How do hormonal fluctuations affect mood throughout the menstrual cycle. What are the main types of menstrually related mood disorders. How can women manage symptoms of PMS and PMDD effectively. What role does perimenopause play in women’s mental health.

The Impact of Hormonal Fluctuations on Mood

The menstrual cycle is a complex interplay of hormones that can significantly influence a woman’s mood and emotional well-being. Estrogen and progesterone, the primary female sex hormones, fluctuate throughout the cycle, affecting neurotransmitter activity in the brain. These hormonal changes can lead to mood swings, irritability, and even more severe mood disorders in some women.

During the follicular phase, rising estrogen levels often correlate with improved mood and increased energy. However, as estrogen levels peak and then drop sharply before ovulation, some women may experience mood instability. The luteal phase, characterized by rising progesterone levels, can bring about premenstrual symptoms, including mood changes, for many women.

Hormonal Influences on Neurotransmitters

Estrogen and progesterone interact with various neurotransmitters in the brain, including serotonin, dopamine, and GABA. These interactions can affect mood regulation, sleep patterns, and cognitive function. For instance, estrogen generally has a mood-elevating effect by increasing serotonin activity, while progesterone can have both calming and potentially depressive effects depending on its concentration and individual sensitivity.

Premenstrual Syndrome (PMS): Symptoms and Management

Premenstrual Syndrome (PMS) is a common condition affecting many women during their reproductive years. It is characterized by a range of physical and emotional symptoms that occur in the days leading up to menstruation. While the exact cause of PMS is not fully understood, hormonal fluctuations are believed to play a significant role.

Common PMS Symptoms

• Mood swings
• Irritability
• Fatigue
• Bloating
• Breast tenderness
• Headaches
• Food cravings

Do all women experience PMS symptoms equally? The severity and combination of symptoms can vary greatly from woman to woman. Some may experience mild discomfort, while others may find their daily activities significantly impacted.

Managing PMS Symptoms

There are several strategies women can employ to manage PMS symptoms effectively:

1. Regular exercise
2. Stress reduction techniques (e.g., meditation, yoga)
3. Dietary changes (reducing salt, caffeine, and alcohol intake)
4. Adequate sleep
5. Supplements (e.g., calcium, vitamin B6, magnesium)
6. Over-the-counter pain relievers for physical symptoms

In some cases, healthcare providers may recommend hormonal contraceptives or antidepressants to help manage more severe PMS symptoms.

Premenstrual Dysphoric Disorder (PMDD): A More Severe Form of PMS

Premenstrual Dysphoric Disorder (PMDD) is a more severe and debilitating form of PMS that affects approximately 5-10% of women in their reproductive years. PMDD is characterized by intense emotional and physical symptoms that can significantly impact a woman’s daily life and relationships.

Distinguishing PMDD from PMS

How does PMDD differ from regular PMS? The key distinction lies in the severity and type of symptoms experienced. Women with PMDD often report more intense mood disturbances, including severe depression, anxiety, and irritability. These symptoms can be so severe that they interfere with work, social activities, and relationships.

PMDD Symptoms

• Severe mood swings
• Intense feelings of depression or hopelessness
• Extreme anxiety or tension
• Persistent irritability or anger
• Difficulty concentrating
• Fatigue or low energy
• Changes in appetite or food cravings
• Sleep disturbances
• Physical symptoms (e.g., breast tenderness, bloating, headaches)

Is there a specific timeframe for PMDD symptoms? Typically, PMDD symptoms emerge one to two weeks before menstruation and resolve shortly after the onset of menses. Women with PMDD should experience a symptom-free interval between menses and ovulation.

Diagnosis and Treatment of PMDD

Accurately diagnosing PMDD is crucial for effective treatment. Healthcare providers often require women to track their symptoms over at least two menstrual cycles to establish a clear pattern. This helps distinguish PMDD from other mood disorders that may worsen premenstrually but persist throughout the cycle.

Treatment Options for PMDD

Treatment for PMDD often involves a combination of lifestyle changes, psychotherapy, and medication. Some effective approaches include:

1. Selective Serotonin Reuptake Inhibitors (SSRIs)
2. Hormonal treatments (e.g., certain oral contraceptives)
3. Cognitive Behavioral Therapy (CBT)
4. Stress management techniques
5. Dietary modifications
6. Regular exercise

Can PMDD be managed without medication? While some women may find relief through lifestyle changes and therapy alone, others may require medication to effectively manage their symptoms. It’s essential to work closely with a healthcare provider to determine the most appropriate treatment plan.

