Women’s Mental Health
Today we finish up the series presented by Kathy Morelli, LPC on hormones and mood disorders. Once again I’d like to thank Kathy for such a well written and informative series. I am also very grateful that she allowed me to share the series with Mamas on Bedrest.
The final installment of the series is Post Partum: How Women’s Brain Biology, Hormones and Mood Relate!
“After giving birth, a woman’s hormone levels drastically plummet. The literature says within one to five days after birth, estrogen levels drop to the level of a normal menstrual cycle. A woman’s body needs time to adapt to all of the physical changes. Remember that estrogen precedes serotonin, the mood stabilizer, in the brain. And a steep drop in progesterone has a depressive effect as well. There’s a big chance for dysregulation in the brain-gland feedback loop (Sichel and Driscoll, 1999).”
“Other hormones that come into play postpartum and have an effect on the HPA and mood are prolactin and oxytocin. Prolactin is produced in the pituitary gland and is the milk-producing hormone. Prolactin levels rise during pregnancy and while breastfeeding. Some studies indicate prolactin is protective of postpartum depression, but others indicate prolactin causes vigilance, appropriate to a protective mother, but this feeling can morph into anxiety and irritability. The presence of prolactin varies whether or not a woman chooses to breastfeed (Donaldson-Myers, 2012).”
“Oxytocin is another neuro-hormone with a big effect on mood and happiness. Oxytocin is synthesized in the hypothalamus and released by the pituitary gland. Oxytocin is secreted during breastfeeding. Research has shown that oxytocin induces feelings of calm and bonding (Donaldson-Myers, 2012). And the presence of oxytocin varies whether or not a woman chooses to breastfeed (Donaldson-Myers, 2012).”
Women’s hormonal levels go from such highs at the end of pregnancy and then plummet to such lows with labor and delivery it’s a wonder that not all women become depressed. Kathy shares that
“85% of women suffer from the baby blues and 20% suffer from a form of postpartum mood disorders”
so clearly these hormonal fluctuations are indeed significant. And let’s not forget that Mamas on Bedrest are at an even greater risk of perinatal mood disorders because of bed rest, so these numbers may not reflect the full scope of perinatal mood disorders.
So much more research is being done on hormones, mood disorders and the lifestages of women. When considering the mental health of post partum women, we also have to take into account their support system, their ability to take time to rest and recover from pregnancy (and bed rest!) labor and delivery, the family situation and interpersonal relationships. All these factors-along with the “pre-wiring” in a woman’s genetic make up will determine how well a woman fares emotionally after pregnancy. Mamas, Take this information, think it over and use it as a catalyst to take exquisite care of yourselves! A woman’s body is designed to do extraordinary things-not the least of which is create new life-but that feat is not without its consequences. In order to be able to successfully reproduce, mamas must take exceptional care of themselves-eat nurtritious meals, drink plenty of water, rest, regular exercise, safe secure home and financial security. Mamas, self care is not a luxury-IT IS A MUST if you want good health for yourself, your baby and your family!
I’m bringing you Part II of Kathy Morelli’s series on physical and hormonal influences on women’s mental health. In Part II she focuses on the changes that occur during pregnancy. Kathy breaks down the emotional responses to pregnancy this way:
Emotional. What if the pregnancy was unplanned? What if this pregnancy follows a stillbirth or miscarriage? What if her primary relationship with the baby’s father is not going well? There is also job stress, financial factors and a whole host of other life stressors that combined can make the news of a pregnancy hard to take and All of these emotional considerations require attention and adjustment. We clinicians and birth workers must be aware of these potential life stressors and be sure that we are as vigilant in addressing these emotional needs of the women that we serve as we are addressing their physical needs.
