Exploring the Impact of Menstrual Cycle Hormones on Mental Health: A Comprehensive Guide

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Menstrual Cycle Hormones on Mental Health

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Introduction

Hormonal fluctuations during the menstrual cycle can have a profound impact on a woman’s mental health and well-being. Menstrual cycle hormones, such as estrogen and progesterone, play a crucial role in regulating mood, energy levels, and cognitive function.

Understanding the intricate relationship between these hormones and mental health can help women better manage the emotional and physical challenges associated with their monthly cycles.

This comprehensive guide will explore the impact of menstrual cycle hormones on mental health, delving into topics such as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), the influence of stress on menstruation, and the effects of the COVID-19 pandemic on women’s mental health.

Additionally, we will discuss coping strategies and self-care practices that can alleviate hormone-related symptoms and promote overall well-being during various phases of the menstrual cycle, including the luteal phase, ovulation, and periods.

Hormonal Fluctuations and the Menstrual Cycle

The menstrual cycle is characterized by fluctuations in the ovarian hormones estrogen and progesterone, which can impact women’s mental health in various ways ^[1]. These hormonal fluctuations across the menstrual cycle can influence women’s mental health through behavioral, psychological, and neuroendocrine mechanisms ^[1].

The menstrual cycle is divided into two main phases:

1. Follicular Phase (Days 1-14): During this phase, follicle-stimulating hormone (FSH) stimulates follicle growth and maturation, leading to increased estrogen levels ^[4]. Higher estrogen levels can improve mood and skin appearance ^[4].
2. Luteal Phase (Days 15-28): After ovulation, progesterone dominates this phase, preparing the uterus for implantation ^[4]. However, hormonal fluctuations during this phase can cause premenstrual syndrome (PMS) symptoms like irritability, negative mood, acne, fatigue, and appetite changes ^[4].

The premenstrual and menstrual phases appear to be the most consistently implicated in exacerbations of various psychiatric symptoms in women ^[1], such as:

• Around 60% of women with major depressive disorder or bipolar disorder report menstrual cycle-related mood changes ^[2].
• In women with schizophrenia, premenstrual exacerbation of psychotic symptoms like hallucinations has been reported ^[2].
• A recent study found that suicidal thoughts worsen during the luteal phase (week or two before the menstrual period) of the menstrual cycle ^[2].

During menstruation, estrogen and progesterone levels are low, which can result in physical discomfort and emotional challenges like mood swings and mild depression ^[3].

Impact of Stress and Mental Health on Menstruation

Stress can have a significant impact on menstrual cycles and mental health. Here are some key points:

• A study on hospitalized female COVID-19 patients in Indonesia found that those with symptoms of mental health disorders like neurotic symptoms, psychotic symptoms, and PTSD were twice as likely to report menstrual changes after infection ^[9]. The length of isolation was a key factor affecting overall menstrual changes and mental health ^[9].
• Menstruation has been surrounded by cultural stigmas and myths, leading to negative perceptions and impacting the mental health of menstruating individuals ^[3].
• Stress, whether emotional, nutritional, or physical, can disrupt hormone production and lead to abnormal menstrual cycles ^[10]. Short-term stress may cause a missed period or delay, while chronic stress can lead to more erratic or absent menstruation ^[10].

• Extreme weight changes and physical activity can also cause delayed menstrual cycles ^[10]. However, over 70% of women experience a resumption of normal menses if their absent periods were associated with psychological stress or weight loss ^[10].
• Stress can disrupt blood sugar balance, lower progesterone levels, and lead to irregular periods, delayed ovulation, and other menstrual irregularities ^[11]. Excess cortisol can deplete essential vitamins, minerals, and nutrients important for regulating the stress response and menstrual cycle ^[11].
• Stress disrupts the gut microbiome, which can negatively impact hormone balance and elimination, contributing to abnormal menstrual cycles ^[11]. Increased stress can delay or prevent ovulation, leading to irregular, early, or missed periods ^[11]. Stress after ovulation can also cause spotting, early periods, or changes in period length, consistency, and symptoms like cramping ^[11].

Mental Health Condition	Impact on Menstrual Cycle
Major Depressive Disorder, Bipolar Disorder	Around 60% of women report menstrual cycle-related mood changes [2]
Suicidality	Suicidal thoughts worsen during the luteal phase (week or two before the menstrual period) [2]
Psychosis, Mania, Depression, Alcohol Use	Tend to increase during the premenstrual and menstrual phases [1]
Anxiety, Stress, Binge Eating	Elevated more generally throughout the luteal phase [1]

In a study, 44.3% of subjects had anxiety, 45.5% had depression, and 47.2% had stress ^[8]. Pearson correlation coefficient test showed a significant positive correlation between menstruation signs and depression, anxiety, and stress ^[8]. Regression analysis revealed that menstruation signs, stress, anxiety, and depression were predictive variables ^[8].

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

The premenstrual and menstrual phases are most consistently associated with exacerbations of psychiatric symptoms across a variety of disorders, including psychosis, bipolar disorder, depression, suicide/suicide attempts, anxiety and stress, eating disorders, borderline personality disorder, and alcohol use ^[1]. Around 60% of women with major depressive disorder or bipolar disorder report menstrual cycle-related mood changes ^[2].

In women with schizophrenia, premenstrual exacerbation of psychotic symptoms, like hallucinations, have been reported ^[2]. A recent study found that suicidal thoughts worsen just prior to the menstrual cycle, and specific depressive symptoms like hopelessness, rejection sensitivity, and perceived burdensomeness were predictive of suicidal planning ^[2].

Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that arise in the week or two before the menstrual period, affecting an estimated three in four women ^[2]. These symptoms can include:

• Mood swings
• Irritability
• Anxiety
• Bloating
• Breast tenderness
• Headaches
• Fatigue

Premenstrual dysphoric disorder (PMDD) is similar to PMS but involves more severe symptoms, including depression, irritability, and tension, that impact a person’s work or social functioning ^[2]. PMDD is estimated to affect about 5% of menstruating women every year and can be treated with antidepressants, birth control pills, nutritional supplements, and lifestyle changes ^[2].

Condition	Description	Prevalence
Premenstrual Syndrome (PMS)	Combination of physical and emotional symptoms before menstrual period	Affects 3 in 4 women [2]
Premenstrual Dysphoric Disorder (PMDD)	More severe symptoms than PMS, including depression, irritability, and tension, impacting work or social functioning	Affects about 5% of menstruating women annually [2]

For more information on PMDD, including possible causes, symptoms, and how to access treatment and support, refer to ^[12].

COVID-19 Pandemic and Women’s Mental Health

The COVID-19 pandemic has had a significant impact on women’s mental health and menstrual cycles. According to a study in Indonesia, 37.3% of hospitalized female COVID-19 patients reported changes in their menstrual patterns after infection, including increases in cycle length, irregularity, and heavy bleeding ^[9]. The pandemic has also exacerbated mental health issues among women:

• Over 50% of participants reported increases in frustration, boredom, loneliness, anxiety, depression, and changes to sleep patterns ^[13].
• Hispanic/Latina and non-Hispanic White participants were more likely to report increased use of alcohol or other substances compared to non-Hispanic Black participants ^[13].
• 44% of participants reported difficulty paying for basic expenses like food, housing, and medical care, with lower education levels and pre-pandemic household income associated with greater financial difficulties ^[13].

The pandemic has also affected physical activity levels, with 32.8%, 39.5%, and 43.3% of participants reporting reductions in mild, moderate, and strenuous exercise, respectively ^[13]. Non-Hispanic Black participants reported less use of outdoor spaces like trails and parks for physical activity compared to other groups ^[13].

Moreover, the pandemic has exacerbated risks of violence, exploitation, abuse, or harassment against women, especially due to lockdown situations ^[15]. Globally, there have been increased reports of gender-based violence (GBV) during the COVID-19 pandemic ^[15], with a 25-30% increase in some countries ^[14].

In the US, the number of women/girls aged 15–49 years who experienced sexual or physical violence by an intimate partner before the pandemic has almost doubled during the pandemic ^[15]. Other countries have also reported significant increases in domestic violence incidents, such as:

• Brazil: 40–50% increase ^[15]
• France: 30% increase ^[15]
• Spain: 18% increase ^[15]

Similar trends have been observed in the Arab world, China, and Nigeria ^[15].

Coping Strategies and Self-Care

Coping with the emotional and physical challenges associated with menstrual cycle hormones requires a proactive approach. Here are some strategies that can help:

• Stay Connected: Talk to someone you trust and stay in touch with friends/family, even if just via text/email ^[12]. Peer support through online groups like those provided by the International Association for Premenstrual Disorders (IAPMD) can also be beneficial ^[12].
• Plan Ahead: Get to know your menstrual cycle and plan ahead for when symptoms may start ^[12]. Creating a ‘self-care box’ with things that help you relax and feel better can be helpful ^[12].
• Manage Stress: Prioritize self-care and make positive lifestyle changes to reduce stress ^[12]. Manage stress through relaxation techniques, spending time in nature, and practicing mindfulness ^[12]. Ensure you get enough sleep, maintain a healthy diet, and incorporate exercise when possible ^[12].

• Seek Support: Contact specialist organizations like the IAPMD or National Association for Premenstrual Syndrome (NAPS) for support and advice ^[12]. If PMDD impacts your work, studies, or access to services, you may be able to request reasonable adjustments under the Equality Act 2010 ^[12].
• Develop Coping Strategies: The Premenstrual Coping Measure (PMCM) is a validated scale to measure ways of coping with negative premenstrual changes ^[16]. It has five subscales: Avoiding Harm, Awareness and Acceptance of Premenstrual Changes, Adjusting Energy, Self-Care, and Communicating ^[16].

PMCM Subscale	Description
Avoiding Harm	Strategies to avoid potential harm or negative consequences during premenstrual phase
Awareness and Acceptance	Acknowledging and accepting premenstrual changes
Adjusting Energy	Managing energy levels during premenstrual phase
Self-Care	Engaging in self-care activities
Communicating	Communicating with others about premenstrual experiences

The subscales demonstrated acceptable to very good reliability, with Cronbach’s alpha ranging from 0.68 to 0.89 ^[16].

• Gain Self-Awareness: Menstrual tracking can help people gain self-awareness and identify patterns in their emotional and physical experiences throughout the cycle ^[3]. Therapists can guide people in developing personalized self-care strategies for different phases of the menstrual cycle, such as mindfulness exercises, relaxation techniques, and seeking additional support ^[3].

Conclusion

The impact of menstrual cycle hormones on mental health is a complex and multifaceted issue that deserves attention and understanding. This comprehensive guide has explored the intricate relationship between hormonal fluctuations and various mental health conditions, shedding light on the challenges women face during different phases of their menstrual cycles. By acknowledging the influence of stress, lifestyle factors, and societal stigmas, we can foster a more supportive and inclusive environment for menstruating individuals.

Ultimately, coping with hormone-related symptoms requires a holistic approach that emphasizes self-care, stress management, and seeking support when needed. By embracing self-awareness, developing coping strategies, and advocating for better understanding and resources, we can empower women to navigate the complexities of their menstrual cycles with resilience and a sense of empowerment.

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