Perimenopausal Depression: Understanding the Midlife Transition

Perimenopause, the transitional period leading up to menopause, can be a time of increased vulnerability to mood disorders, particularly depression. This phase, which can last anywhere from a few months to several years, is marked by significant hormonal fluctuations that can impact emotional well-being.

Hormonal Changes During Perimenopause

During perimenopause, estrogen levels begin to decline, but in an erratic pattern. This hormonal instability can lead to various physical and emotional symptoms, including mood changes. The gradual decrease in estrogen can affect neurotransmitter function, potentially contributing to the development of depression in some women.

Symptoms of Perimenopausal Depression

• Persistent sadness or emptiness
• Irritability
• Anxiety
• Loss of interest in previously enjoyed activities
• Sleep disturbances
• Fatigue
• Difficulty concentrating
• Changes in appetite

Are all women equally susceptible to perimenopausal depression? While hormonal changes play a significant role, other factors such as personal history of depression, life stressors, and genetic predisposition can influence a woman’s risk of developing perimenopausal depression.

Managing Perimenopausal Depression

Addressing perimenopausal depression often requires a multifaceted approach. Treatment options may include:

1. Hormone Therapy (HT): In some cases, estrogen therapy may help alleviate depressive symptoms associated with perimenopause.
2. Antidepressants: SSRIs or other antidepressants may be prescribed to manage mood symptoms.
3. Psychotherapy: Cognitive Behavioral Therapy (CBT) or other forms of talk therapy can be beneficial.
4. Lifestyle modifications: Regular exercise, stress reduction techniques, and a balanced diet can help manage symptoms.
5. Complementary therapies: Some women find relief through acupuncture, herbal remedies, or mindfulness practices.

Is hormone therapy suitable for all women experiencing perimenopausal depression? The decision to use hormone therapy should be made on an individual basis, considering the woman’s overall health, medical history, and the severity of her symptoms. It’s crucial to consult with a healthcare provider to weigh the potential benefits and risks.

The Role of Oral Contraceptives in Managing Menstrually Related Mood Disorders

Oral contraceptives have emerged as a potential treatment option for some menstrually related mood disorders, particularly PMDD. These medications can help regulate hormonal fluctuations throughout the menstrual cycle, potentially alleviating mood symptoms associated with hormonal changes.

How Oral Contraceptives May Help

Oral contraceptives work by suppressing ovulation and stabilizing hormone levels throughout the menstrual cycle. This hormonal stabilization can help reduce the severity of mood symptoms associated with PMDD and, in some cases, PMS. Some newer formulations of oral contraceptives have been specifically designed to address PMDD symptoms.

Can oral contraceptives be effective for all women with menstrually related mood disorders? While many women experience significant improvement with oral contraceptives, individual responses can vary. Some women may find their mood symptoms worsen with hormonal contraceptives. It’s essential to work closely with a healthcare provider to monitor the effects and adjust treatment as needed.

Considerations When Using Oral Contraceptives

• Potential side effects
• Contraindications for certain medical conditions
• Interaction with other medications
• The need for consistent daily use
• Potential impact on fertility plans

Healthcare providers will consider these factors when determining if oral contraceptives are an appropriate treatment option for a woman’s menstrually related mood disorder.

The Importance of Accurate Diagnosis in Menstrually Related Mood Disorders

Accurate diagnosis is crucial in effectively managing menstrually related mood disorders. Many women who seek treatment for conditions like PMDD may actually be experiencing premenstrual exacerbation of an underlying mood disorder. This distinction is vital for developing an appropriate and effective treatment plan.

Challenges in Diagnosis

Diagnosing menstrually related mood disorders can be challenging due to several factors:

• Overlap of symptoms with other mood disorders
• Variability in symptom presentation
• The cyclic nature of symptoms
• Potential co-existence of multiple conditions

How can healthcare providers ensure accurate diagnosis? A comprehensive evaluation typically includes:

1. Detailed medical and psychiatric history
2. Physical examination
3. Laboratory tests to rule out other medical conditions
4. Mood charting over at least two menstrual cycles
5. Psychological assessments

This thorough approach helps distinguish between true menstrually related mood disorders and other conditions that may present similarly or be exacerbated by hormonal fluctuations.

The Role of Mood Charting

Mood charting is a valuable tool in diagnosing menstrually related mood disorders. By tracking mood symptoms alongside the menstrual cycle, patterns can emerge that help differentiate between conditions like PMDD and premenstrual exacerbation of underlying mood disorders.

What should be included in a mood chart? Key elements often include:

• Daily mood ratings
• Physical symptoms
• Sleep patterns
• Menstrual cycle dates
• Significant life events or stressors

This detailed information can provide valuable insights for healthcare providers in making an accurate diagnosis and developing an effective treatment plan.

