There’s an age-old diatribe that most people who menstruate have heard at some point; a jokey accusation that your bad mood is due to your menstrual cycle or the personal affront that your actions are a direct consequence of 'all those raging period hormones'.
This week (14th-20th May) is Mental Health Awareness Week and though only approximately 50% of the population menstruate, 100% of us have mental health. Though there is some scientific evidence to show that the hormonal variation that occurs as part of the normal menstrual cycle can influence someone’s mood, it’s important to recognise that for most people there’s so much more to it than this.
We know that there are many different things that affect someone’s mood and mental health. Firstly, there are biological factors to consider, meaning the hormonal changes kicking off inside your body and the symptoms you experience as a direct result of this as well as your own genetic predisposition. There are psychological aspects too, like your underlying personality type, personal resilience, self-esteem and coping mechanisms. Thirdly, there are social factors to consider, like your financial situation, family support and personal cultural and religious values. All of these factors are affected by stress, which is the theme of this year’s Mental Health Awareness Week.
The menstrual cycle is a minefield of hormonal changes. Two main hormones that are involved with regulating menstruation are oestrogen and progesterone. Levels of oestrogen and progesterone vary across different points in the menstrual cycle and oestrogen levels are lower just after ovulation and before you bleed – the 'pre-menstrual' stage. It’s estimated that about 80% of people menstruating (possibly even more) experience at least one negative symptom as a direct consequence of these pre-menstrual hormones, like bloating, breast tenderness, tiredness or headaches1. Approximately 3% to 8% of menstruators experience a more debilitating form of pre-menstual syndrome (PMS), known as PMDD, Pre-Menstrual Dysphoric Disorder². Relatively little is known about PMDD but it’s thought that when PMS symptoms (like low mood and increased anxiety) start negatively impacting on someone’s work and their personal relationships, it’s indicative of PMDD rather than PMS and perhaps time to seek professional advice.
Low levels of oestrogen are also thought to have a knock on effect on other chemicals in the brain, like serotonin, which affects mood and thought processing and is often implicated in depression. Some common antidepressants (like citalopram and sertraline) work on the basis of trying to increase these serotonin levels in your brain, and low levels of oestrogen causing low serotonin levels could be part of the reason many people feel low in mood around the time of their period. Low serotonin is also known to be associated with craving carbohydrates, so there’s a scientific reason for your burning desire to mainline crisps and toast like there’s no tomorrow, when your period is due3. There are also a number of pretty common medical conditions including acne, irritable bowel syndrome, migraines, epilepsy and asthma which are known to worsen at certain points in someone’s menstrual cycle1.
The psychological and social influences over mental health often tend to be linked together as psychosocial factors. In a similar way to how one can be not in top physical health though not 'properly poorly', the same is true for feeling a bit under the weather with regards to your mental health. For those who frequently face challenges with their mental health, the day-to-day practicalities of periods can make things worse and can be significantly stressful.
The feasibility of frequently ducking out of meetings to run to the loo and change pads on a heavy flow day or the perpetual fear that you’ve bled through your favourite jeans again don’t offer much to keep anxiety at bay and equally, the crippling period pains experienced by roughly 90% of menstruators offer absolutely nothing by way of good mood vibes1. It’s also worth noting that intense stress itself (for example a significant life event such as a bereavement) can sometimes have a physical effect on the body and menstrual cycle, with some people experiencing unpredictable or delayed bleeding during stressful or difficult times.
In terms of social factors, cultural and religious values can also have a big impact on someone’s mental health. As the artist Maia Schwarz pointed out, “menstruation is the only blood that is not born from violence”, yet stigmatisation of menstruation coupled with the stigma surrounding mental health is still a problem in several cultures across the world and particularly in some religious communities.
A lack of social support (understanding friends, partners and family) tends to worsen feelings of loneliness and isolation and financial worries about accessing safe hygiene supplies are also incredibly problematic and not uncommon. As a doctor, I’ve encountered several people who have resorted to shoplifting in order to get pads or tampons they so desperately need every month. Some of them have ended up with a criminal record for doing so which has in turn had a knock-on effect on relationships and their ability to get a job. Having a value pack of tampons might not seem like much offhand, but they’re the Crown Jewels for someone for whom every penny means something and who is trying to get on with their life whilst continuously bleeding for days on end.
Despite everything discussed here, the bottom line is that your mental health is affected by lots of different factors – there are a whole array of things affecting how you feel and in the same vein, there are lots of different things you can try to find what works for you to improve your mental health. However, if you find yourself struggling with your health (mentally or physically), don’t presume it’s due to your period; there are myriad medical reasons that should be explored too and you should see your doctor. More information on PMS, PMDD and looking after your menstrual & mental health can be found at online at Mind, the Mental Health Foundation or the National Association for PMS, but these resources should not substitute seeking professional medical advice.
Dr Sarah Simons is a junior doctor from London with a professional interest in global and refugee health. She works full time in the NHS and has volunteered in Lesbos with an NGO providing urgent and primary healthcare for vulnerable refugees since 2017. She occasionally tweets at @SarahNSimons.
References
JV. Pinkerton, C. G.-P. (2010). Menstrual cycle-related exacerbation of disease. American Journal of Obstetrics & Gynaecology, 202(3), 221-231.
L. Hantsoo, C. N. (2015). Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Current Psychiatry Reports, 17(11), 87.
RJ. Wurtman, J. W. (1995). Brain serotonin, carbohydrate-craving, obesity and depression. Obesity Research, 3(4), 477-480.
Y. Nillni, D. T. (2011). Anxiety sensitivity, the menstrual cycle, and panic disorder: A putative neuroendocrine and psychological interaction. Clinical Psychology Review, 31(7), 1183-1191.