The Anxious Women

Sandra’s mind was not right, she felt something had gone wrong but could not quite explain it. The actual feeling she was experiencing made no sense. It felt like something dangerous was about to happen, but there was nothing she could point to. Just a feeling of unease and low grade panic.

At first Sandra only felt this sense of impending disaster occasionally, quietly managing her unease with will power. It was not until she found herself unable to drive her car that she sought medical help.

It isn’t easy to share your feelings with a doctor. Appointments are scheduled in 15 minute increments. No matter how hard the clinician tries, it is difficult to create a trusting relationship in a rushed environment. Only when a woman feels safe will she allow herself to be vulnerable enough to open up.

Sandra explained to her physician how her symptoms had been building for a few years, she also thought it was important that symptoms were worse with her period. All this was met with a few nods. In the end she was diagnosed with anxiety. He tried to reassure her that it was normal for a woman to experience this. He did not mention the association between her anxiety and her periods, he only offered her a prescription for Xanax.

Sandra’s medical experience was typical for a woman diagnosed with anxiety, in a word: it was disappointing. The visit was brief, the prescription is highly addictive, and at no point did the clinician try to get to the bottom of Sandra’s symptoms.

When Sandra came to my office she was frustrated. I remember her telling me “Im only here because my sister-in-law said you could help”. Sandra was using Xanax daily now. She hated how she felt taking it, “I don’t feel like myself when I take it, I’m zoned out. And when I need a refill, I feel like an addict asking my dealer for more”

Sandra believed she had a personal defect, and the only way to manage it was with drugs. In fact many women feel this way. Society, and the medical industry has conditioned women to believe that it is normal for them to be more anxious then men.

Women are twice as often diagnosed with anxiety than their male counterparts. This statistic begs the question why, why do women experience anxiety in such higher levels then men. Fortunately the answer is very straightforward, and is found in the hormonal balance of a woman.

There is a rhythm in a woman’s cycle, the first two weeks of the cycle are under the influence of estrogen the second two are likewise under the influence of progesterone. The balance between these hormones provides the foundation for a woman’s health. A disruption in this balance can lead to symptoms both physical and  emotional.

In the case of Sandra, I ran labs timed for when progesterone should be at its highest. It is an often overlooked medical fact that progesterone deficiency leads to anxiety. Progesterone is converted to 5-allopregnenolone (5-Allo-P) in the brain. 5-Allo-P in turn binds to the GABA receptor. The GABA receptor is the part of the brain that regulates anxiety. Xanax, Valium, Alcohol all bind to the GABA receptor, but I would argue that the receptor is better stimulated by 5-Allo-P. While the former three have addictive qualities the latter most does not.

Sandra’s lab work showed a severe deficit in her progesterone levels. I prescribed progesterone and asked her to take it the last 10 days of her cycle. After a month I re-ran Sandra’s labs and found her levels were corrected. We sat down to review the results and her feelings. She told me her sense of panic was gone, she was no longer taking Xanax. It was like a weight had been lifted from her. She also shared with me her frustration. “Why didn’t my previous doctor run this test? Why did he just prescribe me Xanax?”

Sometimes I try to answer the question, I try to explain different levels of training, different points of view. Most times I don’t try to explain, I just listen to them and allow them a space to vent their frustration. Either way, I feel accomplished for having sought out the cause of the condition.