Future Directions in Research and Treatment

As our understanding of menstrually related mood disorders continues to evolve, researchers are exploring new avenues for treatment and prevention. Some promising areas of study include:

Genetic Factors

Research has suggested a potential hereditary link to conditions like PMDD. Understanding the genetic components of these disorders could lead to more targeted treatments and early intervention strategies.

Neuroimaging Studies

Advanced brain imaging techniques are providing new insights into how hormonal fluctuations affect brain function in women with menstrually related mood disorders. These studies may help identify biomarkers for conditions like PMDD and guide the development of new treatments.

Novel Therapeutic Approaches

Researchers are investigating new therapeutic approaches, including:

• Targeted hormone therapies
• Neurostimulation techniques
• Personalized treatment based on genetic profiles
• Innovative delivery methods for existing medications

How might these advancements impact the management of menstrually related mood disorders? As research progresses, we may see more personalized and effective treatment options becoming available, potentially improving outcomes for women affected by these conditions.

Integrative Approaches

There is growing interest in integrative approaches that combine conventional medical treatments with complementary therapies. These may include:

1. Nutritional interventions
2. Mind-body practices
3. Herbal remedies
4. Acupuncture
5. Chronotherapy (light therapy)

Research into these integrative approaches may provide new options for managing symptoms and improving overall well-being for women with menstrually related mood disorders.

As we continue to unravel the complex relationship between hormones and mood, the future holds promise for improved diagnosis, treatment, and quality of life for women affected by menstrually related mood disorders. Ongoing research and clinical advancements offer hope for more targeted, effective, and personalized approaches to managing these challenging conditions.

Menstrually Related Mood Disorders – Center for Women’s Mood Disorders

Menstrually-related mood disorders are mood disorders associated with the menstrual cycle. Menopause and cycles of menstruation are time of intense hormonal fluctuation that can cause increased vulnerability to depression. Perimenopausal Depression, Premenstrual Syndrome (PMS), and Premenstrual Dysphoric Disorder (PMDD) are menstrually-related mood disorders treated in our program.

Premenstrual Syndrome (PMS)

Premenstrual Dysphoric Disorder (PMDD)

Perimenopausal Depression

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

Many women experience symptoms of Premenstrual Syndrome (PMS). In some instances the mood symptoms and emotional components of PMS are the most troubling. To women in such cases, PMS is often referred to as Premenstrual Dysphoric Disorder (PMDD).

Premenstrual Dysphoric Disorder is a more severe form of PMS, affecting 5-10% of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance that can seriously impact relationships and impair functioning. Many women with PMDD experience clinical levels of depression or anxiety during the week or two before each menstrual cycle. It is not uncommon that the emotional symptoms of depression anxiety and irritability can seriously interfere with normal functioning and relationships.

Common symptoms include: irritability, depressed mood, anxiety, or mood swings. Mood symptoms are only present for a specific period of time, during the luteal phase of the menstrual cycle. Symptoms emerge one to two weeks before menses and resolve completely with the onset of menses. Women with PMDD should experience a symptom-free interval between menses and ovulation. An estimated 40% of women who seek treatment for PMDD actually have a premenstrual exacerbation of an underlying mood disorder rather than PMDD. Therefore, it is important for patients to be carefully evaluated for the presence of an underlying mood disorder in order to develop the best treatment plan.

For more information:

Watch these videos about PMDD:
The Biology behind PMDD
Oral Contraceptive relief for PMDD

Or read these articles about PMDD research at UNC:
Oral Contraceptives May Ease Suffering of Women with Severe PMS
Study finds hereditary link to premenstrual depression

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Perimenopausal Depression

Menopause is defined as the permanent cessation of the menses. Perimenopause is defined as the transitional period from normal menstrual periods to no periods at all. At this time menstrual periods gradually lighten and become less frequent. The transition to complete menopause may last anywhere from a few months to a few years.
During the perimenopausal transition you may experience a combination of PMS and menopausal symptoms or no symptoms at all. Some normal symptoms of the perimenopause period are hot flashes, insomnia, vaginal dryness, and mood problems. Symptoms of perimenopausal depression are emotional flatness, “inability to cope,” irritability, social isolation, tearfulness, decreased energy, and failure to enjoy normal activities and relationships.

Times of intense hormonal fluctuation can cause increased vulnerability to depression. Perimenopause may be a period of increased vulnerability to the onset of depression in women with no prior history of depression. Since symptoms are gradual in onset, women will not recognize symptoms as part of a reversible disorder, but rather will interpret them as a permanent change in their life.

