Getting to Know Your Menstrual Cycle: Mood, Hormones, and Menstruation - By Dr. Chelsea Cole, ND

While researching the connection between hormones and mood, I was really confronted by the idea that discussing hormonal mood symptoms played into the vision of the hormonal, irrational, crazy woman trope. It was interesting when reviewing the research because some of the papers that didn’t find a relationship between the menstrual phase and negative mood used that as a way to invalidate the negative ideas surrounding women and hormones (1). However, I see people every day who want support with mood related menstrual concerns. The problem lies in the sexist ideas of menstruation, not in a person’s actual experience of menstruation. I think it is important to talk about this, because how we were socialized to think about menstruation can play a role in the subsequent experience. I came across a quote from Dr. Tori Hudson, ND that reads, “Maintaining good health and attitude through all phases of the menstrual cycle is just not as simple as correcting female physiology gone awry but also involves on some level transforming our cultural image of women’s reproductive health, specifically menstruation, from negative (the “curse”) to positive.” (2) So, while I will highlight the research about hormones and mood, the most important thing is to learn to pay attention to the rhythm of your own body so that you are able to reach out for support when you need it.

What’s the Difference between PMS and PMDD?

When we are talking about negative mood and periods, we are really talking about mood related premenstrual syndrome (PMS), or premenstrual dysphoric disorder (PMDD). Most people with a menstrual cycle could list a wide variety of PMS symptoms, including irritability, mood swings, depression, or anxiety. PMDD symptoms are similar, except they are severe enough to interfere with work, school, relationships, and other normal activities. In both PMS and PMDD, symptoms tend to appear in the second half of the menstrual cycle (luteal phase), and resolve once menstruation starts (follicular phase).

Consider Using A Period Tracking App

There isn’t a blood test to tell you whether you are experiencing PMS or PMDD, so tracking your menstrual cycle and the associated symptoms is the best way to know. Period tracking apps are a great way to do this, and will help you discern patterns. Keep in mind, other concerns, like thyroid disorders, present similarly and require blood work to diagnose. In addition, depression and anxiety can both worsen during the luteal phase, which is why it is important to determine if these concerns are present all the time or only during the luteal phase (3). While the research can sometimes be conflicting, there does seem to be a relationship between negative moods and the luteal phase.

The Hormones Involved in the Menstrual Cycle

Understanding why this is the case is still an area of uncertainty, so I want to discuss what we know about the role of estrogen and progesterone. But, before we get into the research, it’s useful to understand how your hormones change throughout the cycle. So, in a typical cycle, the follicular phase starts with the first day of bleeding and continues until ovulation (day 1-14). During bleeding, levels of estrogen and progesterone are low, which in time signals to the brain to release follicle stimulating hormone (FSH), which stimulates the ovaries to develop an egg and begin producing estrogen. By mid-cycle (day 14), FSH decreases, and large amounts of luteinizing hormone (LH) are released from the brain, thereby stimulating ovulation. At this point, the luteal phase begins (day 14-28), estrogen levels start to decline, and progesterone levels rise. If fertilization doesn’t occur, estrogen and progesterone will decrease to allow menstruation to occur.

How Estrogen and Progesterone Levels Affect Mood

While it makes sense to assume that the fluctuating levels of estrogen and progesterone can cause mood disturbance, the research about this isn’t so clear. Numerous papers have demonstrated that the overall levels of estrogen and progesterone didn’t differ between women who experience PMS and women who do not (4).

