Women's Mental Health Needs Disruption: The Time is Now

One in two women will need mental health care in their lifetime. Many will seek it. Too many will be ignored, dismissed, or forced to wait months. I was one of them.

Years ago, I struggled to get the help I needed for postpartum depression. That experience drove me to ask a bigger question: Are other women facing the same barriers — and why?

Over the past year, I surveyed 70 women, interviewed 18, and spoke with 10 healthcare providers — from OB/GYNs to reproductive psychiatrists.

A clear picture emerged:

Women's mental health is significantly influenced by hormonal changes, yet the healthcare system is not structured to provide sufficient support. Awareness is lacking, access to appropriate care is difficult, and systemic gaps continue to affect millions of women.

The connection between hormones and mental health

When I sat down with Dr. Friedman, a reproductive psychiatrist practicing in California, I asked her about the relationship between hormones and mood. She explained:

"We know hormonal changes impact neurotransmitters. Hormonal changes throughout a woman's life, whether it is the onset of first menstruation, pregnancy, going on birth control, stopping nursing, or going through menopause, can result in either the presentation of new mental health issues, exacerbation of existing issues, or improvement of existing issues."

The hormones estrogen and progesterone play a key role in mood regulation. Estrogen helps boost serotonin, the neurotransmitter linked to well-being and emotional stability. Progesterone complements this effect by promoting calmness, reducing anxiety, and supporting sleep. When the delicate balance between these hormones is disrupted — as it often is during menstruation, pregnancy, postpartum, and menopause — it can lead to mental health changes presenting as premenstrual dysphoric disorder (PMDD), anxiety, depression, and even more severe conditions like bipolar disorder and peripartum mood and anxiety disorders.

Hormonal Disorders in Focus

PMDD: More than just PMS

While 90% of premenopausal women in the US experience mild or moderate PMS symptoms (Reference), up to 8% suffer from PMDD — a debilitating condition recognized only in 2013. Women with PMDD are seven times more likely to attempt suicide than the general population (Reference). Despite its severity, PMDD remains under diagnosed and under-treated. To put this number in perspective, the percentage of women with type 2 diabetes in the US is about 10%, yet it has gotten far more attention and clinical research funding than PMDD.

One woman I interviewed shared:

"I feel like it (PMDD) holds me back from achieving my goals because I have such severe fatigue and brain fog during luteal (sic: phase of my cycle) and can't perform at my best like 50% of the time. I'm a very ambitious/ career-oriented person, and this condition puts me at a disadvantage. I also wish I didn't experience monthly suicidal ideation."

Another shared:

"The most frustrating part of living with PMDD is the monthly amnesia where my brain thinks these sudden suicidal thoughts are very real, and definitely not PMDD, like the last time. And the time before that…."

Pregnancy and Postpartum: A critical mental health window

During pregnancy, levels of estrogen and progesterone surge, which can stabilize mood for some women but may exacerbate anxiety or depression for others, particularly if they have a history of psychiatric illness.

After childbirth, estrogen and progesterone levels drop dramatically, contributing to postpartum anxiety and depression (PPD), which affects about 13% of mothers (roughly 8.6 million women) (Reference) in the U.S. While some postpartum mood changes are temporary, untreated PPD and anxiety can have long-term consequences on both mother and child.

Like PMDD and PMS, many women feel that there is a lack of awareness and education when it comes to postpartum depression and anxiety. Many discussions with doctors center around the birthing process and physical recovery. Further, many women are dismissed by their providers, letting them know this is short-lived and will pass, therefore, not receiving the support they need.

One mother I spoke to shared the following experience:

"Postpartum mental health is not talked about enough, and I come from a country where it's talked about, and you are monitored by your doctors. In America, they give you a laminated sheet to circle numbers. I knew I was struggling, and I had to fight to get help. I wasn't taken seriously even after circling the numbers. The answer was… here, take some medication. I appreciate the medication, it helped, but I wish I had more guidance, was able to speak with someone in person. I tried multiple therapists in town, and the wait was too long. I wish I had just had some support group I could have gone to with or without my babe and not felt so alone."

Perimenopause and Menopause: An Overlooked Mental Health Challenge

Perimenopause, the transitional phase before menopause, is marked by unpredictable fluctuations in estrogen and progesterone, leading to increased risks of anxiety, depression, and mood instability. These effects often go unrecognized as healthcare providers may dismiss them as "just part of aging." Women who have previously experienced PMDD, postpartum depression and anxiety, or hormonal mood disorders are particularly vulnerable. One woman in her late 30s explained:

"In the past year, I've experienced frequent night sweats, hot flashes, insomnia, PMDD, mood swings, thinning hair, weight gain, heart palpitations, intense brain fog, fatigue, anxiety…you name it.

