Understanding Women’s Mental Health Across the Menstrual Cycle

Women experience a fluctuation of hormones as their bodies follow the natural course of their menstrual cycles. The cycle is dictated by key hormones, mainly estrogen and progesterone. These hormones have been shown to affect many different aspects of a woman’s physical and mental health. Oftentimes, these changes are small and can go unnoticed. But sometimes these changes can be quite drastic and require some help managing. Research shows how changes in hormone levels across the menstrual cycle may cause changes in the mental health of a woman.

In this article, we will discuss the changes women experience in relation to their cycle, and how fluctuations in specific hormones may induce changes in mental health.

The menstrual cycle

The menstrual cycle can be broken down into different phases depending on the levels of hormones present at any given time. Understanding the different phases is important. The phases indicate the period of ovulation, the time at which fertility and, hence, chances of pregnancy are the highest.

Importantly, understanding the menstrual cycle may help one become more in tune with their body, especially at times when their mood may be affected.

Fluctuation of hormone levels across the cycle

The first day of menstruation traditionally marks the first day of the menstrual cycle and lasts an average of 5‒7 days. During this time, the levels of the two hormones, progesterone and estrogen, remain relatively low.

After menstruation, levels of estrogen steadily rise as the body enters what is known as the follicular phase. The ovulatory phase commences once estrogen peaks. Following the release of the egg upon ovulation, the production of estrogen drops slightly, and the luteal phase commences. This is marked by a steady increase in progesterone. If the egg is unfertilised, both progesterone and estrogen drop, and menstruation starts again, completing the cycle.

As described, the two key hormones vary throughout the month. We will now take a look at some of the research carried out which explores their effects on mental state and wellbeing.

Pre-menstrual syndrome (PMS)

Premenstrual syndrome (PMS) can occur a few weeks or a few days before a woman gets her period. Symptoms can include tiredness, increase or decrease in appetite, acne, and general irritability. These changes have been linked to drops in estrogen and progesterone, but the exact cause of these changes are not known.

Why does PMS happen?

A study in Brazil recorded the specific changes in progesterone concentrations from the saliva of 46 adult women. In those suffering from PMS, these changes followed a specific pattern, in that there was a stable level of the hormone followed by a drop in its concentration 3 days before the period started.

In contrast, those who did not suffer from PMS experienced a steady decline in progesterone across the 8 days before menstruation. However, they emphasise that PMS is multifactorial and could be due to several different things. This includes early life experiences and genetic predispositions, and symptoms can be triggered by the sudden or drastic fluctuations in hormones over the menstrual cycle.

Dealing with symptoms of PMS

Symptoms of PMS can affect the quality of life of individuals, including their work, social and family life. There are some things one can do to ease the symptoms of PMS, which include getting plenty of rest, having a balanced diet, exercising and trying to reduce stress through mindfulness exercises, such as yoga.

Carrying out these practices can help ease the symptoms of PMS. In another article, we discuss the benefits of mindfulness and how it can help reduce stress.

However, some women experience severe forms of PMS. This is termed as premenstrual dysphoric disorder, or PMDD.

Premenstrual dysphoric disorder (PMDD)

PMDD is a serious psychiatric mood disorder in which symptoms usually occur a few days before a woman’s period. Research shows that 3‒8% of women experience PMDD. Some causes for this could be changes in progesterone sensitivities or abnormal hormonal function during the luteal phase. However, like PMS, the exact reasons for PMDD are unknown, but a main risk factor includes high levels of both objective and subjective stress.

Symptoms of PMDD

The main symptoms of PMDD include extreme feelings of low mood, feeling emotionally overwhelmed, anxiety, irritability, trouble concentrating and a loss of interest in usual activities. In addition, PMDD can also cause physical symptoms, such as nausea, bloating, headaches and backaches. These physical symptoms can further exacerbate negative effects on mood.

PMDD is a debilitating and chronic condition, with a lot of women unaware that they may be experiencing this disorder.

Managing PMDD

If you feel like you are experiencing PMDD, make sure to reach out to your doctor to express your concerns and get the help you need.

Current treatments for PMDD include lifestyle management, including an adjustment to diet, levels of physical activity and stress management, as well as prescribing medications.

As mentioned, women experiencing PMDD are much more vulnerable to stress. Research shows that women with PMDD exhibit use of unhelpful coping strategies and remain stuck in cycles of ruminating thoughts. Hence, stress management and self-regulation is a vital part of managing the disorder to help ease symptoms.

Hormonal oral contraceptives are given to patients suffering from PMDD if blood test panels exhibit an imbalance in hormones. This is usually used to try and restore the balance in hormones.

In addition, anti-depressants such as selective serotonin reuptake inhibitors (SSRIs) can be prescribed to help manage extreme mood changes. SSRIs are currently one of the main pharmacological treatments used to treat severe symptoms of PMS and PMDD, with some studies supporting its efficacy in providing relief to patients.

PMDD occurs solely within the luteal phase of the menstrual cycle. However, research shows that disorders such as anxiety and depression are present in women at other stages of the cycle.

Prevalence of depression in women

An international, epidemiological study analysing around 38000 participants in 1996 demonstrated that women present a higher risk of depression compared to men. At present, according to the World Health Organisation (WHO) in 2023, women are approximately 50 times more likely to get depression than men. These staggering statistics may certainly arise from or be exacerbated by social and environmental factors, including gender pay gaps, gender discrimination or domestic abuse.

The multifactorial nature of the disorder makes it difficult to understand the role that a woman’s menstrual cycle plays in orchestrating the deleterious condition. Studies show mixed results concerning the effect of hormones on depressive symptoms in women.

Studies on low mood and the menstrual cycle

One study analysed the level of hormones across two menstrual cycles in 248 women, but found no significant correlation between the changes in hormone concentrations and non-clinically reported depressive symptoms.

Alternatively, studies show that women who have depression are much more at risk of developing more severe symptoms of PMS, including worsening of mood. This was proven in a study that looked at 900 participants comparing females with clinical and non-clinical depression and those with no depression. They found that all participants with depression experienced worsening of moods during the premenstrual period compared to those who did not suffer from depression, which is specifically prominent during the follicular phase. This is unlike the PMDD-associated depressive symptoms which are restricted to the luteal phase.

A 2023 study published in Life illustrates a specific rise and fall in mood during the middle of the menstrual cycle in 60 participants. They found that there was a significant increase in positive mood and a decrease in low mood and negative feelings around the late follicular phase of the cycle. This included an increase in cheerfulness, friendliness, concentration and activity, whilst there was a decrease in feelings of anxiety, depression and fatigue.

Taken together, these studies suggest a potential link between the hormonal shifts taking place across the cycle and the impact on low mood. However, it is clear that much more research is needed to bridge the gap between the two.

Further Research

There is not enough research being done on women’s health, with research being massively underfunded on a global scale. Considering the complexities of the hormonal shifts during the menstrual cycle, more research is required to determine exactly how they affect mood and detrimental mood disorders like PMDD.

MDPI’s Women is an international, peer-reviewed journal where you can read and explore some of the latest research being published on all aspects of women’s’ health. This includes the social detriments of women’s’ health and the healthcare system in relation to women. If you would like to read more about women’s health, check out our other blog articles where we discuss topics on post-menopausal health as well as the physical and mental aspects of post-natal health.

If you would like to submit your work to MDPI, please see our full list of journals.