It’s no secret: during our menstrual cycles, our emotions fluctuate depending on the phase we’re in. Generally, a cycle follows four stages, but before delving into them, it’s crucial to remember that these are generalisations, averages, and that each cycle can vary depending on the individual, health conditions, and emotional experiences… In general, the cycle unfolds in four phases: during the menstruation phase, irritability and mood swings are more frequent; as we enter the follicular phase, mood improves, and we feel a sense of renewal. Then, during the ovulatory phase, the feeling of sociability and extraversion increases. Finally, during the luteal phase, mood swings and irritability begin to resurface, accompanied by a certain sensitivity.
So, the menstrual cycle influences not only our emotions but also our mental health.
Before diving into the details, it’s important to note that research in the field of menstrual health is limited, so knowledge is still unfortunately restricted. For example, some studies on premenstrual syndrome, which questioned individuals about their mood, only put forward negative options to answer the questions. Thus, this shows a bias in research that needs to be considered (1).
- Premenstrual Exacerbation
Premenstrual exacerbation means that a person’s mental and physical conditions deteriorate during the premenstrual phase (2). Thus, during the last days of one cycle and sometimes the first days of another, pre-existing mental health conditions can be negatively affected (including bipolar disorder, chronic major depressive disorder, or even major anxiety disorder) (3). Additionally, suicidal thoughts or even the planning of a potential suicide also worsen (4). This finding is not new in research, but to date, these studies have mainly focused on the luteal phase (the last phase of our cycle, just before menstruation begins).
- Premenstrual Syndrome (PMS)
We hear a lot about PMS these days, and not always positively! Some people use PMS to degrade menstruating individuals by invalidating their emotions: “oh no, but you’re angry, probably because of your PMS,” but the reality is much more complex (5). Let’s take a closer look.
Clue defines PMS as a “cluster of physical, behavioural, and emotional changes in the time before menstruation that recur with most or all menstrual cycles and affect a person’s normal life.” (6). Thus, PMS symptoms vary tremendously, ranging from daily pains to completely paralysing pains that last several days (7). Not all menstruating individuals experience PMS, so some people will have the associated changes and pains, while others will not.
When we talk about PMS, the most common symptoms are irritability, anger, depressive symptoms, tears and extended sadness, hypersensitivity, abnormal feelings of nervousness or anxiety, an abnormal rapid alternation between anger and sadness, or even difficulties in finding or maintaining sleep (8, 9).
Moreover, the main cause of PMS in menstruating individuals remains unknown. Some studies theorise that hormonal changes could be the cause (10).
When a person experiences severe PMS, they may be diagnosed with Premenstrual Dysphoric Disorder.
- Premenstrual Dysphoric Disorder (PMDD)
PMDD is a syndrome directly related to fluctuations in reproductive hormones and will be felt during the late luteal phase (11). PMDD has a very significant impact on the daily life of a menstruating person. It is worth noting that PMDD is considered a psychiatric diagnosis rather than a gynaecological one (12). It was added to Section 2 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 (13). According to the few available figures, it would be around 6% of menstruating individuals who experience PMDD (14).
As for the symptoms, PMDD can take different forms such as severe depression, anxiety and irritability, recurrent panic attacks, episodes of crying and deep sadness, a lack of interest in usual activities and others, or even rapid and deep mood swings (15). PMDD can also worsen suicidal thoughts in some people or make them attempt to plan this event.
Unfortunately, researchers still do not have a precise and concrete idea of the origin of PMDD, but certain theories point to the drop in hormones (estrogen and progesterone) or even the variation in serotonin during cycles (16).
It is also important to note that there are pre-existing conditions that make us more prone to having PMDD, such as generalised anxiety disorder, depressive disorders, or family history (17). Traumatic experiences or stressful recurring situations could also influence a diagnosis.
- Perimenopausal Depression
Let’s start by defining perimenopause: it is the period preceding menopause, which can last between a few months and eight years (18). During this time, hormone levels fluctuate before steadily decreasing. Menstrual cycles experience disruptions, eventually leading to their disappearance (menopause). Perimenopause manifests through various physical symptoms such as hot flashes, abnormal sweating, sleep disturbances, rapid mood changes, and anxiety (19).
Here’s what we know about depression during the menopausal period today: The onset of depressive symptoms during this particular period could be explained by a decrease in hormone levels (20). Thus, this gives us a clue as to why menstruating individuals in the perimenopausal stage are at an increased risk of experiencing severe depression. Research on older menstruating individuals is very limited, which is unfortunate, considering that an estimated four out of ten individuals would experience depressive symptoms during this particular period.
A diagnosis for depression during the perimenopausal period is often delayed because the characteristic physical symptoms of menopause often occur after the onset of psychological symptoms (21). Additionally, menstruating individuals who have already experienced depression and/or are undergoing treatment during perimenopause are more likely to go through perimenopausal depression.
What to do if I have questions?
Here are some tips (the list is not exhaustive) if you have questions about your menstrual cycle in relation to your mental health:
- Talk to a trusted professional. It’s likely that they will suggest trying treatment – antidepressants or contraceptive pills – with a trial-and-error approach (it may take several attempts to find the right medication for your symptoms) (22) ;
- Rely on your loved ones (family, friends, partners) to share your feelings and receive emotional support without judgement and/or assistance if needed (23) ;
- Don’t hesitate to establish small habits that make you feel good during this period: engage in gentle physical activity to relax the body (walking, stretching, yoga), practice guided breathing exercises, or meditation sessions (24).
- One last tip that may be useful over time is to track and note symptoms before and during menstruation to keep a record of experiences and be able to report them to the appropriate professionals (25). This is also helpful to understand one’s own body and emotions. There are applications available for this purpose.
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