3 Factors That Influence Women's Anxiety That Aren't Sex Hormones

Women are twice as likely as men to develop an anxiety disorder in their lifetime. And oftentimes sex hormones are cited as the root cause of that disparity. 

At every stage of life, a woman's hormones put her at a heightened risk for anxiety. From the cyclical changes during menstruation to the sudden drop of estrogen and progesterone after giving birth and the declining (and then resident low levels) after menopause, each phase has been scientifically linked to anxiety. Cue a collective sigh. 

While it's important to recognize these especially vulnerable times, there are other contributing factors to anxiety that are unique to women. 

Integrative neurologist Romie Mushtaq, M.D., ABIHM, always screens for chronic stress and burnout in her patients with anxiety, as she finds that it leads to anxiety if left unmanaged.

And again, levels of stress tend to be much higher in women. A 2023 survey by the American Psychological Association found that women reported higher average stress levels than men and were more likely to rate their stress levels as high. 

Stress not only impacts how we perceive and react to situations, but it also impacts blood sugar levels and the risk of diabetes. 

"Under chronic stress [and anxiety1], the brain's hormonal control of glucose regulation is negatively impacted, starting with insulin resistance," says Mushtaq. "Even before a diagnosis of diabetes (or prediabetes) is made, anxiety may be the only presenting symptom with fluctuations of blood glucose levels." 

Mushtaq also emphasizes that women are more sensitive to insulin during perimenopause (often starting in a woman's 40s) and menopause. High blood sugar levels are also linked to worsened mood and anxiety.

As everything in the body is connected, coping with stress before it snowballs into something unmanageable may help prevent anxiety, and improving blood sugar management if you have anxiety may help improve your symptoms. 

Women are anywhere from five to eight times more likely to have thyroid problems than men. And the connection between thyroid dysfunction (hyper or hypo) and anxiety is a tangled web. 

Thyroid hormones influence mood-related neurotransmitters (like serotonin, dopamine, and norepinephrine), metabolic rate, and the brain's response to stress—all of which can contribute to anxiety or exacerbate symptoms of anxiety2. 

And, "40% of thyroid disease can present with anxiety and mental health symptoms only," asserts Mushtaq. "If we do not advocate for a complete evaluation, a critical diagnosis like autoimmune thyroid disease, subclinical hypothyroidism, or thyroid cancer, can be missed (as it was with me for years)."

Societal expectations and gender roles3 can place additional pressure on women and increase symptoms of anxiety. 

Women are also more likely to face body shaming, domestic violence, and abuse, all of which make women more vulnerable to anxiety (and depression). 

"My message to all women is to remember that you are in control, even if your anxiety and busy brain are robbing you of your sense of control," says Mushtaq. 

Unrelenting feelings of anxiousness should not be brushed off (by you or a health care professional), and Mushtaq does recommend seeking medical attention. 

"You must be your strongest advocate in the health care system," asserts Mushtaq. "When we suffer from chronic anxiety, that can feel challenging, so recruit a trusted friend or family member to join you on an office or virtual visit if needed." 

She notes that while there are numerous tips on social media and in books on ways to cope with anxiousness, you shouldn't overlook getting a laboratory evaluation to screen for a true root cause of anxiety. 

Mushtaq dives into great detail in exactly what tests you should ask your doctor for in her book Busy Brain (all of which can be covered under the traditional U.S. insurance model) and includes a full thyroid panel, fasting insulin levels, fasting blood glucose, hemoglobin A1c, and serum cortisol levels.

"These are a few of the hormones and other nonhormonal labs we check in order to get to the root cause of anxiety," she notes. 

There are numerous social, emotional, and hormonal (sex and otherwise) issues that may be the underlying driver of a woman's anxiety.