate treatment and attention, that's like beyond the scope of just going and talking to someone regularly. I would seek medical attention if that's true for you especially cyclically.

KALENE: Yeah, meet that intensity of struggle with the intensity of support. I commented on how I love that it adds a self-compassionate zone to it, but you know, here and there I'm also hearing you talk about how there is that strong connection between what your hormones are doing and how your brain is reacting. And that's our clinic, that's where our specialty lives. It's like, okay, here's what your brain is doing. Here's how it's impacting your mood and your whole nervous system. What's it's it's doing? I know that helps people kind of ground themselves in, "Oh, I am wired this way!" I wanted to ask the question with the same goal of, okay what can we ground ourselves in, in terms of science? What really is the connection between how our hormones are impacting our moods our our sense of concentration or, how all those struggles kind of play out internally. What does that really look like?

ANNALISA: For sure, and so this is where I'll caveat that I don't have a medical background but I can share the knowledge that I understand. There's a book called Moody Bitches that provides a lot of information and it's very accessible. It's by Julie Holland. So a lot of what I know comes from from her work, too. It's good. Sorry, pardon the language, but that's the name of the title. It's great. I recommend it to all women. But yeah, our bodies are wired for our own primal needs, right? So even if you're on a postpartum rage fit, like, that is information. Your body's trying to tell you something. As far as impact on brain function, obviously it depends on what stage you're in. Are you going through pregnancy? Are you going through postpartum? Are you going through perimeopause, menopause, or somewhere in between? There's going to be a different landscape. Your progesterone, estrogen, cortisol, prolactin, oxytocin, those are the big players especially in the birth/perinatal realm. I would say as an overview I could kind of describe how those function. Oxytocin is the love hormone. That's the bonding hormone. It's not just experienced after birth. It's experienced after love-making or during connected touch. Prolactin is related to to breast milk and breast milk production. Cortisol that's a big one that we all need to know. I mentioned before I think sleep is really integral for people and if you are one who struggles with sleep it's likely that you have some cortisol imbalances. And so that's the stress hormone. People are going to roll their eyes at this, but I technically feel like we should be in bed by 10:00 and like 10 to 6 is kind of ideal sleep cycle. You might notice if you're a late owl that you'll kind of get a wave of tiredness around 10, but if you push past, that's cortisol kicking in. Babies who struggle to sleep, if you don't catch them while they're rubbing their eyes, if you don't get them down on time, they're going to get really tired. That's cortisol kicking in. So, cortisol--I'm like I could geek out on this all day long--if you're in perimenopause, cortisol kicks in when your blood sugar gets low. That's why, you know, you were speaking to our culture kind of being a little bit more patriarchal in the terms of how we research and study the body. So intermittent fasting, not the best thing for women, particularly perimenopausal women because your blood sugar is going to drop your cortisol is going to go up and that can actually cause weight gain. But you know like there's just little shifts. Julie Holland suggests having a spoonful of peanut butter before you go to bed to regulate the levels and that can be enough to sustain you until 12:00. Just something so that you're not dropping so low that your cortisol goes up.

Progesterone is responsible for a lot of the mood swings. I don't know, some women report feeling really calm during pregnancy and like really relaxed and especially if they're normally more high strung, that's the increase in progesterone with that. And it also has a brain link to the shedding of the lining. So women with PCOS have a bit lowered levels of progesterone and higher levels of testosterone. And sometimes that brain-uterus connection gets interrupted without with that lowered progesterone. So they're not shedding their lining every month, you know, maybe it's every three months. Very inconsistent. So it's related to that.

Lowered estrogen is the cause of night sweats, anxiety, depression some of that postpartum rage that can happen quite a bit postpartum and in perimenopause as well. We were talking about when does one feel normal postpartum? It could take up to two years for the body to repair fully. It doesn't mean you're going to be crazy for two years, but you know, your body has been through-- your body grew a human. Let's give a little credit for that. You made a human with body, right? Huge life event for the body. Things take time to go back, whatever even that means, because we probably go back to whatever it was before you became a mother, before you were a maiden.

KALENE: That makes so much sense with how long it takes to, from beginning of conception to when the baby's out. Like that's almost a full year of being in a different body state. So, I guess two years doesn't really sound like too long of a time when you think about how long it's been in a completely different mode.

