How Your Menstrual Cycle May Be Impacting Your Mental Health

You may be familiar with “Aunt Flo,” “the Red Wave,” or “That time of the month” ...some all too familiar euphemisms for periods. We come up with these cutesy slang terms to be more discreet or polite, but we’re doing ourselves a disservice by being covert. Periods are still taboo and this stigma unfortunately manifests in a lack of funding and research for reproductive healthcare. Now combine that with mental health, another historically taboo area, and we’ve got a real lack of transparent and authentic conversation! Our menstrual cycles and resulting hormonal shifts can have a big impact on our mental wellness. But many of us may be stuck silently wondering “Is this normal? Am I normal??” because we fail to talk openly about our experiences both with friends and healthcare professionals. So, let’s dive into the connection between reproductive and mental health. 

Key Hormones 

First, a quick biology lesson! Hormones are messaging chemicals in our bodies produced by various glands and organs. Our hormone levels can change, and particularly the sex hormones of estrogen and progesterone can fluctuate throughout a menstruating person’s cycle. 

• Estrogen: Estrogen is secreted by the ovaries; estrogen levels rise in preparation of an egg being fertilized, which results in pregnancy. During months when a menstruating person does not get pregnant, the estrogen levels then drop and mensuration begins. Drops in estrogen tend to correlate with shifts in mood. Overall estrogen levels tend to drop as we get older, especially in the perimenopause and menopause phases. Estrogen also plays a role in other bodily functions, like brain, muscle, and heart health. 
• Progesterone: Progesterone is the other key hormone in the female reproductive system. Similar to estrogen, progesterone levels drop each cycle that an egg is not fertilized (you don’t get pregnant), leading to the thinning and breaking down of the uterine lining - menstruation. 

Phases of the Menstrual Cycle

The purpose of the menstrual cycle is to prepare the body for pregnancy. A typical cycle is 28 days long, but this can fluctuate. Some people have very regular cycles while others may experience more uncertainty; there can also be a lot of variation in the severity of symptoms. Let’s define the 4 phases of the menstrual cycle and how your mental and emotional state may be impacted by each phase: 

1. Menstrual: The cycle begins with the menstrual phase, which begins on the first day of your period. Estrogen and progesterone levels are at their lowest, and this is sometimes referred to as the “winter” season of the cycle. This phase can bring cramping, back pain, and headaches, and mentally, you may feel exhausted, sluggish, and a desire to withdraw and rest. 
2. Follicular: This phase overlaps with the menstrual stage, as it also begins on the first day of your period and lasts until ovulation. Estrogen levels rise as this phase goes on. People tend to experience higher energy levels and improved mood, as well as more creativity and motivation once menstruation is done. 
3. Ovulation: Estrogen rises to its highest level and around day 14, the body releases an egg. People usually feel the most energetic, focused, and productive during this phase.
4. Luteal: This is the longest phase, lasting almost half the length of the full cycle. Progesterone levels rise early in this phase. If an egg is fertilized, you become pregnant. If not, you experience a drop in hormone levels towards the end of this phase, which can result in PMS symptoms including mood swings and food cravings. Then comes menstruation again. 

Common Concerns & Diagnoses 

As mentioned, the severity of symptoms can range but we often don’t know what is considered “normal” versus worthy of professional attention. This is in large part because we aren’t talking about our experiences enough to be able to compare. Below are a few conditions in which our reproductive and mental health intersect:

• PMS (Premenstrual syndrome): This is a common condition that may bring a combination of physical and emotional symptoms during that luteal phase leading up to your period, and during menstruation itself. This can include symptoms like cramping, headaches, back pain, bloating, irritability, mood swings, trouble concentrating, sleep disruptions and lack of energy. Symptom severity can range from slightly uncomfortable to overwhelming. 
• PMDD (Premenstrual dysphoric disorder): Many of the physical symptoms of PMS may be present, but PMDD is characterized by severe mental health impacts that often interfere with regular functioning. PMDD is a DSM-5 diagnosis in which people may experience a severely depressed mood, loss of interest in activities, anger, and agitation. It may include feeling out of control, hopelessness, and even suicidal thoughts.
• PME (Premenstrual exacerbation): If you are someone who has generalized anxiety disorder, for example, you may notice that your anxiety symptoms flare up around the same time each month. This is not in your head! During certain phases, especially the luteal phase leading up to a period, anxiety, depression, eating disorder behaviors, and bipolar symptoms like mania all may be exacerbated… a very unfortunate “double whammy.” 
  • BDD (Body dysmorphic disorder): People who experience BDD are one such category under the PME umbrella, especially people who are trangender or gender-nonconforming. For people who don’t identify as women, having a menstrual cycle can bring severe distress due to the experience not aligning with their gender identity, and exacerbate feelings of body dysmorphia. 

Treatment & Coping Strategies 

We are contending with a lot! But there are solutions and strategies to better manage symptoms and improve both our gynecological and mental health:

• Track your cycle: A great first step is to get to know your body and understand what your cycle tends to look like. Use a period tracking app or notebook to start mapping your cycle and your emotional/ cognitive symptoms to notice any trends or correlations. 
• Lifestyle changes: Certain lifestyle changes can help, such as getting more sleep and exercise, and good nutrition. Cutting down on caffeine and alcohol may reduce symptoms.
• Medications: Many people find hormonal birth control and/or SSRIs to be helpful in symptom management. Consult with your gynecologist and/or psychiatrist to see if medication may be a good choice for you. 
• Emotional processing with a therapist: Especially for those who experience the depressive symptoms associated with PMDD, talk therapy can be beneficial for processing and learning coping tools. Cognitive-behavioral therapy, mindfulness and breathwork can help. 
• Tap into resources: As we’ve established, these topics are not discussed enough, so accessing resources and normalizing periods is huge! Below are a few resources you may find helpful:
  • It’s Not Hysteria by Dr. Karen Tang (book)
  • Cramped by Kate Helen Downey (podcast)
  • The PMDD Phenomenon by Dr. Diana Dell (book) 
  • Your gynecologist, therapist, and psychiatrist- they have a wealth of knowledge and can take an individualized approach, so feel free to ask them questions! 

By taking a more holistic approach to the intersection between our reproductive and mental health and breaking down the stigma, we can better advocate for the care we need!