Menstruation & mental health: the connection

There might be some truth to the claims that hormonal changes around periods have a tendency to result in poor mood as well as aggravate other existing mental health conditions. While not severe for most of the menstruating population, there are many clear symptoms that can be observed throughout the cycle which make this correlation increasingly clear.
Abnormalities in the menstrual cycle, or the presence of  severe disorders like PMDD, PCOS/PCOD, can have a significant impact on mental health. Awareness about these connections may help devise a more personalized plan for psychological care through the different phases of the menstrual cycle. 

The Science of Hormones

Feeling irritable, intense feelings of sadness or low mood are some of commonly experienced symptoms which can occur both during or before the start of our periods, & for some, can even last long after the period. While a lot of us are primarily impacted

Though there is still a dearth of conclusive proof these symptoms can be largely associated with the hormonal changes that occur during different parts of the menstrual cycle, which can ultimately, have an impact on the modulation of serotonin, dopamine, and many other mood regulating hormones. 

Estrogen, a group of sex hormones, have been extensively studied for their connection to brain functions. It can play a significant role in the regulation of serotonin & dopamine levels, as well as in increasing the number of serotonin/dopamine receptors in the brain. It is also reported to be instrumental in stimulating nerve growth & moderating the production of other “feel-good” hormones like endorphins.

Progesterone, another significant sex hormone, is also involved with the transmission of serotonin &  dopamine within different sites of the brain. Along with one of its metabolites called allopregnanolone, progesterone is known to have anxiety-relieving & antidepressant tendencies, by working on the regulation of amygdala functioning.

The menstruation (menses phase) is characterized by low levels of estrogen & progesterone, followed by the preovulatory phase where these hormone levels slowly rise to prepare the uterus for ovulation. Estrogen levels reach their peak right before ovulation and begin to drop once the egg is released. Subsequently, in the luteal phase a rise in progesterone levels is observed. If the egg remains unfertilized, progesterone levels drop, followed by the next period. The fluctuation of these hormones, when within healthy limits, may play a role in maintaining a good mood during the cycle.

In contrast, irregularities in these hormone levels can lead to marked disturbances in our cycle. For example, excess estrogen may present itself with symptoms like irritability, low mood, fatigue, etc. Thus, understanding this balance of hormones becomes more crucial when we explore it in the context of mental health related conditions. 

Menstruation and mental health

PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER:

You may have heard the term PMS (Premenstrual Syndrome) in conversations regarding mood swings in the days leading up to the periods. Characterized by symptoms like depressed mood, difficulty in concentration and anger regulation, anxiety, insomnia etc, PMS, is understood to be a consequence of abnormalities in hormone levels.
A significant chunk of the menstruating population (3-8%) are also prone to a more severe manifestation of PMS, known as PMDD (Premenstrual Dysphoric Disorder) during the luteal phase, between ovulation and menstruation. This disorder can have some distressing psychological symptoms like severe depression, mental fatigue, panic attacks and in extreme cases, suicidal tendencies, which may be severely debilitating to day-to-day work and social life. Though it usually lasts till a day or two after the period, there are instances where it may extend for much longer. PMDD can be either passed down genetically or may come with other pre-existing mental health concerns. 

PREMENSTRUAL EXACERBATION:

PME refers to worsening of mental health conditions prior to or during one’s period. Research shows that about 60% of the menstruating population with major depressive disorder or bipolar disorder report menstrual cycle-related mood changes, and those with schizophrenia have observed marked premenstrual amplification of psychotic symptoms, like hallucinations.

PCOD/PCOS:

PCOD (Polycystic Ovarian Disease) is a condition where swollen ovaries release immature eggs which can lead to hormonal imbalances and many other related issues. Whereas, PCOS (Polycystic Ovarian Syndrome) is a more severe condition where poor metabolism leads to endocrine issues, making the ovaries produce excess androgen (male sex hormone). This makes the eggs more prone to becoming cysts, which are not released and can accumulate inside the ovaries. Obesity, lifestyle problems, hormonal imbalances, insulin resistance, genetics, and stress, can be some of  contributing factors for the development of PCOS/PCOD.
Though the exact correlation between androgen levels and depression has still not been established, some studies suggest that people with PCOS can be more prone to depressive disorders. The associated estrogen-progesterone imbalances may also be a contributor. Furthermore, Hormone therapy, a suggested treatment, may also lead to an increase in body weight, which may further contribute to stress surrounding body image. Additionally, fertility issues or infertility due to PCOS/PCOD may also put a strain on relationships and may also become a contributing stressor.

What can we do to feel better?

Though a medical diagnosis as well as care might be necessary, self-care strategies throughout the menstrual cycle may be helpful. Some are as follows:

• A balanced diet, keeping in mind individual nutritional requirements, & reducing the consumption of potentially inflammatory foods.
• Regular exercise in whichever mode that suits you best. 
• Relaxation techniques like breathing exercises can be beneficial.
• Good sleep is vital. Consider reducing the caffeine intake close to sleeping hours.
• Keep track of monthly cycles so as to be better prepared for recurring symptoms & concerns during this time.
• Visit the gynaecologist regularly and be aware of your own menstrual health. In case of a diagnosis of a menstruation-related disorder, consulting a therapist can also help you be better equipped to care for your mental health.

The intersection of menstrual cycle and mental welfare is still an under-researched area which not only includes hormones, but also various other factors like genetics, lifestyle choices, and other physiological and socio-economic influences. Also, even though only the effects of a few primary sex hormones are discussed here, there is an abundance of other types of hormones which may also contribute to maintaining mental health. Exploring and understanding, not just the menstrual cycle but also how it interacts with other areas in our lives can help create a better relationship with our body as well as allows us the freedom of medical autonomy.