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New research shows hormones impact how well women respond to anxiety treatment

Women are twice as likely to develop anxiety but treatment often doesn’t work. Ground-breaking findings from an MQ-funded study offers hope for changing that and developing approaches specifically tailored to women.

In research just published, MQ Fellow Dr Bronwyn Graham has found that women with anxiety who had low levels of the hormone oestrogen were less likely to get better – and stay better – following treatment. 

Oestrogen levels are low during the early phase of the menstrual cycle, and even lower when women are taking hormonal contraceptives, such as the pill. Up to 80% of women will use hormonal contraception at some point in their lives so it is important to understand the effect they have on treatment outcomes.

This new research provides the understanding we need in order improve treatment outcomes for women. Bronwyn explains: “The study indicates potential new ways to bolster treatment for women: we could deliver treatment at optimum times in their menstrual cycles, women could temporarily come off the pill during treatment, or women could be administered medication containing oestrogen during treatment.”

This study at the University of New South Wales in Australia is the first of its kind to take recent lab findings looking at oestrogen and anxiety and test them in a clinical setting. 

Dr Bronwyn Graham researcher
Dr Bronwyn Graham, MQ Fellow and researcher at University of New South Wales

To gain this understanding, Bronwyn and her team measured the oestrogen levels of 90 women with spider phobia (including 30 women on hormonal contraceptives) after one session of treatment. She determined the success of the treatment by asking the women about their fear of spiders, and measuring their behaviour in the presence of a live spider, before treatment, straight after treatment and 12 weeks later.

Following the treatment, compared to women not using hormonal contraceptives, women using hormonal contraceptives exhibited significantly slower rate of improvement during treatment, and less overall reduction in symptoms after treatment and at the 12-week follow-up assessment. The study showed that across the whole sample, low levels of oestrogen were associated with slower rates of improvement. 

Previous lab work has showed that the ability to manage fear, which is important to succeeding in treatment, is affected by oestrogen levels. Oestrogen is key to forming new memories so researchers believe that low levels of oestrogen might be impairing the success of treatment as therapy encourages people to generate new ways of thinking about things that cause them fear.

More research is needed to determine whether the effects of oestrogen are comparable across different conditions which have similar treatments, like OCD, Generalised Anxiety Disorder and PTSD. 

Moving forward, Bronwyn and her team now want to explore the impact that different types of hormonal contraception has on psychological treatment. For example, Bronwyn is interested in whether progesterone-only arm implants have less of an effect than the oral combined pill, which was consistent with the pattern of results in her recent study. 

Dr Sophie Dix, Research Director at MQ said: Dr Graham’s findings demonstrate the power that research has to make significant changes to the lives of people struggling with mental illness. Anxiety is twice as likely to affect women compared to men, this research not only sheds light on why that might be the case, but also provides tangible ways to improve treatment outcomes for those affected. If we are to see more breakthroughs in how we treat these common conditions, we must invest in research.” 

Last updated: 27 April 2018

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