For more information:
UNC researchers investigate estrogen replacement therapy to prevent depression and cardiovascular disease

How Hormones Affect Mood Throughout Your Menstrual Cycle

Why Am I In A Good Mood After My Period Starts?

You’re likely well acquainted with premenstrual syndrome (PMS), the set of symptoms that can occur in the days leading up to your period. But have you ever noticed that once your period actually starts, the clouds seem to part, and you suddenly feel a whole lot better?

It’s not just your mind playing tricks on you. There’s actually a scientific reason for why you might feel in a good mood after your period starts and why your mood can seem to change throughout the month.

It all relates to hormones and how they shift once your period starts. Let’s look at hormones throughout your cycle, especially around your period, and how they can affect your mood.

Menstrual Cycle 101 

I’ve covered the complex dance of hormone changes throughout your cycle in more detail in this article, but to make sure we’re all on the same page, let’s just quickly review the basics.

Your menstrual cycle is controlled by two main sex hormones: estrogen and progesterone (you’ll want to see that other article for how your brain is involved). These hormones fluctuate throughout your cycle, with estrogen levels rising in the first half and peaking around ovulation and progesterone levels rising in the second half and peaking just before your period.

The first phase of your cycle is called the follicular phase because it’s when the follicle that contains the egg develops.  

The second phase of your cycle is called the luteal phase. The egg is released, and the follicle becomes the corpus luteum, which produces progesterone and estrogen. 

Throughout your cycle, estrogen and progesterone fluctuate. As they shift, it can impact how you feel physically and emotionally. The balance between these hormones can also influence your mood, as we’ll discuss below.

Period Mood Swings, Both Happy and Sad

Since we are all different, and there’s no single way that our bodies respond to hormonal changes, it’s not surprising that some of us feel good after our period starts while others take a little longer to feel better.

Some people notice an immediate change when they start their period, while others need to wait a few days for the mood-boosting effects of estrogen to start kicking in. And some just feel not-so-great for the entire period.

It’s also worth noting that not everyone experiences premenstrual syndrome (PMS), and not everyone experiences the same symptoms if they do have PMS. And the same is true for premenstrual dysphoric disorder (PMDD).

Hormone Levels During Menstrual Cycle Phases

You’re not alone if you’re someone who usually feels pretty good during your period or right after it starts. In fact, there’s a scientific reason for why you might feel this way. When hormone levels increase during the follicular phase of your cycle, it can positively affect your mood. 

On the other hand, changes in estrogen and progesterone can have the opposite effect. 

Let’s take a closer look.

The Follicular Phase: Mood Enhancer

The follicular phase tends to be when you may notice your mood is lighter and you have more energy. It lasts around two weeks until ovulation.

Day one of your follicular phase is the first day of your period. So, even though estrogen levels are low at the start of your period, they don’t stay there for long. Estrogen starts to rise as the follicular phase progresses. Estrogen (plus follicle-stimulating hormone, FSH) is needed to develop the follicle that contains the egg and thickens the uterine lining in preparation for the implantation of a fertilized egg.

As estrogen levels increase, you might notice a positive effect on your mood. It may take a few days, but those symptoms of PMS irritability or low mood start to dissipate once your period starts. By the time your period ends, you’ll (hopefully) feel more social and happy.

One reason could be that estrogen is linked to serotonin, a neurotransmitter that plays a role in mood. As estrogen levels increase, so does serotonin production, and this can lead to feelings of happiness and well-being.

Progesterone levels remain relatively stable and low during the follicular phase until they start to climb in the luteal phase following ovulation.

The Ovulatory Phase is Your Menstrual Cycle Midpoint

Ovulation is the release of an egg from the ovary and usually occurs midway through your cycle. A sudden rise in estrogen levels plus a surge in luteinizing hormone (LH) triggers ovulation. This is the point in your cycle when the body is prepped to make a baby (even if it’s not in your plans).  

Some people may feel temporarily low mood when estrogen drops back down from its pre-ovulation spike, but since it climbs again a few days after ovulation, it’s usually short-lived.

The Luteal Phase Can Lead to Low Mood

After ovulation, the corpus luteum, the temporary endocrine structure left behind in the ovary following ovulation, begins producing progesterone. This phase is called the luteal phase and lasts for the remainder of your cycle until you get your period. 

Progesterone levels rise for the first half of the luteal phase to prepare for a possible pregnancy. You may feel relaxed and sleep better as progesterone increases because it can stimulate calming neurotransmitters in the brain.

