When Hormones Drive the Nervous System: Understanding Anxiety

Tracy Tranchitella, ND | Sunrise Functional Medicine

That flutter in your chest. The sudden sense of unease. The feeling that your body is revving even though nothing stressful seems to be happening. For many women, anxiety doesn’t begin in the mind—it begins in the body. Heart palpitations, shallow breathing, racing thoughts, restlessness, sleep disruption—these experiences often arrive together.

While anxiety is frequently framed as an emotional or psychological issue, it is very often a physiological response driven by hormones, particularly during times of hormonal transition such as perimenopause, menopause, postpartum recovery, or periods of chronic stress. From a functional medicine perspective, anxiety is rarely the result of a single imbalance. It tends to emerge when several systems—hormones, the nervous system, blood sugar regulation, and even the gut—fall out of rhythm with one another.

The Hormone–Nervous System Connection

Hormones are chemical messengers that influence nearly every system in the body, including the brain and nervous system. Estrogen and progesterone, in particular, act as neurosteroids, meaning they directly affect brain chemistry, mood regulation, and the stress response. When these hormones fluctuate or decline, their ability to moderate the nervous system weakens. The result is often an increase in sympathetic nervous system activity—the “fight or flight” response. This can feel like anxiety, panic, heart palpitations, or a persistent sense of being on edge.

In earlier years, estrogen and progesterone help buffer stress by regulating neurotransmitters, calming stress hormone output, and maintaining healthy heart rhythm variability. As these hormones change—especially during perimenopause and menopause—the nervous system can become more reactive, even to everyday stressors that once felt manageable.

Why Anxiety Often Shows Up During Hormonal Transitions

Many women notice that anxiety appears or intensifies during specific life stages:

• The luteal phase of the menstrual cycle
• Postpartum hormone shifts
• Perimenopause and menopause
• Times of prolonged emotional or physical stress

These are all periods marked by rapid hormonal change, not just low hormone levels. The nervous system tends to tolerate stable patterns well—even if levels are not ideal—but it struggles when signals are inconsistent.

Estrogen, for example, plays a role in moderating the release of norepinephrine, a key stress neurotransmitter. When estrogen declines or fluctuates, norepinephrine levels can rise more easily, amplifying feelings of urgency, fear, or agitation. Progesterone metabolites, particularly allopregnanolone, have calming effects on the brain through their interaction with GABA, a neurotransmitter associated with relaxation. When progesterone drops, that calming influence is reduced. The result is a nervous system that feels less regulated and more reactive.

Anxiety Is Not Just “In Your Head”

Anxiety has emotional, mental, and physical dimensions, and many of its symptoms overlap with other hormone-related conditions:

• Heart palpitations
• Shortness of breath
• Muscle tension
• Digestive upset
• Sleep disruption
• Dizziness or lightheadedness

This overlap is one reason anxiety can feel confusing or alarming. It may appear suddenly, feel disproportionate to circumstances, or mimic other health issues. From a clinical standpoint, this is often a signal to look deeper—not just at mental health, but at hormonal and metabolic balance.

Hormones Commonly Linked to Anxiety

Several hormone systems are closely tied to anxiety symptoms:

Thyroid hormones
Both overactive and underactive thyroid function are strongly associated with anxiety. Autoimmune thyroid conditions, even when labs appear “normal,” can still contribute to mood instability and nervous system activation.

Sex hormones
Rapid drops in estrogen—as seen postpartum, during perimenopause, or after ovulation—are commonly associated with increased anxiety. Testosterone, in both women and men, appears to have a protective effect against anxiety, though balance is key.

Stress hormones
Cortisol, epinephrine, and norepinephrine drive the body’s stress response. When these hormones are dysregulated—whether elevated, depleted, or poorly timed—anxiety can become persistent or cyclical.

Insulin and blood sugar hormones
Blood sugar instability can trigger symptoms that closely resemble anxiety, including shakiness, sweating, rapid heartbeat, and irritability. Chronic blood sugar swings place additional strain on the nervous system.

The Role of the Gut–Brain–Hormone Axis

The gut microbiome plays a surprisingly influential role in both hormone balance and mental health. Gut bacteria assist with hormone metabolism, neurotransmitter production, and immune regulation. When the microbiome is disrupted—a state known as dysbiosis—it can contribute to estrogen imbalance, impaired neurotransmitter production, and increased inflammation, all of which may worsen anxiety. This gut–brain connection helps explain why digestive symptoms and anxiety so often travel together—and why addressing gut health can be a key part of calming the nervous system.

A Functional Medicine Approach to Supporting Anxiety

When hormonal imbalance is suspected, anxiety and hormone regulation are best addressed together, rather than as separate issues. Because hormone balance takes time to restore, supportive strategies that reduce nervous system activation are essential along the way. Key areas of support often include:

• Improving sleep quality and consistency
• Stabilizing blood sugar through balanced meals
• Reducing inflammatory and highly processed foods
• Supporting gut health
• Incorporating movement that calms rather than overstimulates the nervous system

Certain supplements, nutrients, and herbs may also play a role, depending on individual needs. These might include targeted probiotics, vitamin D, omega-3 fatty acids, magnesium, or botanicals traditionally used to support hormonal transitions. Careful evaluation is important, as the same intervention can affect people differently depending on their underlying physiology.

Measuring What Matters

Because anxiety can be influenced by multiple systems at once, comprehensive testing is often helpful. Evaluating sex hormones, thyroid markers, adrenal output, and metabolic indicators can provide clarity and direction. Measuring patterns—rather than isolated values—allows for a more nuanced understanding of what is driving symptoms.

This individualized approach is central to how Dr. Tracy Tranchitella works with patients, particularly those navigating complex or overlapping symptoms that don’t fit neatly into a single diagnosis.

Bringing the Nervous System Back Into Balance

Anxiety is not a personal failing, nor is it simply a mental health issue. For many women, it is a biological signal—one that points toward hormonal shifts, nervous system imbalance, or unmet physiological needs. By addressing hormones, stress physiology, nutrition, and lifestyle together, the nervous system can regain a sense of safety and stability. When balance is restored, anxiety often softens—not because it was “managed,” but because the body no longer needs to sound the alarm.

If you’re interested in taking a more personalized, preventive approach to your health Dr. Tracy Tranchitella, ND offers comprehensive care designed to support your long-term health. Learn more and request a consultation >>