How Do Menstruation Cycles Affect Mood?
In general, the menstrual cycle is controlled by various hormones secreted by the pituitary gland and the ovaries. Certain parts of the monthly cycle seem to be accompanied by significant mood changes, but how the menstrual cycle affects women tends to be more complicated. While some of the hormones involved in menstruation can affect mood, everyone may have a different experience regarding how their menstrual cycle affects their mental health. Those who experience mood swings and other challenging symptoms may benefit from working with a licensed therapist.
About the menstrual cycle
A normal menstrual cycle typically has four parts, each triggered by the rise and fall of hormones. However, those who take hormonal birth control pills or use other kinds of hormonal birth control may not experience these four parts of the menstrual cycle, as this type of birth control can affect the uterus lining and prevent the ovaries from releasing eggs.
Follicular or proliferative phase
The first phase is usually referred to as the follicular or proliferative phase. It starts on day one (when a woman’s period starts) and generally lasts through day 14 of an average menstrual cycle of 28 days. Not everyone who menstruates has a 28-day cycle, however, so this phase may be shorter or longer, depending on cycle length. The follicular phase ends when ovulation occurs.
The primary hormone involved in the follicular phase is estrogen. As estrogen increases, the endometrial layer of the uterus typically grows, preparing for possible implantation in the event of a pregnancy. This is also the phase when a follicle in the ovary normally begins to mature. The follicular phase can also be important for creating a welcoming environment for sperm, creating elastic, fluid-filled channels in the cervix to allow sperm to enter the uterus.
Ovulatory phase
At the end of the proliferative phase, estrogen levels tend to be high, stimulating a surge of two other hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones normally stimulate ovulation, which generally refers to when the mature follicle releases an egg or oocyte, and it travels down the fallopian tubes. At the end of this phase, estrogen levels usually fall. This phase typically lasts for about one day.
Luteal or secretory phase
The luteal phase normally occurs in the last 14 days of the cycle. The dominant hormone during this time is progesterone, which typically prepares the uterus for possible implantation. Mucus production and blood supply in the endometrium tend to increase, and the lining of the uterus usually thins. If pregnancy does not occur, progesterone generally decreases.
Contrary to the changes seen in cervical mucus during the follicular phase and ovulation, at this point, the cervical mucus starts to thicken, making it non-elastic. In general, since the fertilization period has passed, sperm entry is no longer a priority, and levels of progesterone and estrogen fall rapidly.
Menstrual phase
When estrogen and progesterone plummet, the endometrium, which has been preparing for implantation, generally cannot be maintained. Menstrual flow usually occurs as the uterus sheds the endometrial lining. When menstrual blood starts, it’s considered day one, and the cycle begins again with the follicular phase.
Mood, hormones, and menstrual cycles
The effects of hormones like estrogen and progesterone on mood and mental health can be complex. Some research suggests that these hormones may play a role in depression and anxiety, but other research has found that estrogen has mostly beneficial effects on these conditions, and that progesterone may influence some mood regulators and have a positive impact on mood.
Everyone who menstruates may have a different experience, but generally, there is no substantial evidence to support that the menstrual cycle is related to severe changes in mood.
What about premenstrual syndrome?
Some people experience premenstrual syndrome (PMS) in the days before their next menstrual period. PMS typically occurs during the luteal stage, when estrogen is falling and progesterone is fluctuating, and disappears within the first few days of menstruation, when the levels of both hormones fall.
Not everyone experiences PMS. Research has found that it affects about 47.8% of reproductive-age women worldwide. PMS can come with many physical symptoms, including cramps, back pain, headache, changes in appetite, nausea, and constipation, but it can also affect mood. Some women with PMS may experience anger, irritability, anxiety, sadness, and mood swings.
Premenstrual dysphoric disorder
Some people experience premenstrual dysphoric disorder (PMDD), which is often viewed as a more severe form of PMS that may be linked to progesterone. Similar to PMS, PMDD normally occurs during the luteal phase, when progesterone rises and falls.
A few symptoms of PMDD include depressed mood, increased anxiety, frequent tearfulness, self-critical thoughts, mood swings, irritability, fatigue, overwhelm, and trouble concentrating. These symptoms are usually so severe that they impact a person’s ability to carry out daily responsibilities and can negatively affect an individual’s relationships.
While this disorder may be affected by hormone changes, research has not been able to determine why PMDD occurs. Some medical professionals believe that rather than being caused by abnormal or unbalanced hormones, PMDD may result from the brain being abnormally sensitive to normal changes in progesterone and estrogen.
PMDD is included as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). There are some non-pharmacological therapies that may be beneficial, but when symptoms are severe, medication, specifically selective serotonin reuptake inhibitors (SSRIs), is often recommended. These medications must be prescribed by a doctor or psychiatrist.
How to manage mood changes due to PMS
Mood changes may also happen because the menstrual cycle can bring significant physical discomfort. Cramps, severe pain, bloating, sore breasts, headaches, and fatigue can all be challenging to cope with during daily life. In addition, some women experience ovary pain called “mittelschmerz” prior to ovulation. Learning to cope with these symptoms may reduce mood changes throughout the menstrual cycle.
There are some things you can try to manage mood swings and other symptoms of PMS in the weeks leading up to your next period, including the following:
- Eat smaller, more frequent meals and limit salt intake to avoid bloating or other forms of GI discomfort.
- Avoid simple carbs. Opt for complex carbohydrates like vegetables, fruits, and whole grains.
- Avoid caffeine and alcohol, as they can affect mood and sleep.
- Get at least 30 minutes of exercise most days.
- Practice stress-reduction techniques like meditation, yoga, breathing exercises, and journaling.
- Apply a heating pad to the abdomen if you’re experiencing cramps or the lower back if you have back pain.
- Take over-the-counter pain relievers.
- Ask your doctor about hormonal birth control, which can lessen symptoms of PMS.
If you have PMDD, the above suggestions may help, but if your symptoms are severe, talk to your doctor about other treatment options.
Get help with mood changes
Whether you’re experiencing mood changes related to PMS or symptoms that could indicate PMDD, talking to a therapist can help. Online therapy can be a flexible, accessible way to work with a licensed professional from the comfort of your home. Whether you’re experiencing mood swings, cramps, fatigue, or other symptoms, being able to talk to your therapist from your bed or living room can make attending sessions more convenient.
Research has shown that online therapy can be effective in treating women with symptoms of PMDD. A 2019 study concluded that online cognitive behavioral therapy could be highly effective at reducing symptoms of PMDD and helping participants learn stress management and coping skills.
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