Two Reproductive Psychiatrists on Hormones and Your Nervous System
By Lienna Wilson, PsyD | Vagus Vitality
If you have ever been told that your anxiety, sadness, or mood swings during a hormonal transition are “just hormones,” this interview is for you. I asked Jessica Benson, MD, and Morgan Lewis, DO, the reproductive psychiatrists behind Sunstone Psychiatry for Women, to explain what is actually happening in the brain during the hormonal shifts, such as the postpartum period and perimenopause, and why the real story has less to do with how much hormone is in your blood than with how sensitive your particular nervous system is to hormones changing.
Drs. Benson and Lewis met while working together at Main Line Health’s Women’s Emotional Wellness Center in Pennsylvania and went on to establish Sunstone Psychiatry for Women, a virtual practice supporting women through pregnancy, postpartum recovery, perimenopause, and other life transitions. You can learn more about their practice at sunstonepsychiatryforwomen.com.
Hormones Do More Than Run Your Cycle
Estrogen and progesterone are usually thought of as reproductive hormones, but Drs. Benson and Lewis point out that receptors for both are found throughout the brain, “in the very areas that regulate mood, sleep, memory, and how you handle stress.” Estrogen helps the brain make and use serotonin, “the same system that many antidepressants act on,” while progesterone breaks down into a compound called allopregnanolone that has “a calming effect on the brain, similar to how it settles anxiety and supports sleep” (Barth et al., 2015).
For most people, these hormone shifts are mild from day to day. But at certain life stages, hormones change quickly and dramatically, and that is when mood, anxiety, and overall mental health can be affected. As the doctors put it, “It is the change, not ‘bad’ hormones.”
Perhaps most reassuring is this: research suggests that mood symptoms during these transitions “usually are not because your hormone levels are abnormal or ‘off’” (Schiller et al., 2015). Blood levels often look completely normal. What differs is how sensitive a particular brain is to the shift itself, a biological difference, not “a personal weakness,” and “not something you caused.”
The Postpartum Crash and the Perimenopause Rollercoaster
Pregnancy floods the body with high levels of estrogen and progesterone, and after delivery, “these levels crash back down within days.” For a brain that is sensitive to that drop, Drs. Benson and Lewis explain the steep withdrawal can trigger low or sad mood and tearfulness, anxiety or feeling on edge, trouble enjoying things, and difficulty sleeping beyond ordinary newborn sleep loss.
Brief “baby blues” in the first days are common, but when symptoms last longer than about two weeks or start interfering with caring for yourself or your baby, “this may be postpartum depression, which is common and very treatable.”
Perimenopause tells a different story. Rather than a single drop, estrogen “becomes erratic, swinging up and down unpredictably before eventually declining,” and the doctors emphasize that it is this instability, more than any single low number, that is linked to new or returning depression and anxiety, irritability and mood swings, sleep problems and hot flashes, and brain fog. The good news, they add, is that “for many, mood tends to settle again after menopause, once hormone levels become steady at a new baseline” (Gordon et al., 2019).
Both transitions hit some people harder than others. Drs. Benson and Lewis note that vulnerability tends to be higher for anyone with a personal or family history of depression, anxiety, or postpartum depression, a history of severe premenstrual mood symptoms (PMS or PMDD), or high life stress with limited support during the transition.
It Is Not “Just Hormones,” It Is Sensitivity
When asked why one person sails through a hormonal transition while another struggles with the same hormone levels, Drs. Benson and Lewis reach for an analogy that will sound familiar to anyone who thinks about the nervous system in terms of accelerators and brakes. “Your body has a built-in nervous system that controls how you respond to stress,” they explain. “Think of it as having two settings: a gas pedal that speeds you up when you’re stressed... and a brake that calms you down and helps you feel settled and safe.” Estrogen and progesterone normally help keep that gas pedal and brake balanced. When hormones rise and fall quickly, as they do after childbirth or during perimenopause, “the balance can be thrown off. The brake may not work as smoothly, and the gas pedal can get stuck ‘on.’”
They emphasize that it is rarely about having too much or too little of a hormone. “It’s about how sensitive your particular brain is to hormones changing.” They compare it to a peanut allergy: the problem is not in how many peanuts people eat, but how their system reacts to them. “Your hormones work the same way... A blood test can measure the amount. It can’t measure the sensitivity.”
That is also why a single hormone panel so often comes back “normal” even when someone feels far from fine. A one-time blood draw is only a snapshot, and during perimenopause in particular, levels “can swing dramatically from day to day, even hour to hour.” Drs. Benson and Lewis are direct about what a normal result does and does not mean: “Normal hormone results do not mean your symptoms are imagined or that nothing can be done.”
What Actually Helps: Track Symptoms and Protect the Foundations
If a blood test cannot capture what is going on, what can? Drs. Benson and Lewis point to something more old-fashioned and, in their experience, far more useful: tracking. “The single most important message to leave patients with is that mood symptoms during hormonal transitions are real, treatable, and worth acting on early,” they say, and the most impactful concrete step is to “track symptoms prospectively and protect the modifiable foundations (sleep, movement, stress regulation) rather than waiting to ‘tough it out.’” Because these conditions are defined by the pattern and timing of symptoms rather than a single lab value, prospective daily symptom charting “confirms the diagnosis, reveals the windows of vulnerability, and lets treatment be timed precisely.”