ANNALISA: 100%. And there's, I struggle to pronounce this, but you may have heard of it, I think it's called microchimerism. The baby's DNA mixes with the birth mother's blood. So your children's DNA is mixed in with yours like permanently. So there really is no returning to a pre-birth state. The last one that I haven't mentioned is testosterone. Women have testosterone, too. So that's responsible for some to some degree concentration, libido and energy. So as that goes down some of those things might decrease as well.

KALENE: I can see how there's such a huge fusion between mental health and hormones like an unbreakable bond here.

ANNALISA: We talked about the nervous system and the mapping and fight or flight mode. So that cortisol, it's that's the primary function when we're in fight or flight. It's like our adrenal glands are on and it's excreting cortisol. So that puts you in a sympathetic state, right? But what happens when you're in a sympathetic state for too long? You go into a parasympathetic state and that's the kind the collapse state. That's like you and that's usually you're going from high anxiety to depression. And that cortisol is sort of like the instigator of all that.

KALENE: Since we're talking about changing our view here of they're not separate things. They're fused together. They're one. Are there other mythbuster things you want to share? Misconceptions that people tend to carry around that you just want to chalk it out right here. Let's get let's get clear on what the reality is.

ANNALISA: Definitely. One is, especially here in Southern California and I'm sure you guys see it too in Northern California, there's a big boom of health and wellness, going to the gym, and it's great, it's wonderful, like yes let's go take care of our bodies. Please know that most of this research is based on men's bodies and men's bodies are cyclical, but their cycle is within a 24-hour period. That's why like intermittent fasting is completely geared toward a male body. Women's bodies are not on a 24-hour cycle. We're on a monthly cycle. Misconception number one is a lot of the stuff in the zeitgeist right now is not for your body. It's for the male 24-hour cycle body. So, if you're looking at your cycle, which is more of a 30-day cycle, how can you tailor your health care needs to that cycle and it'll make you feel better. Another thing is mood fluctuations are healthy and informative. I touched on this earlier, there's a tendency to want to get rid of emotional pain. There's a place for that obviously, like I said if you're having suicidal ideiation of course address it but if you're having some anxiety or some negative thinking or you know something's just kind of tugging at you and you notice that it it's increased during that luteal phase. Turn toward it and take a deeper look at what's calling your attention, what needs to shift, what needs to change. That's that self-compassion piece, being a little more gentle with yourself instead of expecting that you're going to be high functioning all the time, right?

Another thing, hormone therapy is talked about a lot. It's a bit controversial. You know, some people say wait until your numbers show that you need replacement therapy. Other camps say start it as soon as you know you're in perimeopause, which could be age 35. So, I think this is where I'm going a little out of scope obviously like this is something you might want to talk to your doctor about or do more research on. But what I have come to learn in my research is HRT is better to start during perimeopause versus menopause. The earlier the earlier the better. With certain ones, you know, like when I'm talking about progesterone and estrogen. Estrogen, if you take a synthetic form of estrogen, it will interfere with your natural production. So that's one to maybe wait until later. Progesterone doesn't interfere with your own hormones. So there's only a benefit to it if you're lower in those numbers.

KALENE: I know you started mentioning how people could track their hormones. What are your top recommendations on how people can start tracking themselves better?

ANNALISA: So, if you want to do it at home, and I have no connection to this, like this isn't a promotional ad or anything, but I've used this resource I would say it's called Oova. So, you can do it as long as you want. I've I recommend at least three months. You're peeing on a stick every day and then it shows you lines and you take a picture with your phone and then it shows up in the app like okay today these are your hormonal numbers. If you do it at the same time every day it's going to be more accurate information. And like I said the the longer you do it if you can, if you can stick it out for three months, you're going to get more comprehensive information. You can get a hormone panel done through getting blood work too through your doctor. But that's just one snapshot of one day. So, I like that this gives some longitudinal information. I was saying earlier, right, I recommend getting a hormone panel done like sooner than later. Like, you know, if you haven't started experiencing perimenopausal symptoms yet, go in now, get your panel done so that you have a baseline and then you know if and when you start to experience changes or shifts, your gynecologist or OB has an understanding of what's normal for you, because everybody's numbers are different; what looks like low estrogen for one could be one's normal range of estrogen.

