The rate of mental health issues in women begins rising in puberty, with two notable hormone-related trigger points in life: giving birth and going through menopause. In 2012, Harvard University researchers explained why this might be the case. They did this after examining links between the female sex hormone oestrogen and anxiety. In one test, they found that women with higher levels of oestrogen in their blood were less likely to be startled when put through tests examining fear responses. Researchers concluded that low or fluctuating oestrogen levels make women more vulnerable to anxiety and mood disorders. Men, on the other hand, were deemed less at risk since the male sex hormone testosterone is converted to oestrogen in the male brain and is more stable there than in a woman’s body. During a woman’s monthly cycle, oestrogen drops during the luteal phase between ovulation and the beginning of a period, potentially triggering anxiety, and mood swings, among other pre-menstrual symptoms (PMS). Similar drops occur immediately after childbirth and as women enter perimenopause.

Despite all the hormonal problems experienced by women, hormones cannot be the only factor affecting a woman’s mental health. Otherwise, women all over the world would record similar mental health levels, and that's, of course, not the case. In 2021, University College London (UCL) academics highlighted this after analysing data that studied psychological well-being among just over half a million 15-year-olds across 73 countries. They found that no matter how rich or gender-equal a country may be, there will always be a gender gap. They also discovered that countries with worse gender equality scores, such as Saudi Arabia, reported some of the narrowest gender mental health gaps, while those at the other end of the scale, such as Sweden and Finland, reported the widest. The team used the World Health Organisation’s definition of mental health as their starting point: where the young people felt they arrived on the spectrum between ill health and positive well-being. They looked at four metrics: overall life satisfaction, emotions experienced by 15-year-olds, and whether they felt their lives had meaning or purpose. They concluded that women and young girls in gender-equal countries are encountering the dual weight of managing higher economic and political participation, along with the conventional female norms and responsibilities. They also noted that while women have entered male-dominated areas of employment, men have not done the same in female areas and do not undertake equal amounts of housework.

Recent research has also revealed clear gender differences in psychological responses to childhood emotional or physical abuse. While boys are more likely to exhibit disruptive or anti-social behavior that gets them excluded from school or in trouble with the police, girls are more likely to internalize their pain. Girls that do not have an outlet to express their feelings can turn to self-harm (a factor that is three times more prevalent than boys) or develop eating disorders as coping strategies. Others enter early sexual relationships, which puts them at further risk of abuse or exploitation.

An understanding of the clear differences between the mental health experiences of men and women is now gaining currency. Healthcare services are also now starting to respond by structuring their services differently, while acknowledging that there is still a long way to go. It is hard to provide support if it is not sought in the first place. And in the UK, a government-commissioned Women’s Mental Health Taskforce found that women access mental health services less often than men do. The taskforce attributed this to services being designed consciously or unconsciously around the needs of men. The career roles that women undertake can make them reluctant to access help for fear of their children being taken away or of being judged as bad parents. All said and done, the solution is to provide access to support in a de-stigmatized environment where women not only feel safe and listened to but also empowered with a voice about the range of options open to them, ranging from medication to therapy.