After delving into multiple studies to identify links between hormonal activity during a woman’s menstrual cycle and the negative physical and psychological symptoms experienced by many, such as bloating, breast soreness, muscular pain, anger, irritation, stress, and a desire for isolation, I found the data to be mixed and somewhat unreliable. This is frustrating, both for my desire to provide solid biological insights and for the many women who struggle with mood and physical challenges before their period. However, it is clear that many women do experience significant psychological and physical changes during their menstrual cycle. A significant study, analysing 241 million observations from 3.3 million women across 109 countries, used a women’s health mobile app to track 15 dimensions of mood, behaviour, and vital signs. It found that mood, vital signs, and sexual behaviour varied most significantly over the menstrual cycle, whereas sleep and exercise behaviour were more stable. The menstrual cycle had the most substantial impact on most of these dimensions, and these effects were directionally consistent across countries (Pierson, et al., 2021). This is something many of us can relate to, myself included.
Personally, I was fortunate to start menstruating at 16 and a half years old and rarely suffered from the common physical and psychological symptoms throughout most of my life. My main issue was being diagnosed with Polycystic Ovary Syndrome (PCOS) at 18, leading to irregular periods. I often went months without menstruating, which didn’t particularly bother me—in fact, I felt lucky compared to others who suffered from mood swings and painful periods. It was only after the birth of my second child (a son, though I’m not sure if that’s relevant) that my cycle became more regular. With this regularity came noticeable changes in my tolerance for stress and irritability. Just yesterday, an unexpected bout of irritation and anger, following a week of optimism and drive, made me check the calendar, only to realise I was about five days from starting my period.
So, what are the mechanisms of menstrual cycle?
In short, about every 28 days a biological woman’s ovaries release an egg. The egg moves down to the uterus where it sits on a thick, spongy bed of lining waiting to be fertilised by a sperm. If there’s no sperm, the egg and the lining is released, and this is what is known as a ‘period’.
Hormones during the menstural cycle
The widespread consensus is that hormones significantly influence mood. In preparing for this post, my research concentrated on identifying the specific hormones involved in the menstrual cycle, understanding their interactions, and exploring how fluctuations in hormone levels or these interactions contribute to the physical and psychological changes experienced by many women during their menstrual cycle.
Functions of hormones during the menstural cycle
The pituitary gland (a small, pea-sized gland found at the base of your brain that tells other glands in your body what to do) releases the follicle stimulating hormone (FSH) which travels in your bloodstream to the ovaries in order to mature an egg. It also triggers the hormone oestrogen which creates the thick, spongy lining in your uterus and stops the pituitary gland from releasing more FSH.
At this point, the pituitary gland begins to excreet the luteinizing hormone (LH) instead (peek levels of LH at around day 14) which triggers ovulation (realeases the egg from the overies). At this point, the ovaries now produce the hormone progesterone which keeps the uterus lining thick for fertilisation and stops the pituitary gland from releasing any more FSH and LH (to prevent more eggs being released).
At what phase of the menstrual cycle do the challenges occur
Most the of the studies show that any psychological or physical changes found during the mentsural cycle usually happen within the luteal phase of the menstural cycle. The luteal phase happens in the second part of your menstrual cycle. It begins around day 15 of a 28-day cycle and ends when you get your period. The luteal phase prepares your uterus for pregnancy by thickening your uterine lining. A long luteal phase is the opposite of a short luteal phase. It means your period comes 18 days or later after ovulation. People with a long luteal phase may have a hormonal imbalance like PCOS (polycystic ovary syndrome).
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD)
Premenstrual syndrome (PMS) is a constellation of physical and psychological symptoms that start during the luteal phase of the menstrual cycle or 1 to 2 weeks before the onset of the menstrual cycle. Once symptoms of PMS become severe, patients are diagnosed with premenstrual dysphoric disorder (PMDD). The latter is one I had not heard of before, so I searched YouTube to find some information and found some good videos that give a little more insight into the condition. You can view these below.
I searched for some research around this and I found: 1. a strong association between early life trauma and PMDD. Emotional abuse and/or chronic trauma across childhood may be most strongly associated with PMDD (Kulkarni et al., 2022);
2. Findings from a large prospective study suggest that early life emotional and physical abuse increase the risk of PMS in the middle-to-late reproductive years. The persistence of associations after control for potential confounders and mediators supports the hypothesis that early life abuse is importantly related to PMS. (Bertone-Johnson et al., 2014);
3. a study in Turkey concluded that both clinicians and researchers should be alert for PMDD when they detect a history of child abuse in female patients (Soydas et al., 2014).
Physical symptoms of PMS and PMDD
Bloating, weight gain, swelling of the fingers and ankles, Breast soreness, Headaches, Increased appetite, Food cravings, Increased acne, Constipation, Dizziness, Fatigue, Muscle aches and pain, Palpitations.
Psychological symptoms of PMS and PMDD
Irritability, Depression, Anxiety, Mood swings, Anger.
The science – what can we detect from studies around the biological effects of the menstrual cycle?
Many studies lean towards the conclusion that conditions such as PMS and PMDD are due to fluctuations of hormones such as oestrogen and progesterone (Pinkerton, 2023, Khasanova, 2022) – the dominant thinking is that cyclic changes in the ovarian steroids estrogen and progesterone cause changes in many body systems, including brain neurotransmitters, which then have emotional and physical manifestations. Functional magnetic resonance imaging (MRI) supports this as a plausible etiology (Katzinger and Hudson, 2020).
Serotonin deficiency is also thought to contribute because women who are most affected by PMS have lower serotonin levels and because selective serotonin reuptake inhibitors (SSRIs), which increase serotonin, sometimes relieve symptoms of PMS (Pinkerton, 2023; Khasanova, 2022; Parry, et al., 2009.).
