Medically reviewed
It's not just all in your head: How the menstrual cycle affects mental health
MAY 7, 2021
They help us grow, sleep, eat and move–but did you know our hormones also regulate our moods? Read on to hear just how much the rise and fall of our hormones each month has a hold over our mental health–and how you can work with the waves.
Key Takeaways
Our mental health is intimately linked with, and influenced by, our hormones.
Fluctuations of estrogen, progesterone and testosterone throughout the menstrual cycle can significantly alter our moods.
By understanding what’s happening at each stage of our cycles we can learn to work with, not against, our hormones.
Some more serious mental health conditions, such as PMS and PMDD, can be hormonally influenced and you should always feel supported to find help.
Trigger words: suicide, depression, anxiety, PMDD
It’s possibly the oldest insult in the archives, a real humdinger...‘you’re just hormonal’.
Throwing shade aside, it’s true that for us folxs with cycles, the highs and lows of our hormones each month can bring about immense emotional changes. Whilst some of us might feel like we swing from Jeykll to Hyde (and then all the way back again), others may only notice subtle shifts, or even none at all (alright, don’t rub it in).
Regardless of which camp we fall into, the state of our mental health is inextricably linked to our hormones(1) Women are nearly twice as likely to experience depression than men(1), and research suggests that fluctuating estrogen levels during the menstrual cycle and perimenopause can be a predominant cause of depression in women(2).
Understanding just what the actual (insert expletive here) is going on with our hormones each month and how they’re influencing our moods, can help us to view our mental health in a whole new light. Appreciating the magnitude of the mind-body connection can help us to cultivate more compassion towards ourselves–allowing us to start working with our hormones and mental health, symbiotically.
So, without further ado, let’s take a journey–from our cycles to our synapses.
How do sex hormones influence mood?
So, we hear a lot about the physical changes they bring about… but what about changes to our mental health? Here’s a super quick 101 of how our sex hormones impact our mood:
Estrogen:
O’ so good, estrogen really is the matriarch of female sex hormones. Estrogen makes us glow, feel and look fabulous. It boosts our levels of serotonin and dopamine (the happy hormones), increases production of endorphins (our natural painkillers), boosts libido, and if that wasn’t already enough, dampens the effects of our stress hormones, adrenaline and cortisol(2). Generally, all round goood vibes.
Progesterone:
The under-dog, pensive, placid and generally a party-pooper, progesterone has distinct calming qualities which leave us feeling more subdued, introspective and sometimes, on-edge(3). This is because progesterone is literally preparing the body to grow a fetus and support it throughout pregnancy, so prompting us to stay in, be calm and quiet is in our baby-growing favour.
Testosterone:
Mainly helping us regulate muscle mass and boost our libido(4) (especially when it peaks just before ovulation), temptress testosterone helps us feel fiery, fierce, and frisky. On the flip-side, too little testosterone can feel us leaving quite the opposite, low, languid and lacking in libido.
Mood throughout the menstrual cycle
So now we know how our major sex hormones can impact our mood, let’s see them get to work.
Phase 1 - Menstruation
Just before menstruation (your period) starts, estrogen, progesterone and testosterone completely collapse to their lowest levels. Dropping estrogen, and it’s feel good factors, can leave us feeling vulnerable, fatigued and emotional–whilst a collapse in progesterone, and it’s calming qualities, can cause irritability and anxiety.
Just before our periods, many of us can feel awash with uncomfortable emotions, berating and belittling ourselves about our mental state, only for it then to alllll make sense when our period comes in.
Top tips: This is your monthly moment to slow down, take stock and recenter yourself. Remember to be compassionate, and if you need a break–take it! Tracking your period and the days you feel in a funk can really help to remind yourself your mental health dip might be because your period is on the horizon.
Red flags: If you are feeling seriously depleted during your bleed, this can be a symptom of low iron levels–which can also drag you down mentally(5).
Phase 2 - The Follicular Phase
And… you’re back. Riding the wave of your rising estrogen during your follicular phase, is increased energy, enthusiasm and stronger self-esteem. You may feel like you’ve got your spark back and a spring in your step.
Top tips: This is the perfect time of the month to say yes, yes and yes. Socialise, start a project, sing from the rooftops–embrace the natural boost in your serotonin, dopamine and endorphins from your increased estrogen levels.
Reg flags: Estrogen dominance is a common hormonal imbalance (where you have too much estrogen in relation to progesterone), bringing on symptoms like bloating(6) , breast tenderness, irritability and anxiety(7)–which can commonly show up in this stage of the cycle.
Phase 3 - Ovulation
Estrogen peaks and your testosterone bumps up, bringing us to the brink of all those feel good factors. You may feel curious, flirty and yes–frisky, before and around ovulation(8). After ovulation estrogen takes a nose-dive and progesterone is on the rise again, which can bring about a sense of calm, quiet(9), a drop in libido and fatigue.
Top tips: Before and during ovulation is probably the time of the month you’ll be feeling and looking your best, with the most mental clarity. Go on that first-date, schedule that work presentation, book that holiday, generally get out there and get em.
Red flags: Estrogen dominance can be common during this stage of the cycle too. If you’re sensitive to estrogen dropping after ovulation this can bring on more intense fatigue.