There's also something called Oura ring which I think has caught some popularity lately that it's going by temperature and heart rate so it's not as accurate as urine or blood but it's on your finger all day, every day so it's collecting a lot of data and I think it's it's it's really helpful for tracking your cycle. I've had it for about a year and it knows right away. It's like you are going to get your period today and it's pretty accurate. It links up with another app called Natural Cycles app. So that's good for family planning or if you want to prevent pregnancy too, it will tell you green days, red days, depending on what your goal is. That's cool technology to be able to track these things.

If you don't want to invest in these fancy things, just keep a calendar, like most of us have calendars on our phones. I put the moment that I get my period, I just put 'code red' in my calendar so I know, and that way if I need to go back and look, all I have to do is search 'code red' and I can see okay but this is when my period comes like it's roughly every 27 days, you can track it that way too. Or if you're starting to notice that your negative experience is increasing, you can kind of go in your calendar, go, okay, that's coming up in five days. I really recommend, however whatever works best for you, keeping track, knowing about when you're going to expect your period.

KALENE: And it sounds like any tracking can be helpful as long as you're just not in the dark with it and just wondering why these things are coming up. It seems so helpful just to know when your cycles are. You had mentioned before, once you get to know your cycles you know how to take care of yourself. What are specific lifestyle things or helpful things that your clients have noticed to help guide them through their different stages of their cycles?

ANNALISA: Definitely. Follicle phase which is right after your period, so day one would be considered when your period starts. That's when you're entering into the follicular phase and then and then that two weeks afterwards. So that's the time to make social plans. That's the time to be out and about. That's the time to put on your Lululemons and go to the gym. That's like that's the time when you're going to have the most energy. That's the time when you're going to feel the most sociable. Your body's just kind of cleansed. You're primed.

Ovulation, ideal time for baby making if that's your goal, ideal time to abstain if it's not. Also if you're really in tune with yourself, you might notice especially if you're in a long-term marriage, you know, desire's probably waned a little bit. Like if you're really paying attention to what cycle you're at in your body, you might notice that you're a little more open to it or a little more willing and your body's a little more primed for it. And it's okay if it's not too, by the way, like that might not be the case for you. Some women actually experience cramping during this phase. They can they can actually feel the egg transitioning. So, it's not always a feel-good time, and it's okay if it's not. And then we go into the luteal phase, which is, you know, everything's going to kind of come down at that point. Hormones are dropping or they're going up and down, which is even more of a roller coaster. This would be the time to for, if you're active, do a little more yoga, less HIIT work workouts. It's a time to be a little bit more introspective, right? I do a lot of moon circles and then I realized something wasn't lining up and I was like it's because I want to be more insular during this time. I actually want to do the journaling and I want to do the feeling but I want to do it alone. Full moon circles, that's more like tied in with the follicular phase that would be the time to go in and do something with a group and be social. I'm tying it with the moon because if you're thinking about a moon cycle, this is when it's waning?

So, you're going inward a little bit and then obviously menstruation, most of us don't feel great. We don't feel 100%. We don't live in a world where you can take a full week off of work unfortunately for that purpose. But do less, do less where you can and give yourself some room to like nap. I had a client in yesterday who was on day one of her period and she laid on my couch in a fetal position. I could tell her energy was super low and I was like, "Okay, well, we're not going to do super deep work right now. What do you need? Maybe you just need to feel nurtured right now." And that's what she wanted. So, just listening to that and not feeling bad because we're so conditioned to be 'doing' all the time, right?

KALENE: And push through that pain and not slow down to take care of yourself. I'm so glad your client was able to do that with you and I do want to give people a chance to know how they can become a client of yours or reach out to you if they want a consultation or any resources. How can people learn more about you and connect with you?

ANNALISA: Thank you and I appreciate that. I do have a website annalisabarrett.com. Lots of double letters in that one. And through my website, I believe there's a link to my email. So reaching out via email is probably the best way if you want to set up a consultation. I do offer a 15- 20 minute phone consultation for prospective clients and, you know, from there, if there's an alignment, we can book.