But as you get closer to your period, things can change. If there is no HCG (the pregnancy hormone) available to keep the corpus luteum producing progesterone, it will degrade. This triggers the fall of progesterone and estrogen, which is normal if there has been no implantation of a fertilized egg (pregnancy). Serotonin can also decline with the dip in estrogen. Serotonin has been linked to low moods and symptoms of depression.

While the above can be characterized by mild shifts in mood, motivation, and energy, which is normal, there are situations where mood changes are not considered normal in the luteal phase. 

PMS and PMDD in the Luteal Phase

PMS or Premenstrual dysphoric disorder (PMDD) occurs towards the end of the luteal phase, right before your period starts. PMDD is much more severe than PMS, although both should be taken seriously by your provider. 

In certain cases, PMS can be an issue of too little progesterone, leaving estrogen to stimulate cell receptors. If you’re struggling with mood and hormone symptoms, I encourage you to grab my free Hormone Balancing Starter Kit to help you get a handle on those symptoms.

When it comes to PMDD, research now tells us that there is a genetic component where women with PMDD are more sensitive to estrogen and progesterone. It’s also believed to be higher among people with ADHD and autism spectrum disorder.

Symptoms of PMDD can look like PMS, but the critical difference is the severity and duration of symptoms like:

• Irritability
• Mood swings
• Sadness
• Anxiety
• Anger
• Fatigue
• Trouble concentrating
• Changes in appetite
• Bloating
• Breast tenderness

In most cases, your mood should improve once your period starts and hormone levels stabilize again. If your PMS or PMDD is seriously impacting your everyday life, please reach out to your doctor for help. You don’t need to suffer.

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Anxiety Before Your Period

One reason you may be feeling relief with the onset of your period is due to the anxiety that can arise as part of the luteal phase. Anxiety is often a symptom of too little progesterone. You’ll find 12 ways to reduce anxiety before your period in this article, but here are a couple of things that have helped my patients, in addition to what you’ll find below.

PhosphatidylSerine

PhosphatidylSerine is an amino acid that helps bring cortisol into balance by supporting the body’s natural rhythm, which is why it is best taken at night. We’ve included this amino acid, along with other nutrients that support healthy progesterone and cortisol levels at the right time in our Adrenal Calm formula.

Box Breathing

Inhale to the count of 4. Hold for a count of 4. Exhale for a count of 4. Congratulations, you just did a round of box breathing that can help calm the nervous system and lower anxiety. 

Magnesium

Eating magnesium rich foods (click the link for a list) and considering 300 mg nightly may help improve moods and promote healthy sleep.

Vitex (chaste tree berry)

If you’re low on progesterone, this little herb may be one of your greatest allies. We have a Vitex guide that goes over all the details, but in short, it helps your body do its job in making the mood calming progesterone you need. I generally recommend it as part of our Balance Women’s Hormone Support formula.

@drjolenebrighten If these are the tips you’re looking for, check the LaNK in my bio for dosages of the supplements mentioned + how to give your hormones the love they need to keep your #mood in check! If you’re feeling the problem is you once a month, it might actually be your hormones. Your brain has receptors for your #hormones. So yes, your hormones can influence your #neurotransmitters and therefore, your mood. Check that article I mentioned for #menstrualcycle hormone #moodtips! #moodboost #hormonehealth ♬ Anti-Hero – Taylor Swift

Support Your Mood Throughout Your Menstrual Cycle

Small shifts in mood don’t necessarily mean something’s wrong (because life happens), but they can be tough to deal with. If you’re struggling with your mood during your cycle, there are a few things you can try to help.

• Get enough sleep. Being tired makes everything feel harder. Plus, lack of sleep can increase cortisol and worsen PMS symptoms. If you are having a hard time with sleep, start by ensuring your sleep environment is set up for success. Keep the room cool, dark, and quiet, and try to disconnect from screens an hour before bedtime.

If you wake up at 3 am and can’t get back to sleep, chances are your adrenals need a little love. You can try a nourishing adrenal supplement that includes ingredients like Ashwagandha or magnesium (both are also helpful for hormones).

• Eat a blood sugar-balancing diet. Ever seen a child after eating too much sugar and no protein, fat or fiber to accompany? Adults aren’t so different. Foods that don’t keep us full, but instead signal a spike in insulin, can wreak havoc on hormones. When blood sugar is all over the place, so are our moods. Diet is so important for even energy levels and mood. Blood sugar balance is especially crucial for hormone balance and mood. 