However, many other papers have outlined different roles that estrogen and progesterone each play in mood. One paper found that sudden estrogen withdrawal, fluctuating estrogen levels, and sustained low estrogen were all related to mood disturbance (5). This has implications for the mood changes that can occur in the postpartum period, during perimenopause, menopause, and while taking or discontinuing hormonal birth control. Another interesting paper induced sadness in female participants by having them watch a sad movie, and then measured their blood estrogen and progesterone levels, and had them answer mood and emotional regulation questionnaires. The researchers found that women with higher estrogen levels were more likely to engage in rumination (repetitive thinking pattern associated with depression), but less likely to report low mood following rumination. In addition, women with low estrogen were more likely to report low mood following rumination. The researchers concluded that the negative impact of rumination might be worsened when estrogen is lower (6). Estrogen is typically lower in the luteal phase of the menstrual cycle, and higher during the follicular phase, so this finding could help explain the connection between the luteal phase and low mood. Progesterone has also been studied, and one paper found that while overall levels of progesterone in the saliva during the luteal phase didn’t differ between women who experience mood related PMS and women who do not, the rate at which progesterone broke down differed between the two groups. In women with PMS, progesterone levels sharply decreased three days prior to menses. In women without PMS, progesterone levels would decrease gradually eight days prior to menses. This means that the rate of progesterone breakdown, and not the overall levels might play a role in luteal phase mood changes (7). A more recent study that measured salivary progesterone during the follicular and luteal phase in women, found that women were more likely to experience low mood following social exclusion in the luteal phase compared to the follicular phase. However, higher levels of progesterone during the luteal phase helped to buffer against these negative feelings (8). In addition, during perimenopause, when hormone levels are becoming more variable, one study found a correlation between depressive symptoms in perimenopausal woman when blood estrogen levels were variable and blood progesterone levels were low (9).

The Relationship Between Hormones and Neurotransmitters

When you start to read the research, you begin to understand that the relationship between hormones, the menstrual cycle, and mood is very complex. Estrogen and progesterone likely play a direct role, but they also influence neurotransmitter levels, which could be another explanation for the mood shifts during the luteal phase. In fact, selective serotonin reuptake inhibitors (SSRI), which are a class of anti-depressants, are often a first line treatment for PMDD and mood-related PMS. SSRI’s function by increasing serotonin levels in the brain, thereby improving mood. Estrogen has been found to increase serotonin levels, and in women with PMS or PMDD, luteal phase serotonin levels were lower (10). Remember, estrogen is lower during the luteal phase. There are more interactions between hormones and neurotransmitters than was outlined in this article, and our knowledge on this subject is still growing. The menstrual cycle is complicated!

Time to Explore how to Support your Hormonal Health and Mood

Taken together, this information helps to validate the intuition that hormone fluctuations can influence mood and the luteal phase can be a tough time of the month. While hormones may not be the whole answer, if low moods predictably occur during the luteal phase, then it might be time to explore how to support your hormone health, and overall mood. Keep in mind that lifestyle factors, like stress, sleep, diet, activity level, and support network, all influence mood. Therefore, improving your experience of menstruation will likely include addressing so much more than your hormones.

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References:

1. Romans S. E. et al. Mood and the menstrual cycle. Psychotherapy and Psychosomatics. 82:53-60, 2013.

2. Hudson T. Women’s encyclopedia of natural medicine. McGraw Hill, 2008.

3. Gonda X. et al. Patterns of mood changes throughout the reproductive cycle in healthy women without premenstrual dysphoric disorders. Prog Neuropsychopharmacol Biol Psychiatry. 32(8): 1782-8, 2008.

4. Hofmeister S. et al. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 94(3): 236-240, 2016

5. . Douma, S. L. et al. Estrogen-related Mood Disorders: Reproductive Life Cycle Factors. Advances in Nursing Science: 28(4): 364-375, 2005.

6. Graham B. M. et al. Sex hormones are associated with rumination and interact with emotion regulation strategy choice to predict negative affect in women following a sad mood induction. Front Psychol. 11, 2018.

7. Lovick, T. et al. A specific profile of luteal phase progesterone is associated with the development of premenstrual symptoms. Psychoneuroendocrinology. 75: 83-90, 2017.

8. Lobmaier, J. et al. Increased sensitivity to social exclusion during the luteal phase: progesterone as a resilience factor buffering against ostracism? Psychoneuroendocrinology. 107: 217-224, 2019.

9. Joffe, H. et al. Impact of estradiol variability and progesterone on mood in perimenopausal woman with depressive symptoms. JCEM. 105(3), 2019.

10. Barth, C. et al. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Front Neurosci. 9(37), 2015.