Generalized anxiety is debilitating, profoundly hormone-sensitive & more than twice as frequent in women, its abrupt attacks episodically clustering during periods of hormonal flux such as PMS, where estradiol is dipping.  

Generalized anxiety is a common, highly intrusive disorder, far more frequent in women, based on disrupted activity in the brain's emergency/fear machinery located in the amygdala & associated functional units. Anxiety is a natural experience, perfectly appropriate in dangerous situations where rapid, intuitive action is essentially required in the support of survival.  When this normal response mechanism is set on a hair trigger or when its volume becomes exaggerated or inappropriate to circumstance however, it acts abnormally, by virtue of switching on both too often & too easily and in the process paralyzing us.  This is a matter of abnormal salience. 

Although anxiety may be amplified by buying into its physical cues or tuned-down by virtue of meditation or desensitization, the underlying process is biological, not psychological.  The loud intrusiveness of anxiety-related symptoms reinforces its power over us, but since biological factors such as dips in the sex hormones are often or always involved, hormone therapies such as estrogen stabilization or cortisol reduction may greatly help.  Anxiety is also a prominent core component of OCD, another hormone-sensitive neural disorder.  

The brain biology of anxiety is very well described for the public by Joseph Le Doux in his book 'Anxious'.  He is an international expert on the brain's strategic, structure known as the amygdala, which serves a vital purpose in sudden, acute, emergent situations but when activated excessively, chronically and in situations that do not truly represent emergency, can be counter-productive, even behaviorally paralyzing.   And amygdalar over-activity can contribute to stress-sensitive events such as cardiovascular disease & heart attacks.  However, anxiety, far from arising within a single brain circuit, emanates from the dynamic interplay between opposing circuits, some anxiety-inducing, others anxiety-reducing. That's because the amygdala in turn projects to an area called the BNST, & the BNST in turn possesses two sub-regions, one of which promotes while the other inhibits anxiety.  

Low versus dipping estrogen levels? 

Some researchers have suggested that both anxiety and post-traumatic stress are linked to low estrogen levels and that higher estrogen levels may protect women against trauma.  In my opinion it is not low levels but dipping levels that are the culprit, particularly if the dipping level crosses over some crucial line or threshold of lowness.  Estrogen levels do have an important regulatory impact upon the stress response machinery of the brain, specifically the secretion of the critical stress-related hormone known as CRH that is produced in the hypothalamus, after which it projects both upward to the amygdala where it provokes this structure, as does nor-epinephrine, the so called flight or flight neurotransmitter. At the same time it also projects downward so as to impact along both wired and wireless connections with the body, fueling palpitations, shortness of breath, butterflies in the pit of the stomach and all the other very real physical symptoms that accompany anxiety.

Hormonal treatments? 

Hormonal treatments that stabilize estradiol levels are often far more effective & safer in the treatment of anxiety than are the sedative, highly addictive benzodiazepine (BDZ) drugs such as Valium, Ativan & Xanax.  Some researchers also suggest that oral contraceptive pills might offer benefit to women with PTSD.  I believe they are terribly wrong.  Do not take my idea of estrogen stabilization to mean using oral combination contraceptive pills.  These drugs contain a synthetic estrogen called ethinyl estradiol which cannot cross the blood-brain barrier while also reducing the ability of natural estradiol & testosterone from accessing the brain, by a large factor of some 400%.  It is the levels of these hormones getting to the brain rather than those circulating in the blood-stream that really matters, & recent studies increasingly associate depression, anxiety & stress-sensitivity with the use of birth control pills, especially the progestin-only pills, which paradoxically lower brain estrogen levels instead of raising them. 

Why are the progestin pills such a problem? 

The natural hormone progesterone not only operates in a slow-acting, classic hormonal capacity, by stimulating progesterone receptors, but also by rapidly being converted into a substance called allo-pregnanolone, which then stimulates structures called GABAa receptors in the brain.  But these are the very same structures upon which sedatives like the BDZs and the barbiturates operate, so natural progesterone can function as a natural sedative of sorts, thanks to its prompt conversion into allo-pregnanolone.  But the synthetic progestins in birth control pills inhibit ovulation, leading to the total loss of natural progesterone production by the ovaries. And synthetic progestins, unlike natural progesterone, do not convert into allo-pregnanolone!  it is also interesting to note that some mutations in progesterone receptors can increase the risk of anxiety.  

The bottom line here is that patients are far too frivolously & lazily treated for the frequent condition of anxiety with addictive drugs when a precise, hormone-oriented approach could be far safer & more effective.