Menstruation and Mental Health
Jessica Chang, MHC-LP
Nobody who menstruates likes to be told by someone else that their behavior is a product of their menstrual cycle and hormones. However, the truth of the matter is that menstruation and mental health are closely linked - menstruation often influences one’s mental health and one’s mental health often affects menstruation. This bidirectional process has a large impact on not just the lives of people who have periods, but everyone who knows someone who gets their period, so, essentially, the global population at large. The stigma and shame around “PMS-ing” and periods is a product of the general population’s ignorance and lack of access to sex education, and this has serious consequences for the world’s collective mental health and wellbeing.
Menstrually-related Mood Disorders
Premenstrual Syndrome (PMS)
PMS includes a wide range of signs and symptoms – emotional, behavioral, physical, and mental – including but not limited to mood swings, irritability, tender breasts, food cravings, fatigue, and depression. These symptoms tend to recur in a similar pattern for each individual, varying in intensity and severity. About 75% of people who menstruate experience PMS symptoms (Mayo Clinic, 2022).
Premenstrual Dysphoric Disorder (PMDD)
PMDD is a more severe form of PMS, affecting 5-10% of people who menstruate during their reproductive years. Symptoms are characterized by greater premenstrual mood disturbance [than PMS] that can have a serious impact on relationships and impair functioning. PMDD may involve clinical levels of depression and anxiety during the week or two before each menstrual cycle. Common symptoms include irritability, depressed mood, anxiety, or mood swings which are only present during a specific period of time (i.e., luteal phase of the menstrual cycle). Those with PMDD should experience a symptom-free stretch of time between menses and ovulation. Important to note is that 40% of women who seek treatment for PMDD actually have an underlying mood disorder which is exacerbated during pre menstruation rather than PMDD. Thus, people seeking treatment for PMDD should be thoroughly evaluated for underlying mood disorders in order to develop the best treatment plan.
Causes of Premenstrual Symptoms
It is unknown exactly what causes PMS and PMDD, but multiple factors may contribute to the conditions. Namely, PMS and PMDD patterns follow along with cyclic changes and fluctuations in hormones, disappearing with pregnancy and menopause. Chemical changes in the brain may also influence premenstrual symptoms. The neurotransmitter serotonin is thought to play a significant role in mood states, and premenstrual depression, fatigue, food cravings, and sleep problems may in part be due to insufficient amounts of serotonin.
Perimenopausal Depression
Perimenopause is the transitional period from normal menstrual periods to menopause, the permanent cessation of the menses (UNC School of Medicine). During this time, which can last anywhere from a few months to a few years, menstrual periods progressively lighten and become less frequent. Typical symptoms during perimenopause include hot flashes, insomnia, vaginal dryness, and issues with mood. Symptoms of perimenopausal depression include emotional flatness, “inability to cope”, irritability, social isolation, tearfulness, decreased energy, and inability to enjoy daily activities and relationships.
Times of intense hormonal fluctuation such as perimenopause can make one more vulnerable to depression, increasing the likelihood of onset of depression even in folk with no prior history of depression. With the gradual nature of onset of symptoms during this time, perimenopausal depression can often go unrecognized as a reversible disorder and instead be interpreted as a permanent change in life. This may bring on feelings of shame which prevent people from speaking up about what they are going through and receiving the care they need.
Menstruation and Mental Health
Research has shown significant evidence of menstrual cycle-dependent fluctuations in psychiatric symptoms. This includes increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during premenstrual and menstrual phases. During the luteal phase appears to be a rise in anxiety, stress, and binge-eating. Self-esteem declines in certain intervals of the menstrual cycle as well, and has been linked with symptoms of physical discomfort. An estimated 15% of women with PMDD will attempt suicide in their lifetime according to the international Association for Premenstrual Disorders (IAPMD), with transgender folk at even higher risk (Handy et al., 2022).
Treatment
Antidepressants (SSRIs), birth control pills, and over-the-counter pain relievers may help mitigate symptoms related to chemical changes in the brain, hormone fluctuation, and physical pain associated with the menstrual cycle. More natural ways to relieve premenstrual and PMDD symptoms may include relaxation and stress management techniques, eating balanced and nutritional meals low in salt and sugar, and increased physical activity.
Menstruation and mental (as well as emotional, behavioral, and physiological) health are closely linked and sometimes involve serious symptoms which should be discussed with a medical professional in order to find treatment options best suited and most effective for each individual. If you are experiencing symptoms which feel overwhelming and unmanageable and have noticed patterns which correspond with your menstrual cycle, you are not alone and your experience is valid. Everyone needs to play their role in combating stigma surrounding menstruation and mental health and continuing the discourse. No one should be made to feel shame about how their body functions and how it affects their mental health. This begins with everyone having access to education on periods and mental health, including those who do not menstruate.
Sources:
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. https://doi.org/10.1097/HRP.0000000000000329
Menstrually Related Mood Disorders | UNC School of Medicine
Premenstrual syndrome (PMS) | Mayo Clinic