A quick Google of “why do I feel so angry/sad/emotional on my…” suggests that “on my period” or “before my period” are some of the most popular ways that question is entered into the search bar. I picture all the people who enter those questions in, perhaps as they are trying to understand why on earth they (or a loved one) feel as if their world is crumbling before or during menstruation.
The simplest and most general explanation is that our hormones, oestrogen and progesterone, are the main culprits behind the emotional symptoms relating to menstruation. Our serotonin levels may also decrease and cause a dip in mood. Some emotional changes before or during our period are considered normal and part of premenstrual syndrome (or PMS).
PMS is a collection of symptoms that people who menstruate experience in the lead-up to their periods.
In saying that, a hormonal imbalance can significantly affect someone’s mental health, even if it’s a mild one. It is always helpful to understand how your menstruation impacts your mental health and how you can improve the symptoms.
I have my own journey through this. When I was in my late teens and early 20s, I searched far and wide for an explanation as to why I would feel so sensitive, irritable, angry, or simply sad in the days leading up to my period. For a while, the mood swings I would get during my period made me feel like I had two people living in my body. I would lash out or start crying if someone said something that irritated me during my period or feel cheerful and loving during the rest of the month. It wasn’t until I stopped taking birth control, and more importantly sought God’s counsel, that I started to understand how I could manage my mood swings and support my mental health. It felt as if the clouds lifted and made me feel like myself again like I regained the power to control how I felt and reacted to the world around me.
Why does this happen?
The menstrual cycle influences women’s mental health in a variety of ways. The physical discomfort some women experience, such as breast tenderness, joint and muscle aches, and abdominal pain, can lead to stress, irritability, and impact self-esteem, which is worsened if women already struggle with their mental health (such as an experience with generalised anxiety or depression). Additionally, symptoms such as irritability may create or worsen relationships and conflict, which leads to isolation and worsened mental health. It’s almost as if it is a negative cycle on its own. There is also research that has found that all of these symptoms lead to more impulsive behaviour and substance use (Handy et al., 2022).
So what is going on inside our brains to lead to this?
Let’s go back to the hormones that take the main stage during our menstrual cycle.
Oestrogen and progesterone are the two main hormones that increase and decrease during the menstrual cycle, which is thought to be responsible for the mood swings associated with periods.
Oestrogen affects how your brain cells connect, being closely linked with the transmission of dopamine and serotonin. Both dopamine and serotonin are mood-balancing chemicals. Particularly high or low levels of oestrogen can significantly impact our mental health. If oestrogen is too high or too low it can worsen premenstrual syndrome, and affect mood and quality of sleep. If you’re a little confused about how both low AND high levels of oestrogen can affect your mental health, don’t worry, I was confused too.
Progesterone is the pro-gestation hormone and therefore supports pregnancy if it were to occur, but it has many other health-boosting benefits such as: reducing inflammation, calming the nervous system, soothing mood and improving sleep. This is why it may be easier for you to fall asleep and sleep more deeply in the week after ovulation (Hill, 2019). Progesterone can have anxiolytic effects, that is, it can calm down feelings of anxiety. However, if you are feeling stressed, progesterone is converted into cortisol, increasing stress responses and impairing emotional processing.
Generally speaking, our bodies need our hormones to be balanced to function correctly. That is not to say that hormonal imbalance is the only explanation for symptoms you may be experiencing in relation to your menstrual cycle. The first point of call to deal with any mental health issues that may be associated with your menstrual cycle is a trusted health professional like your GP. There may be a range of treatments such as lifestyle changes (more on that below), medication or a referral to a psychologist.
It might be helpful to track your symptoms over a cycle or two (a cycle being the time from Day 1 of your period to Day 1 of your next period), making notes of how you’re feeling on particular days (e.g. “I am feeling very irritable on Day 25”, “I cried today and I didn’t have a specific reason for it, it’s day 12”). This can help the doctors identify if your symptoms could be attributed to specific points of your menstrual cycle, like ovulation, your period, or other hormonal changes. Click here to check out my own experience tracking my cycle for a month!
References
Ajari, E. (2021). Connecting the Dots Between Mental and Menstrual Health: An Exploratory Review. Journal of Health Reports and Technology. In Press. 10.5812/jhrt.114869.
Effects of Alcohol on Mental Health Australia. Alcohol Think Again. (n.d.). https://alcoholthinkagain.com.au/alcohol-and-your-health/alcohol-and-mental-health#:~:text=Alcohol%20and%20mental%20health%20conditions,can%20leave%20them%20feeling%20worse.
Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric symptoms across the menstrual cycle in adult women: A comprehensive review. Harvard Review of Psychiatry, 30(2), 100–117. doi:10.1097/hrp.0000000000000329
Hill, M. (2019). Period power. Green Tree.
Jean Hailes (2023). PMDD: PMS: Premenstrual dysphoric disorder. Retrieved from https://www.jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms#what-is-pms
Wiebe, J. (2019) What is the relationship between hormones and anxiety? Talkspace. https://www.talkspace.com/mental-health/conditions/articles/anxiety-hormones-connection/#:~:text=This%20hormone%20increases%20shortly%20after,maybe%20even%20a%20little%20depressed. Accessed 14 October 2023
Queensland Health, The State of Queensland (2023). Breaking the cycle: A guide to understanding and managing premenstrual dysphoric disorder (PMDD). Retrieved from https://www.health.qld.gov.au/news-events/news/breaking-the-cycle-a-guide-to-understanding-and-managing-premenstrual-dysphoric-disorder-pmdd