Alongside tracking, Drs. Benson and Lewis describe daily habits as genuine support for recovery, not replacements for treatment when symptoms are moderate or severe. They liken medication and therapy to turning down the volume on symptoms, while lifestyle habits “help steady your nervous system so it can recover and stay well.” Sleep is foundational, since poor sleep and low mood “feed each other.” A consistent sleep and wake schedule, sharing nighttime duties postpartum, and treating night sweats in perimenopause all help protect that sleep. Aerobic exercise has “the strongest evidence for easing depressive symptoms during menopause” (Wang et al., 2025) and also eases PMS symptoms (Ayyub et al., 2025), while regular meals and social connection round out the picture (McElhany et al., 2024).
But they are careful to draw a line: “for moderate to severe symptoms... medical treatment... is needed, with lifestyle habits alongside. Asking for that treatment is not a failure of ‘trying hard enough.’”
Nervous System Regulation Practices Worth Trying
For day-to-day regulation, Drs. Benson and Lewis recommend a short list of practices with solid research behind them. Slow, paced breathing with a longer exhale than inhale, for example, in for four counts and out for six, “activates the body’s calming system and can ease anxiety” (Bae et al., 2021). Mindfulness-based stress reduction, combining meditation and gentle yoga over several weeks, “can help prevent low mood and build resilience during the menopause transition,” especially for those at higher risk (Gordon et al., 2021). And cognitive behavioral therapy is, in their words, “a recommended treatment for PMDD and for mood and sleep problems in menopause,” teaching practical skills for managing stress, worry, and negative thought patterns (Hunter, 2021; Weise et al., 2019).
Across pregnancy, the postpartum period, and perimenopause, Drs. Benson and Lewis return again and again to the same reassurance: what you are feeling is real, it has a biological basis, and it is not a character flaw. “Feeling different during the postpartum period or perimenopause is not ‘all in your head,’” they say, “it reflects a real interaction between shifting hormones and a brain that is sensitive to those shifts.” The path forward is not to wait it out, but to notice the pattern, name it, and get support, whether that is a lifestyle adjustment, therapy, medication, or, most often, some combination of all three.
About Drs. Benson and Lewis
Jessica Benson, MD is a reproductive psychiatrist and co-founder of Sunstone Psychiatry for Women. She earned her medical degree at Drexel University College of Medicine and completed her psychiatry residency at Temple University Hospital, where she pursued additional training in psychodynamic psychotherapy. She later joined Main Line Health’s Women’s Emotional Wellness Center, where her interest in reproductive psychiatry grew into a defining focus of her career. She is board-certified by the American Board of Psychiatry and Neurology.
Morgan Lewis, DO is a reproductive psychiatrist and co-founder of Sunstone Psychiatry for Women. She earned her medical degree at the Philadelphia College of Osteopathic Medicine and completed her psychiatry residency at Temple, where she received the Marie J. Mignogna, MD Faculty Award for excellence in teaching. She began her career in emergency psychiatry on the faculty of Temple University Hospital’s Crisis Response Center and later spent four years at Main Line Health’s Women’s Emotional Wellness Center, where her passion for women’s health took shape. She is board-certified by the American Board of Psychiatry and Neurology.
Together, Drs. Benson and Lewis offer virtual psychiatric care for women across Pennsylvania navigating hormonal, emotional, and life transitions. Learn more at https://sunstonepsychiatryforwomen.com/.
Note: This interview reflects the general clinical perspective of Drs. Benson and Lewis and is intended for education, not as a substitute for individualized psychiatric care. If you are experiencing persistent mood or anxiety symptoms, please reach out to your healthcare provider.
References
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Bae, D., Matthews, J., Chen, J., & Mah, L. (2021). Increased exhalation to inhalation ratio during breathing enhances high-frequency heart rate variability in healthy adults. Psychophysiology, 58(11), Article e13905. https://doi.org/10.1111/psyp.13905
Barth, C., Villringer, A., & Sacher, J. (2015). Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience, 9, Article 37. https://doi.org/10.3389/fnins.2015.00037
Gordon, J. L., Peltier, A., Grummisch, J. A., & Sykes Tottenham, L. (2019). Estradiol fluctuation, sensitivity to stress, and depressive symptoms in the menopause transition: A pilot study. Frontiers in Psychology, 10, 1319. https://doi.org/10.3389/fpsyg.2019.01319
Gordon, J. L., Halleran, M., Beshai, S., Eisenlohr-Moul, T. A., Frederick, J., & Campbell, T. S. (2021). Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial. Psychoneuroendocrinology, 130, Article 105277. https://doi.org/10.1016/j.psyneuen.2021.105277
Hunter, M. S. (2021). Cognitive behavioral therapy for menopausal symptoms. Climacteric, 24(1), 51-56. https://doi.org/10.1080/13697137.2020.1777965
McElhany, K., Aggarwal, S., Wood, G., & Beauchamp, J. (2024). Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review. Maturitas, 190, Article 108118. https://doi.org/10.1016/j.maturitas.2024.108118
Schiller, C. E., Meltzer-Brody, S., & Rubinow, D. R. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48–59. https://doi.org/10.1017/S1092852914000480
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Weise, C., Kaiser, G., Janda, C., Kues, J. N., Andersson, G., Strahler, J., & Kleinstäuber, M. (2019). Internet-based cognitive-behavioural intervention for women with premenstrual dysphoric disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 88(1), 16-29. https://doi.org/10.1159/000496237