Phase 4 - The Luteal Phase
The last phase of your cycle is all about our anti-hero, progesterone. For most of us, this is the not-so-nice stage of our cycles. Dominating progesterone brings about all kinds of feelings that make us want to cocoon and peel away from the world–whilst a lack of estrogen can leave us feeling drained, vulnerable and increasingly emotional(10).
When progesterone takes a dip just before menstruation it’s also common to feel increasingly anxious, angry(7), or swing from pillar to post between every emotion known to woman.
Top tips: Make the most of your new found introspection, cultivate your compassionate mind and indulge in your quieter more contemplative pastimes. This is the perfect time to get tracking (like we mentioned earlier), so you can remind yourself–these feelings won’t last forever!
Red flags: This is the prime time of the month Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) to rear their ugly heads(7). If you feel significant negative shifts in your emotions during this time of the month it’s worth further investigation.
More serious mood disorders
Whilst it’s common to experience mood fluctuations throughout the menstrual cycle, as we’ve seen, there are a number of more serious mental health conditions that can be cyclically influenced(5).
Premenstrual Syndrome (PMS)
PMS is a fairly ubiquitous term that most of us use to describe the vast array of symptoms, from cramps to crying, that can show up in our premenstrual luteal phase. Whilst PMS is common, research suggests that up to 80% of women experience PMS symptoms(10), they can greatly vary in severity and present differently in each of us.
Premenstrual Dysphoric Disorder (PMDD)
PMDD is PMS on steroids, and then some. Occurring within the follicular phase, it’s symptoms include depression, extreme anxiety and irritability, panic attacks, and even suicidal thoughts(11). Around 5% of menstruators of childbearing age have PMDD(12), but it’s commonly misdiagnosed as bipolar disorder. In order to be diagnosed with PMDD you need to meet a diagnostic criteria and have symptoms resolve up to a week after your period.
A familial or personal history of mental health conditions can leave us more likely to experience PMS symptoms, or even suffer with PMDD(12).
Cultivating compassion
When our hormones and mental health are concerned, knowledge really is power.
Once we begin to understand our own unique patterns and that, no, it’s not just ‘all in our heads’–it’s our hormones too, we can begin to be kinder to ourselves, and start to work with our cycles, not against them.
Editor's note: Our mental health is complex, and our hormones can make up just one piece of our individual puzzles. Remember, if you are struggling with your mental health–you’re not alone. There are numerous resources available to help, below are listed just a few:
Mind: https://www.mind.org.uk/
Samaritans: https://www.samaritans.org/?nation=wales
Give us a shout: https://giveusashout.org/
References
Kessler RC. Epidemiology of women and depression. J Affect Disord. 2003 Mar;74(1):5–13.
Wharton W, Gleason CE, Olson SRMS, Carlsson CM, Asthana S. Neurobiological Underpinnings of the Estrogen – Mood Relationship. Curr Psychiatry Rev. 2012 Aug 1;8(3):247–56.
McEwen B. Estrogen actions throughout the brain. Recent Prog Horm Res. 2002;57:357–84.
Cappelletti M, Wallen K. Increasing women’s sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016 Feb;78:178–93.
Kocaoz S, Cirpan R, Degirmencioglu AZ. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pak J Med Sci. 2019;35(2):365–70.
Stachenfeld NS. Sex Hormone Effects on Body Fluid Regulation. Exerc Sport Sci Rev. 2008 Jul;36(3):152–9.
Reynolds TA, Makhanova A, Marcinkowska UM, Jasienska G, McNulty JK, Eckel LA, et al. Progesterone and women’s anxiety across the menstrual cycle. Horm Behav. 2018 Jun;102:34–40.
Roney JR, Simmons ZL. Hormonal predictors of sexual motivation in natural menstrual cycles. Horm Behav. 2013 Apr;63(4):636–45.
Andréen L, Nyberg S, Turkmen S, van Wingen G, Fernández G, Bäckström T. Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology. 2009 Sep;34(8):1121–32.
Lete I, Lapuente O. Contraceptive options for women with premenstrual dysphoric disorder: current insights and a narrative review. Open Access J Contracept. 2016 Aug 25;7:117–25.
Hylan TR, Sundell K, Judge R. The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med. 1999 Oct;8(8):1043–52.
Potter J, Bouyer J, Trussell J, Moreau C. Premenstrual syndrome prevalence and fluctuation over time: results from a French population-based survey. J Womens Health 2002. 2009 Feb;18(1):31–9.
Written by
Annalisa Hayes (she/her)
Copywriter at Tuune, Annalisa has worked for various pioneering health-tech startups and healthcare companies with purpose-led missions. Driven by empowering people to take control of their health, she helps make the science behind hormones accessible for our community, so they can make clued-up choices about their healthcare.
Medically reviewed by
Dr. Alejandra Elder Ontiveros, MD, PHD (she/her)
Ale is a PhysicianScientist with a doctoral degree in Development Biology and Embryology and is currently a Postdoctoral Scholar at UCSF. Ale believes that the union of academia and business can lead to transformative discoveries for women’s health.
Scientifically researched by
Hannah Durrant (she/her)
Hannah is a Biomedical Content Writer at Tuune, with a BSc in Biomedical Sciences from University College London. She is passionate about bringing together the scientific community and the general public by disseminating modern science via digestible, engaging and thought-provoking content.
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