Bump up the fiber and protein at each meal and snack to help stabilize blood sugar. Add healthy fats like avocados, olive oil, and nuts, which are all great for hormone balance, and limit simple carbs and sugary foods, which can cause fluctuations in blood sugar levels. You can grab a free meal plan and set of recipes here to help you get started.

• Reduce stress. Stress can make every symptom feel worse, so finding ways to relax is essential. If you’re feeling overwhelmed, try a few stress-relieving techniques, such as yoga, meditation, or deep breathing. In fact, stress can mess your periods, ovulation, and certainly be culprit in mood swings.

Supplements to nourish the adrenals work here too, like Ashwagandha, Passion flower, magnesium, or L-Theanine. You’ll find this blend in our Adrenal Calm formula, which is the perfect bedtime companion.

• Exercise. Movement promotes those feel-good endorphins to mitigate stress and boost your mood. Just find what you love and do it, whether going for a walk outside, taking a yoga class, or dancing around your living room. If you feel like your mood is low, get outside and walk. Walking is an unsung hero in the mood elevating conversation. If you’re feeling anxious, try to move big muscles with some jump squats, lunges, or even just squat at your desk. If you’re in the two hour window before bed, stretch, do a gentle yoga routine, and practice your deep breathing. This will promote quality sleep and help you calm the mind before bed—you know, that time when the “to-do list goblins” try to get us.

• Connect with friends or loved ones. Social support is one of the most important factors in overall well-being. When we feel connected to others, we have an increased sense of belonging, worthiness, and gratitude. So reach out to your people when you’re feeling down—even if it’s just a text or phone call. And if you feel at a loss for a reliable social network, try a new hobby, join a class, go to the gym, find a moms group, or engage in community service programs.

And of course, if you’re struggling with severe mood changes, always reach out to your healthcare provider.

Mood and Menstrual Cycle: Key Takeaways

Your menstrual cycle and period can clearly affect your mood. Hormone balance is key to feeling better before, during, and after your period. Eating a balanced diet, getting enough sleep, and reducing stress can help. Exercise and mood-supporting supplements may also be helpful. 

If you struggle with hormone balance and aren’t sure where to start, check out my free Hormone Kit filled with recipes, a meal plan, and the resources you need to better understand and take care of your hormones.

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References

1. Soares CN, Zitek B. . Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability?. J Psychiatry Neurosci.. 2008. 33(4). 331-343.
2. Fehring RJ, Schneider M, Raviele K.. Variability in the phases of the menstrual cycle.. Journal of Obstetric, Gynecologic & Neonatal Nursing.. 2006. 35(3). 376-384.
3. Barth C, Villringer A, Sacher J.. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods.. Front Neurosci.. 2015. 9. 37.
4. Joffe H, de Wit A, Coborn J, et al.. Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms. J Clin Endocrinol Metab.. 2020. 105(3). e642-e650.
5. Dubey N, Hoffman JF, Schuebel K, et al.. The ESC/E(Z) complex, an effector of response to ovarian steroids, manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder. . Mol Psychiatry.. 2017. 22(8). 1172-1184.
6. Cappelletti M, Wallen K.. Increasing women’s sexual desire: The comparative effectiveness of estrogens and androgens.. Horm Behav.. 2016. 78. 178-193.
7. Skiba MA, Bell RJ, Islam RM, Handelsman DJ, Desai R, Davis SR. Androgens During the Reproductive Years: What Is Normal for Women?. J Clin Endocrinol Metab.. 2019. 104(11). 5382-5392.

About The Author

Hormones during the menstrual cycle and PMS

Comment from an expert
Gynecologist Anastasia Degteva

“The diagnosis of PMS is made only on the basis of the patient’s complaints and the testimony of his diary: mark the symptoms that bother you in the menstruation app. There are diseases that may be more disturbing before the start of the cycle than on other days: depression, anxiety disorder, thyroid disease. It is important to see a gynecologist to understand if PMS is really bothering you.
If you are told “you just have PMS” to the manifestations of emotions regarding some unpleasant situation, then these are manifestations of gaslighting.

In order to understand what PMS is, it is worth first understanding what female hormones are and how they affect the reproductive system of women, because they control all the processes associated with the menstrual cycle – from the first menstruation to the very last, each cycle, without exception, depends on hormones.

Hormones affect not only menstruation, but also mood, ability to perform physical work, and even food preferences. Despite the fact that the menstrual cycle in all women depends on the same hormones, someone tolerates such changes easily and imperceptibly for themselves, and for some it becomes a monthly test.

What is PMS?

PMS is a condition that affects mood, physical condition, and behavior on certain days of your menstrual cycle, usually a few days before your period starts.

