Menstrual cycle and mental health: PMS, periods, and menopause
Reviewed by Stephanie Steinman, PhD, CSAC
Written bytherapist.com team
Last updated: 09/14/2023
Mental Health During Your Menstrual Cycle
A person’s menstrual cycle can affect their mental health depending on where they are in their cycle. Hormones fluctuate throughout the menstrual cycle, which impacts mood and mental balance. Unfortunately, the relationship between menstruation and mental health is still often misunderstood, ignored, or understudied, partly because both menstruation and mental health are still somewhat taboo topics.
For those individuals whose menstrual cycle impacts their mental health, knowing how and why this happens is important. Understanding your menstrual cycle better can help you implement strategies of support as you handle mental health challenges during different phases of your cycle.
1. Menstruation (Period)
Menstruation is when you have your period. It can be a bit of a roller coaster for your mental health.
At the beginning of your period, you may feel tired and sluggish. You may also experience physical symptoms like bloating or cramping.
It’s common for people to experience feelings of depression, irritability, and moodiness during the first few days of their period. However, as your estrogen levels rise toward the middle and end of your period, your mood may improve.
2. Follicular Phase
In the follicular phase of your menstrual cycle, your estrogen and testosterone levels go up, helping to prepare your body for ovulation. You may experience more positive feelings during this time. Your mood may lift and you may feel like you have more motivation and energy.
At the beginning of ovulation, when an egg is released from the ovaries, testosterone levels increase. For some people, this results in a higher sex drive. However, both testosterone and estrogen levels drop by the end of the ovulation phase. This is when progesterone levels begin to increase, which can make you feel tired and sluggish. Some people may experience symptoms similar to premenstrual syndrome (PMS), which can affect mood and increase irritability.
4. Luteal Phase (PMS)
The luteal phase is the week leading up to menstruation. In this phase, you may experience PMS. Most people who menstruate experience one or more symptoms of PMS, including:
- Fluid retention and/or abdominal bloating
- Appetite changes
- Breast tenderness
- Trouble concentrating
- Crying spells
- Constipation or diarrhea
- Mood swings
- Depressed mood
In addition to potentially making you feel depressed, anxious, and irritable, PMS can also exacerbate existing mental health issues. While not everyone who menstruates will experience mood changes, those who do may have changes in their mood due to chemical changes in the brain.
One theory is that the drop in progesterone before your period also creates a drop in the chemical allopregnanolone, which calms the brain during earlier phases. This could create a hangover-like effect when the brain is suddenly starved of the chemical.
Another theory suggests that the fluctuation in estrogen and progesterone also influence the level of serotonin in the brain. Low levels of serotonin may lead you to feel sad, tired, anxious, and irritable.
Menstruation-Related Mental Health Conditions
There are two common mental health conditions that are tied to the menstrual cycle:
- Premenstrual syndrome (PMS): PMS consists of physical, emotional, and behavioral effects for most people who menstruate. Some people may experience few or mild symptoms, while others may have more severe effects. PMS is likely caused by fluctuations in hormones.
- Premenstrual dysphoric disorder (PMDD): PMDD is a more severe form of PMS that can cause extreme mood swings as well as physical symptoms. With PMDD, at least one emotional effect, such as extreme moodiness, sadness, anxiety, irritability, or anger, is present. This is a medical condition that often requires treatment. Medication, therapy and lifestyle changes can help regulate the symptoms.
Individuals with a preexisting mental health disorder may notice that their symptoms may be impacted by their menstrual cycle. For example, people with depression or anxiety may find that their symptoms are worse in the luteal phase before their period. In some cases, people may be diagnosed with PMS or PMDD instead of anxiety or depression because their symptoms are related to the changes due to their period.
PMS vs. PMDD: What’s the Difference?
PMDD is a more severe form of PMS. Both PMS and PMDD can include the following symptoms:
- Breast tenderness
- Appetite changes
However, PMDD includes more severe emotional and behavioral changes than PMS. These symptoms can include:
- Panic attacks
- Severe depression, irritability, and anxiety
- Frequent crying spells
- Severe mood swings
- A loss of interest in social interaction or activities
How Your Mental Health Can Affect Your Period
Your mental health can also impact your period. If a mental health issue creates additional stress, this can make your PMS and period symptoms worse. Studies have also found that some mental health issues are related to shorter and/or irregular periods. For example, people with bipolar disorder1 who menstruate are twice as likely to experience irregular periods.
Can Antidepressants Affect Your Period?
Some medications for mental health issues can affect your period. Antidepressants can sometimes cause symptoms like heavy bleeding, painful cramps, and missed periods for some people. If you experience issues, it’s best to talk to your doctor to determine if medication or another cause might be behind the changes in your period.
Mental Health Tips for How to Feel Better on Your Period
Taking care of your mental health when you are on your period can help you feel better physically, emotionally, and mentally. Some tips for feeling better include:
- Practicing self-care
- Engaging in regular movement or exercise
- Getting good nutrition
- Practicing stress management skills
- Getting plenty of rest
- Staying connected to family and friends
Menopause & Mental Health
Menopause occurs when a person’s menstrual cycle stops for over a year. The time when your body starts the transition to menopause is caused perimenopause. Perimenopause and menopause can create a host of changes physically, emotionally, and mentally. These changes can impact your mental health in a variety of ways.
Perimenopause & Mental Health
The hormonal changes during perimenopause can lead to mental health challenges such as increased stress, anxiety, and depression. Perimenopause may contribute to cognitive decline and memory changes, which can lead to increased anxiety and stress in relationships. Some people may also experience increased concerns and worries about aging. Anyone experiencing perimenopause can experience mental health issues, and the changes in the body can also make navigating existing mental health disorders more challenging
Can Menopause Cause Mental Health Problems?
Like any other stressor, menopause can result in new mental health challenges or exacerbate existing ones.
Because of lower levels of estrogen, menopause can result in mood swings, depression, and anxiety. In addition, menopause can result in insomnia, which may influence moods as well.
Postmenopausal Mental Health
Once you’ve reached menopause, you may experience improved mental health or have new mental health challenges to tackle. Some people may find that more stable hormones can reduce the moodiness and other symptoms that can come with menstruation. As a result, they may experience greater emotional stability. However, lower levels of estrogen can also impact brain chemistry and lead to an increased risk2 of depression, anxiety, addiction, and dementia.
Therapy for Menstruating and Menopausal People
If you are experiencing mental health challenges related to menstruation, you may find that therapy can help you manage symptoms. Cognitive behavioral therapy (CBT) and other forms of talk therapy can be helpful for those experiencing depression or anxiety. In some cases, medication may also be prescribed to help with symptoms.
If you want to discuss the emotional and mental symptoms that you may be experiencing from your menstrual cycle or menopause, browse our directory of therapists today to get the help you need.
About the author
The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.