This special report explores why affective disorders are more prevalent in women across the lifespan, highlighting the interplay between ovarian hormones, stress, and socio-cultural context. It argues for moving beyond purely biological explanations toward a more contextualized understanding of women’s mental health
Hormones and the lifetime prevalence of affective disorders in women
Affective disorders, like depression or anxiety disorders, are on average diagnosed twice as often in women compared to men[1]. This disparity may in part be explained by higher rates of underdiagnosis in men[2]. Nevertheless, it is striking that this prevalence disbalance is not equally distributed across the lifespan, peaking during adolescence, where girls exhibit prevalence rates triple those of their male peers1. Women’s mental health varies across the lifespan with marked increases during phases of major hormonal change[3]. Affective disorders increase during puberty, hormonal contraception, pregnancy, the postpartum period and menopause. Thus, a lot of research focuses on the role of hormones in causing those mental health symptoms and – more recently – on identifying women’s individual sensitivity to those hormonal changes.3
Stress and the lifetime prevalence of affective disorders
However, these ovarian hormonal changes do not happen in isolation but need to be contextualized in various ways. First, every single one of these hormonal transition periods comes with significant life changes that require psychological adjustment. This is evidenced by the fact that affective disorders also peak during adolescence in boys[4], and post-natal depression can also occur in fathers.[5] Thus, focusing on the interactions between ovarian and stress hormones in explaining affective symptoms is a much-needed approach. However, this does not explain the gender disparities in prevalence rates during each of these periods.
Society and the lifetime prevalence of affective disorders in women
What we hardly talk about, though, is that those hormonal changes happen within a socio-cultural context that is so inextricably intertwined with the hormone actions themselves that we do not even know where to begin to disentangle them. Because every single one of the hormonal transition periods mentioned above comes with a variety of bodily changes – many of which are highly visible and change the way that women are treated in society.
For each of these hormonal transitions, there is a complicated set of rules and expectations about what we are supposed to do with our bodies – how we are supposed to look, how we are supposed to behave, how we are supposed to feel. Rules about how we are supposed to deal with menstruation, contraception, pregnancy, motherhood and menopause. Because society does not seem to trust women to make the right choices for themselves and their bodies. Because society is scared, they might make the “wrong” choices. When it comes to contraception, for instance, we are scared that the wrong choice may cause unwanted pregnancies, a lack of sexual satisfaction for their partners or health consequences.
Socio-cultural factors coinciding with ovarian hormonal changes
The example of contraception already demonstrates one of two examples for socio-cultural factors that coincide with ovarian hormonal changes, particularly during puberty.
This first factor is responsibility. Having a female body comes with responsibility! From the onset of menarche, every hormonal or sexual choice includes the management of potential pregnancies. This can severely limit girls’ freedom to discover their own bodies and sexuality. And all the rules and behavioral expectations cultures put in place are designed to control what women do with this responsibility. Because this responsibility is scary! But we cannot change that by limiting women’s choices or their access to information about their own bodies. What we can do is ask ourselves whether that responsibility is equally distributed. Do we really expect the same amount of behavioral responsibility from boys?
The second factor is danger. Having a female body is dangerous! It comes with an increased risk of physical and sexual abuse. Are we really surprised that anxiety disorders are twice as high in women when, depending on the country, they are 2-10 times more likely to get raped[6]? It is well documented that experiences of violence may exacerbate affective symptoms during hormonal transition periods. For instance, early life trauma is more common in women with premenstrual dysphoric disorder.[7] Likewise, postpartum depression is higher in women who experienced any form of violence as a child[8] or in an intimate relationship as an adult.[9]
Putting ovarian hormones in context
So yes – changes in ovarian hormones correlate with increases in affective disorders. But we need to put those hormonal changes into context. Because they do not act alone. They act within various layers of threat and expectations. It is easy to label women who are experiencing affective symptoms as “just being hormonal”. Because that means that we – as a society – are not responsible for those symptoms – biology is! And it also means we don’t have to take these symptoms seriously or change as a society. Well, it is high time we did! Because it speaks to the strength of women that, within this context, prevalence rates of affective disorders are not much higher than they are.
[1] Salk et al. (2017). https://doi.org/10.1037/bul0000102
[2] Faisal-Cury et al. (2022). https://doi.org/10.1016/j.jpsychires.2022.04.025
[3] Kundakovic & Rocks (2022). https://doi.org/10.1016/j.yfrne.2022.101010
[4] Lu et al. (2024). https://doi.org/10.1016/j.jad.2024.03.074
[5] Smythe et al. (2022). http://doi.org/10.1001/jamanetworkopen.2022.18969
[6] Borumandnia et al. (2020). https://doi.org/10.1186/s12889-020-09926-5
[7] Kulkarni et al. (2022). https://doi.org/10.1016/j.psychres.2021.114381
[8] Camargo Junior et al. (2025). https://doi.org/10.1016/j.apnu.2025.151892
[9] Wei et al. (2022). https://doi.org/10.1177/15248380231188068
Acknowledgement to ECR grant: ERC Grant (850953)