PMS, like many other aspects of women’s health not directly related to childbearing, is still little studied, and there are still no clear criteria for assessing PMS.

Research shows that PMS is more or less affected by 5 to 97 percent women.

In fact, it is worth distinguishing premenstrual dysphoric syndrome (PDS), which is observed in about 3-8% of women, from the myth of PMS.

PMS is a monthly premenstrual condition in which at least 5 symptoms of PMS are present and are severe enough to interfere with a woman’s daily life.

In one way or another, many women experience monthly symptoms that are related to PMS, and they are quite real.

What are the symptoms of PMS?

Symptoms of PMS are usually mild or moderate.

About 80% of women experience at least one of the symptoms of PMS to a degree that does not interfere with their daily lives. About 20-30% of women experience tangible symptoms that can affect certain aspects of daily life. 3-8% have PDS.

The severity of symptoms may vary from cycle to cycle and also depends on the individual assessment of each woman.

• Breast hypersensitivity

• Puffiness

• Headaches

• Fatigue

• Acne and skin eruptions

• Irritability

• Distended abdomen

• Increased appetite

• Anxiety

• Sadness

• Diarrhea or constipation

• Depressed mood

• Abdominal pain

• Sensitivity to light and sound

Why do PMS symptoms occur?

The causes of PMS are still not clear, but many researchers attribute it to changes in hormone volume and serotonin levels in the period 5-10 days before the onset of menstruation.

Levels of the hormones estrogen and progesterone first rise and then fall sharply just before menstruation, and this can probably cause anxiety, irritability and mood swings, as they modulate activity in areas of the brain associated with PMS symptoms. Serotonin is one of the neurotransmitters that strongly influences mood and emotions, it is also called the “hormone of happiness”.

How do female hormones work?

The hormone estrogen and progesterone play a huge role in the human body and are part of its endocrine system, which controls almost all the functions of our body.

Moreover, these hormones are also produced by the male body, only in smaller quantities, so they are usually called female hormones. In the female body, they control the reproductive system and sexual health, including libido. It is precisely because they play such an important role that it is important to understand how they work.

Estrogen

Estrogen is a female hormone secreted by the ovaries, the level of which rises during the first two weeks of the menstrual cycle, causing the growth of endometrial tissue in the uterus. This phase of the cycle is called follicular. A sharp drop in estrogen (and progesterone) levels causes menstrual bleeding. It also affects heart and bone health. Active production of estrogen begins in adolescence, and decreases with age until it reaches menopause, when menstruation stops.

Progesterone

Progesterone levels rise after ovulation, during the second half of the menstrual cycle. If conception has occurred, then the level of progesterone continues to rise, maintaining the thickness of the uterine endometrium for the further development of pregnancy. If there was no conception, then the level of progesterone drops, giving a signal to the body to start rejecting the thickened endometrium. Some of the unpleasant symptoms of PMS, such as breast tenderness, acne, and swelling, have been linked to this hormone.

When does PMS usually start?

Symptoms of PMS in women occur in the second half of the cycle, after ovulation. Most often, the strongest both psychological and physical symptoms of PMS are observed 3-4 days before menstruation, and then disappear with the onset of bleeding. PMS symptoms can start and end at other times as well: for example, some women begin to experience symptoms immediately after ovulation, and for some, they may disappear after the end of menstruation, and not with it.

How do I know if I have PMS?

The best way to find out if you have PMS is to use a diary of symptoms, which should be noted on the same calendar that you use to mark your cycle. If you have a smartphone, there are now many applications in which it is convenient to do this and which can even prompt your statistics on their own. If symptoms appear at about the same time each cycle, then PMS is the most likely cause.

When should I see a doctor?

If physical pain or other symptoms persist or seriously interfere with your daily life, you should see a doctor.

PDS is diagnosed if you have one of the symptoms regularly and then disappear on other days. However, such symptoms can be associated with a variety of other conditions, such as endometriosis, thyroid disorders, irritable bowel syndrome, anemia, connective tissue diseases, and rheumatism, and the doctor will need to rule them out.

Remember that all people have hormones in general, and their level is not constant.

PMS is not something to be ridiculed or embarrassed about, and you don’t become magically inadequate during it: according to research, mood swings happen with about the same frequency in both men and women.

How does the day of the cycle affect mood? Count and check

The more you know about yourself and your internal cycles, the easier it is for you to understand what is happening with the body and feel its needs.

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Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

First phase. Renaissance

The 1st day of the cycle is considered the day of the beginning of our menstruation.

What happens to hormones?