When I went to see my doctor about this, he had me fill out a sheet of paper that asked me to rate the common symptoms of perimenopause…which about 85% of the list I rated as moderate to high. Even with that, he told me I was too young and that my symptoms were likely due to "repressed anxiety/stress"."

Pregnancy Loss and Birth Trauma: The Silent Impact

Although not tied directly to hormonal fluctuations, pregnancy loss, traumatic births, and fertility struggles profoundly impact women's mental health. These experiences often carry deep emotional wounds — grief, shame, anxiety, and a sense of isolation — that are frequently overlooked in clinical care. Many women I spoke with described feeling dismissed or invisible, as the focus of care remained on physical recovery while their psychological pain went unacknowledged. Support systems are scarce, and conversations around these topics are still stigmatized, leaving women to navigate these life-altering events in silence and without the emotional care they desperately need.

Gaps in Care and the Urgent Need for Change

In 2022, a Kaiser Family Foundation Women's Health survey found that 50% of women needed mental health care in the last two years. Of those, 60% sought care, but many encountered long wait times, high costs, or lack of insurance coverage. 20% of privately insured women reported that their provider didn't accept their insurance.

A survey I conducted in March 2024 validated these findings.

Systemic Barriers to Diagnosis and Treatment

Clinicians noted a widespread lack of understanding about PMDD and related hormone-sensitive disorders among primary care and OB/GYN providers, leading to delays in accurate diagnosis and appropriate treatment referrals. They often encounter patients who have struggled for years without proper support, which not only prolongs distress but exacerbates the psychological toll.

Dr. Cheng, a reproductive psychiatrist who is based in the Bay Area, California, shared that she has seen many women with PMDD struggling to get a timely diagnosis, in part, due to these gaps at primary care and OB/GYN practices.

"It's usually the same story over and over again. Lack of proper referrals and knowledge of what PMDD is…"

Diagnosis is further delayed by the requirement for at least three months of symptom tracking — something most women aren't aware of or don't have tools for.

Meanwhile, mental health screenings in OB/GYN and primary care settings are inconsistent. With not enough time during appointments and limited guidance and support, there often lacks sufficient encouragement for providers to conduct thorough mental health evaluations.

One woman who waited 24 years for a diagnosis shared her experience:

"…I've been hospitalized, misdiagnosed repeatedly, medicated for the wrong things, and essentially gaslit by healthcare providers who would write it off as all in my head. I felt like a lost cause for so long, and then started seeing a therapist who helped me recognize the patterns and figure out what was really going on. I've been on my treatment journey since August now and exploring all sorts of different things like herbal tinctures, supplements, SSRI and SNRI meds, exercise, yoga, and so on. I've seen some improvements for sure, but am still nowhere near where I want to be."

Care Deserts and Financial Barriers

Women face significant barriers to accessing mental health care, from provider scarcity to prohibitive costs when insurance is not accepted. In regions like Truckee, CA, clinicians noted that the shortage of behavioral health specialists is particularly severe, with just a few therapists and psychiatrists available, leaving many patients on long waitlists or struggling to find local care. This shortage is exacerbated by a lack of culturally sensitive, gender-focused care options, forcing women to navigate complex insurance and provider networks without adequate support.

Clinicians emphasized that insurance challenges remain one of the most formidable barriers to accessing mental health care, as many providers operate on a cash-pay basis. This disproportionately affects women seeking specialized mental health services, as they are often faced with high out-of-pocket expenses or limited insurance coverage for mental health services. Without comprehensive insurance support, many women delay or forgo necessary mental health care, worsening their symptoms and decreasing overall quality of life.

What Needs to Happen Next

Women's mental health issues related to hormonal changes have been overlooked for too long. The consequences of untreated PMDD, postpartum depression and anxiety, and perimenopausal mood disorders extend beyond personal suffering — they affect families, workplaces, and communities.

The data, stories, and research paint a clear picture: we are failing women when it comes to mental health care, particularly as it relates to hormonal fluctuations. The time for action is now.

Here's how we can change that:

• For providers: Routinely screen for mental health symptoms during life stage transitions. Learn to recognize PMDD and related disorders.
• For policymakers and insurers: Expand mental health coverage and incentivize collaborative care models across OB/GYN and primary care.
• For women: Share your story. Seek second opinions. Advocate for the care you deserve.

If you are a woman struggling with hormone-related mental health challenges, you are not alone. Awareness is growing, and together, we can demand a system that finally listens, understands, and acts.

That's why I started Meera Health — a platform designed to help women better understand the connection between their hormones and mental health, track their symptoms, and access trusted, specialized care. Meera is built to close the gaps that I — and so many others — have lived through.