I Thought It Was Anxiety. It Might Have Been Hormones.

I keep hearing women describe themselves with the same word. Just.

I'm just a stay-at-home mom. I'm just an office manager. I'm just helping my husband with the business. I'm just a teacher. I'm just a nurse. It keeps coming up in conversations with women in my own network, and honestly, it makes me a little sad. Every time I hear it, I want to stop them.

Because you are not just anything.

I used to do this too. For years I would say, "Oh, I'm just a family medicine doctor," which sounds ridiculous out loud when I think about the medical school, the residency, and the years of training behind it. Family medicine wasn't something I fell into because I couldn't do anything else. It was a choice, and I loved it. So no, I'm not just a family medicine doctor, and you're not just a stay-at-home mom.

Somewhere along the way, a lot of women start sounding less like themselves. Women who used to be confident become more self-critical. Women who used to trust their judgment start second-guessing themselves. Women who spent decades managing careers, families, and crises suddenly feel less certain than they used to. And I don't think that's an accident.

But I also think something else is happening that we don't talk about enough. Our brains are changing.

For years women were often told they had anxiety or depression when what was really happening underneath was far more complicated. And to be clear, anxiety and depression are real. They deserve treatment. Sometimes medication is life changing. Sometimes therapy is life changing. Sometimes both.

But we now have a growing body of evidence showing that the menopause transition itself is associated with a significantly increased risk of mood symptoms. A 2025 analysis that pooled data from over a million women found that nearly one in three experiences symptoms of depression, anxiety, or insomnia during the menopause transition [1]. And large studies that followed women for more than a decade found that the risk of depressive symptoms climbs during perimenopause, with one study showing the risk more than quadrupled. That makes it one of the highest-risk windows in a woman's life for mood changes [2].

And honestly? That makes a lot of sense to me. Because looking back, I knew something wasn't right.

I've always had test anxiety. Always. But I've also spent my entire life taking tests. Medical school exams. Board exams. Recertification exams. Thousands of tests. So imagine my surprise when I found myself standing at the DMV feeling anxious about the vision screening.

The vision screening.

I don't wear glasses. I don't wear contacts. There was absolutely no reason for me to think I wouldn't pass. Yet my heart rate was elevated. I was nervous. I was thinking, "What if I fail?" Which was completely irrational. And also completely unlike me. I've spent over a decade working in urgent care and emergency medicine, and one of the things I always liked about those environments was that I stayed calm when things got chaotic. The more pressure there was, the more focused I became. But somehow a vision test at the DMV had me spiraling.

That wasn't me. Or maybe a better way to say it is that it wasn't the version of me I was used to.

What I didn't appreciate at the time was how much fluctuating hormones can affect the brain. Estrogen doesn't just affect hot flashes. It interacts with serotonin, dopamine, and norepinephrine, the same brain chemicals involved in mood, motivation, resilience, and anxiety [3]. And during perimenopause, hormone levels don't decline in a nice predictable line. They fluctuate, sometimes dramatically. Researchers have actually found that the bigger those estrogen swings are, the more likely women are to experience mood symptoms, and that this holds true whether or not they're having hot flashes at all [4].

For some women, that shows up as irritability. For some it shows up as sadness. For some it shows up as anxiety. For others it shows up as waking up at 3 a.m. replaying every awkward thing they've ever said since middle school.

The point is this.

Before you convince yourself that this is just who you are now. Before you accept the racing thoughts. Before you accept the anxiety. Before you accept feeling unlike yourself. Let's make sure we're looking at the whole picture. Because maybe it is anxiety. Maybe it is depression. Maybe it's hormones. Maybe it's all three. But whatever the answer is, you deserve more than being told to simply live with it.

And please stop saying you're "just" anything. You are not just a mom. You are not just a wife. You are not just an employee. You are not just a caregiver. And you are certainly not just a collection of symptoms.

You deserve to feel like yourself again. And if you don't feel like yourself right now, let's figure out why.

I'm so happy you're here.

Dr. Caravelli