The endometrium, which covers our uterus, peels off, and the blood stream flushes it out, cleansing occurs. At the very beginning of this phase, the level of estrogen and progesterone is extremely low, but at the same time hypota-

lamus, which regulates thirst, hunger, sleep, libido and endocrine functions, releases follicle-stimulating hormone. Yes, yes, preparations for ovulation are already beginning, hope is already dawning!

Energy

During this period, at first we want to close for the time being, and we strive to be left alone. But gradually we begin to wake up, become prettier and feel cheerful again.

What are we doing?

The first day of the cycle, we are the most vulnerable. Insist that you are not disturbed on this day. If possible, take a day off. Be alone with yourself, feel how your body actually feels, what you are experiencing. Ask your lover to be especially gentle and caring during this period. On the first day, it is better to refrain from exercise and physical activity.

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During this period it is necessary to pay attention to the body. the body calls for your attention. Take a bath with your favorite aromatic oils, nourish yourself, your body needs care. Actually, in many ways, the reasons for our emotional breakdowns on others during this period are that you need to stay alone and take care of yourself, and you are forced to maintain activity that is unusual for this cycle. Your body and psyche require solitude and nourishment! Calm yin yoga, stretching, yoga nidra are best suited for exercises during this period.

second phase of the cycle. Preparation for fertilization, or the Creative phase

What happens to hormones?

An increased synthesis of pituitary and hypothalamic hormones begins, which affect the ovaries. The main one is follicle-stimulating hormone (FSH), which causes intensive growth and development of several follicles. The ovaries, in turn, produce the sex hormone estrogen; its significance is to stimulate the renewal of the endometrium and prepare the uterus to accept the egg. This stage lasts about two weeks and ends due to the release of hormones into the blood that suppress the activity of FSH. Your uterus is lined with endometrium, you are preparing to accept life. Readiness for fertilization is born in our body! We feel with our whole being that we can give life. Therefore, this is the most creative, I beg your pardon, creative phase!

Psychological aspect: according to our hectic hormonal life during this period, we are oh-oh-very friendly to male energy, we are very feminine, flirtatious and very attractive!

Energy

Physical, sexual energies increase, estrogen levels increase. Closer to ovulation, this hormone is at its maximum level! And here it is, our favorite radiance, and the eyes shine, the skin is tender, velvety, the mood is playful. Even the most difficult things are on the shoulder. We easily achieve success these days both with men and in everyday affairs. Increased sexual desire. There is a need to actively participate in society.

What are we doing?

First of all, pay attention to how you feel. What does your body feel, what does it yearn for? How is your body experiencing this beautiful phase of being ready to create? Pay attention, do you accept it, rejoice, let it into your life? Do you feel how your creative energy has increased? What projects are knocking and require implementation? And if you have caught this rhythm, this wave energy of your own cycle, then ride it! Rejoice, be active, flirt, dress brightly and beautifully, meet men or arrange romantic dates with your lover.

Third phase. Recession, or the Period when we reap the rewards

What happens to hormones

oocytes from the follicle. The egg enters the lumen of the fallopian tube and begins its movement towards the uterus, while waiting for fertilization. As soon as ovulation occurs, the amount of progesterone increases. With a reduced rate of the hormone in the blood in the second half of the cycle, a woman may experience irritability, which, in turn, can lead to depression.

Progesterone is responsible for women’s health, regulates the ability to conceive and bear a child, shapes the female body, is responsible for metabolism, and even affects such seemingly exclusively psychological characteristics as maternal feelings and peace of mind. Today it is called the hormone of motherhood, it is necessary for carrying a pregnancy. If conception has occurred, then in the prevailing amount it persists until the very birth.

Psychological aspect: the hormone of motherhood makes us reasonable, balanced. A woman turns into a hostess, loves to stay at home, bring comfort, cook a delicious dinner. Men are more tempted to feed them than to flirt with them. If the pregnancy did not take place, then closer to menstruation, the level of hormones decreases. At this time, the body is cleansed, resting, gaining

Energy

As soon as ovulation ends, the decline gradually begins, our energy seems to slow down. We may become more depressed and sad. It is worth paying attention to your condition and accepting it, take care of yourself, reduce stress factors in life. And by the way, experience joy!

Psychological aspect. Here, depending on your hormonal background and psychological harmony, you can feel two diametrically opposite energies: an unreasonable feeling of failure, dissatisfaction, or pride in your success.

During this period, you may want to change. All aspects that have not been working for you for a long time and from which it is time to get rid of begin to manifest themselves especially actively in this phase.

Fourth phase. Distillation

What happens to hormones?

The decline continues. The production of both estrogen and progesterone is reduced.