From Chrissy Teigen to Padma Lakshmi, women are coming forward about their struggle.

Did you know that women are twice as likely as men to be diagnosed with depression or an anxiety disorder?

Before rushing to assume doctors are being sexist—diagnosing women as hysterical simply for having emotions—we might gain more insight by considering what role women's physiology plays in certain mental conditions. According to the National Institute of Mental Health, anxiety disorders and depression stem from “a combination of genetic, biological, environmental, and psychological factors.” And researchers suspect that, specifically, female hormones put women at a greater risk of developing anxiety disorders and depression.

In the past two decades, social attitudes and general knowledge toward mental health issues have changed drastically. Public figures such as Kate Middleton have worked hard to raise awareness and remove the stigma of mental health. Others such as Selena Gomez, Demi Lovato, and Chrissy Teigen have spoken openly about their struggles. Behind the scenes, scientists are trying to unravel how hormonal changes lead to mental health conditions and why some women are prone to developing these conditions. In the meantime, by raising awareness of the possible link between mental health disorders and other common health conditions, more women are being encouraged to seek treatment for their symptoms.

Which mental health conditions seem to target women in particular, and why? I researched some of the top women’s health conditions connected to mental health to find out.

Hyperthyroidism and Hypothyroidism

Thyroid disorders affect an estimated twenty million Americans and are five to eight times more common in women than men. TV fitness trainer Jillian Michaels, famed talk show host and producer Oprah, and actress and screenwriter Nia Vardalos are just a few public figures who have said they experience thyroid disorders.

Anxiety and depression have long been associated with thyroid disorders. Some symptoms of an overactive thyroid, or hyperthyroidism, resemble the symptoms of anxiety and panic attacks. These symptoms include nervousness, irritability, rapid heartbeat, tremors, and trouble sleeping. In fact, hyperthyroidism (along with other conditions) can prompt panic attacks.

Hypothyroidism, an underactive thyroid, shares several of the same symptoms as depression: loss of energy, fatigue, trouble focusing, and sleeping more than usual. Depression can even be a symptom of an underactive thyroid. Conversely, symptoms of hypothyroidism, such as “slowing of thought and speech, decreased attentiveness, and apathy,” can be mistaken for depression. Though symptoms are similar, a person can, in fact, have both a thyroid disorder and a mental health condition at the same time. In a 2016 study of a hundred people with hypothyroidism, for example, more than 60 percent of women with the disorder reported symptoms of anxiety, depression, or both.

Depressive symptoms are also common among patients with hyperthyroidism, while some patients “develop mania-like symptoms,” said a 2013 study of hypothyroidism and bipolar disorder. The study concluded that having hyperthyroidism may increase one’s chance of developing bipolar disorders.

So, do thyroid disorders cause mental health problems? Or do mental health conditions cause thyroid dysfunction? These questions have been subject to debate. But the long-standing association between thyroid disorders and mental health conditions cannot be ignored.

Polycystic Ovary Syndrome

The most common endocrine disorder in women, polycystic ovary syndrome, or PCOS, affects an estimated 6 to 10 percent of reproductive-age women. Celebrities Daisy Ridley and Jaime King have opened up about their struggles with PCOS.

The symptoms of PCOS, which vary from woman to woman, include anovulation (no ovulation), polycystic ovaries, androgen (a male sex hormone) excess, insulin resistance, and metabolic dysfunction. More than 60 percent of women with PCOS have depression, anxiety, or some combination of psychiatric disorders. These women are also at greater risk of suicide. Researchers of a 2016 meta-analysis revealed, “Women with PCOS may report clinically significant symptoms of anxiety or depression at least in part as a result of significant body changes imposed by their illness.”

Published in 2015, another meta-analysis found that low self-esteem due to symptoms like unwanted hair growth, obesity, and acne can account for anxiety symptoms as well as social anxiety in women with PCOS. Other common concerns of women with PCOS, such as future health or infertility, may also trigger anxiety.

Though the authors of these studies call for further research to understand the association between PCOS and mental health, they propose possible explanations. Women with PCOS may be more prone to anxiety and depression due to dysregulation of their hypothalamic–pituitary–adrenal (HPA) axis. The HPA axis regulates hormones like androgens and cortisol (a stress hormone). HPA dysfunction is associated with stress and, though less studied, anxiety and depression. Other research suggests that high testosterone levels in the womb or “maternal testosterone exposure” can lead to anxiety and depression later in life. Some scientists suspect that these gestational conditions may also cause PCOS.

The Postpartum Period

As an estimated 50 to 85 percent of mothers experience the “baby blues” following delivery, doctors consider this experience normal. Yet, in the postpartum period, some mothers develop other, more serious conditions, such as postpartum depression, obsessive-compulsive symptoms, anxiety disorders, and post-traumatic stress disorder. Celebrities such as Hayden Panettiere and Teigen have come forward to share their experiences with PPD in the past year.

Though postpartum depression is perhaps the most known of these postpartum psychiatric disorders, it remains misunderstood. More severe than the baby blues, PPD is “clinically indistinguishable from depression,” the Massachusetts General Hospital Center for Women’s Mental Health says. Its symptoms include feeling guilty or worthless, sadness, crying, sleeplessness, trouble concentrating, and loss of interest. Symptoms of anxiety are also common.

Women who have experienced major depression or bipolar disorder before are more prone to developing PPD. Half of the women who suffer from PPD, however, have never experienced depression before.

Researchers suspect that hormonal shifts make mothers susceptible to depression in the months following childbirth. Levels of the hormones estrogen and progesterone rise dramatically during pregnancy but plummet in the first twenty-four hours after delivery. “This is much like the way smaller hormone changes can affect a woman's moods before she gets her period,” says the Office on Women’s Health of the U.S. Department of Health and Human Services. Postpartum depression may stem from other factors, as well.

Postpartum depression affects up to one in seven mothers. Many women develop PPD in the first two to three months after giving birth, but milder symptoms can develop during pregnancy. While the baby blues should last no more than two weeks, postpartum depression persists if not treated.

Of course this list is not exhaustive of the health issues that affect women’s mental health. Other conditions like premenstrual dysphoric disorder (PMDD), perimenopause, and menopause, for instance, can affect women's mental health, too. But lest we think nature has it out for women, let's remember men aren’t immune to their own issues. And besides, for all these challenges, we have some pretty amazing superpowers unique to ourselves, as well. Here’s hoping that the more we know about these issues and challenges that women uniquely face, the more understanding we can be of the mental health symptoms that come with them. And for those of us who experience them, that we remember we’re not alone.

Photo Credit: Tina Sosna