Physiologic/Hormonal. By the first six weeks of pregnancy, estrogen levels rise to three times more than during the menstrual cycle! Progesterone levels also rise quickly and Progesterone is also implicated in depressive moods. As the pregnancy progresses through the second and third trimester, along with elevated estrogen and progesterone levels, the hormones cortisol, prolactin and oxytocin rise. Cortisol is a strong player in the HPA feedback loop. High levels of cortisol are also associated with depression. And prolactin is also associated with anxiety, anger and irritability. Oxytocin is known as the bonding and happiness hormone. Natural oxytocin causes nutrition absorption, uterine contractions, pair-bonding, mother-infant bonding, pain amnesia, calmness and feelings of belonging and happiness. Now add in bed rest! Mamas on Bedrest are at increased risk of developing perinatal mood disorders because in addition to the normal hormonal fluctuations of pregnancy, the stress of being on bed rest and the unsurety of the pregnancy stimulate the “fight or flight” response, releasing additional cortisol and neurotransmitters that will affect Mamas’ mood.
During an uninterrupted birth, there is a surge of oxytocin, beta-endorphin, adrenaline, noradrenaline and prolactin. These hormones all combine to orchestrate the event of birth and positive emotional outcome. Oxytocin for uterine contractions, calmness, love. Beta-endorphins for a protective emotional high during a peak physical activity. Adrenaline rush for energy and the final push of the fetal ejection reflex. And high prolactin levels to consolidate breast milk production and breastfeeding. However, if there is medical intervention of any sort during labor and delivery; an epidural, episiotiomy, forceps/vacuum extraction or cesarean section, this natural hormonal protection and mood enhancement is disrupted and often lost resulting in birth trauma, post tramautic stress disorder and post partum depression. The extent of the trauma is different for every woman and typically correlates to the level of intervention. Researchers are just beginning to understand the delicate interaction between hormones, labor and deliver and a women’s mental health, and as more research is done, we will have better understanding of this complex interaction and how best to care for women during pregnancy labor and delivery to protect their mental and as much as possible, minimize negative emotional effects.
In Part III, Kathy looks at hormones and post partum!
The next three blog posts feature a series on perinatal mental health by my friend and colleague Kathy Morelli. Kathy is a Licensed Professional Counselor (LPC) in Wayne, NJ and the Director of BirthTouch® LLC. As an LPC, she provides Holistic Counseling in Wayne, New Jersey with a focus on Maternal Mental Health, Family Systems and trauma from sexual abuse and medical intervention. Kathy is also an author and very engaging speaker on perinatal mood disorders and mental health. When I saw her series on the effects of hormonal changes on a woman’s mood, I knew I wanted to share this important information with Mamas on Bedrest. Almost daily I hear women say, “I feel so sad/angry/lonely/irritable…yet I know that I shouldn’t complain.” It’s not complaining to express how you are feeling and according to Kathy’s articles, there are some real physical and hormonal reasons for how you feel.
The first part of the series is called, Pre-Pregnancy: How Women’s Brain Biology, Hormones and Mood Relate. In this first installment, Kathy gives an excellent-albeit a bit technical-explanation of why women seem to have such wide ranging mood fluctuations. Beginning at birth we are all “pre-wired” with our temperaments based on our innate physiology as well as genetic influences. Then based on our external environments and life experiences, our innate temperaments are either augmented or tempered, but remain underneath it all in the “pre-wired” state.
Next women begin menstruating and the complex neural feedback systems kick into high gear in response. The Hypothalamus-Pituitary-Adrenal Cortex Loop (HPA-C) links the brain with the adrenal glands. It puts out cortisol and adrenaline in response to stress, and sometimes that stress is simply the menstrual cycle. The Ovarian-Hypothalamic-Pitutary Axis (O-HPA) is a feedback loop system between the ovaries. Located in the midbrain, the HPA is in part responsible for regulating menstrual function. The HPA puts out cortisol and serotonin, the “feel good” chemicals while the ovaries put out estrogen and progesterone. The big crux of this feedback system is that the precursor to serotonin is estrogen! So when women begin menstruating and having the various fluctuations in their estrogen and progesterone levels, the messages being sent back to the brain-the variations in estrogen levels-will cause fluctuations in the serotonin levels put out by the HPA and thus impact women’s moods.
There is an important take home message that runs through all three posts. Kathy gives the indepth, bio-physiologic reasons for women’s mental health fluctuations so that women can be aware of when their hormones are up and down and take care of themselves accordingly. Self Care is key to good mental health and with this information, I believe women have some powerful information to use to take care of their mental/emotional health.
In the second part of this series, Kathy looks at the hormonal influences during pregnancy and childbirth!