A study also showed that, during the luteal phase, HPA axis (involves the central nervous system and the endocrine system adjusting the balance of hormones in response to stress) function is lower and urinary cortisol concentrations were significantly lower (Symonds, et al. 2004). Suppression of the HPA axis results in inadequate cortisol production. Cortisol is the natural stress hormone found in humans. When this hormone is produced insufficiently, response to stressors may be impaired and defences may be inadequate. Too little cortisol may be due to a problem in the pituitary gland (that gland that kicks off the menstural cycle!) or the adrenal gland. Symptoms may include fatigue, dizziness (especially upon standing), weight loss, muscle weakness, mood changes and the darkening of regions of the skin (NHS, cited in Jones, et al., 2021).
From my analysis, if the suppression of the HPA axis during the luteal phase of the menstrual cycle leads to reduced cortisol production, this could be connected to the symptoms of fatigue and mood changes commonly observed in PMS and PMDD.
A little more science
There are several brain chemicals, beyond just hormones, that might play a role in PMS and PMDD. These include the adrenergic system (related to adrenaline), opioid system (related to pain relief and mood), and the GABA system (which helps control fear and anxiety). One study suggests that altering the metabolic pathway of progesterone to reduce the production of its metabolite, allopregnanolone, can have a positive effect on PMDD symptoms. This alteration caused a significant reduction in core symptoms among women with PMDD, including irritability, sadness, anxiety, food cravings, and bloating, with 75% of women enrolled in the study no longer meeting the criteria for PMDD after 1 month of active treatment (Katzinger and Hudson, 2020). The study highlights the potential significance of the hormone progesterone in PMDD.
Furthermore, a disorder involving your luteal phase can affect getting and staying pregnant. It would be beneficial to have some more research around whether biological women who suffer with PMS or PMDD also have trouble conceiving and staying pregnant.
While there seems to be a correlation between biological changes during the luteal phase of the menstrual cycle and their sometimes significant impact on a woman’s psychology and physiology, solid evidence pinpointing the specific hormones responsible and their mechanisms remains elusive. This complexity arises from the vast differences in individual cycles, cellular makeup, hormone levels, etc. Discovering a universal remedy for PMS and PMDD seems improbable due to the need for extensive data to develop generalised treatments. However, it’s crucial that this topic remains a focus and continues to be taken seriously in scientific research.
I hope this post has provided you with deeper insights into the menstrual cycle and suggested some potential areas for exploration so you can learn about potential coping strategies, especially if you experience monthly discomfort. Recognising that we are undergoing a biological process can often help in understanding that our feelings and experiences are not irrational.
References
Bertone-Johnson ER, Whitcomb BW, Missmer SA, Manson JE, Hankinson SE, Rich-Edwards JW. Early life emotional, physical, and sexual abuse and the development of premenstrual syndrome: a longitudinal study. J Womens Health (Larchmt). 2014 Sep;23(9):729-39. doi: 10.1089/jwh.2013.4674. Epub 2014 Aug 6. PMID: 25098348; PMCID: PMC4158950.
Jones C, Gwenin C. Cortisol level dysregulation and its prevalence-Is it nature’s alarm clock? Physiol Rep. 2021 Jan;8(24):e14644. doi: 10.14814/phy2.14644. PMID: 33340273; PMCID: PMC7749606.
Joseph Katzinger, Tori Hudson, 212 – Premenstrual Syndrome, Editor(s): Joseph E. Pizzorno, Michael T. Murray, Textbook of Natural Medicine (Fifth Edition), Churchill Livingstone, 2020, Pages 1739-1747.e3,
ISBN 9780323523424, https://doi.org/10.1016/B978-0-323-43044-9.00212-0.
Khasanova, D. (2022). PREMENSTRUAL SYNDROME IN THE MODERN SCIENCE. International Bulletin of Medical Sciences and Clinical Research, 2(12), 16–22. Retrieved from https://www.researchcitations.com/index.php/ibmscr/article/view/373
Jayashri Kulkarni, Olivia Leyden, Emorfia Gavrilidis, Caroline Thew, Elizabeth H.X. Thomas,
The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD), Psychiatry Research,
Volume 308, 2022, 114381, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2021.114381.
B.L. Parry, S. Nowakowski, L.F. Martinez, S.L. Berga, 94 – Premenstrual Dysphoric Disorder, Editor(s): Donald W. Pfaff, Arthur P. Arnold, Anne M. Etgen, Susan E. Fahrbach, Robert T. Rubin, Hormones, Brain and Behaviour (Second Edition), Academic Press, 2009, Pages 2945-2974, ISBN 9780080887838, https://doi.org/10.1016/B978-008088783-8.00094-2.
Pierson, E., Althoff, T., Thomas, D. et al. Daily, weekly, seasonal and menstrual cycles in women’s mood, behaviour and vital signs. Nat Hum Behav 5, 716–725 (2021). https://doi.org/10.1038/s41562-020-01046-9
Pinkerton, J, V. (Jan 2023). Premenstrual Syndrome (PMS). MSD Manual. Available at: https://www.msdmanuals.com/en-gb/professional/gynecology-and-obstetrics/menstrual-abnormalities/premenstrual-syndrome-pms#v44228004 (Accessed 15.01.23)
Soydas EA, Albayrak Y, Sahin B. Increased childhood abuse in patients with premenstrual dysphoric disorder in a Turkish sample: a cross-sectional study. Prim Care Companion CNS Disord. 2014 Jul 24;16(4):10.4088/PCC.14m01647. doi: 10.4088/PCC.14m01647. PMID: 25664213; PMCID: PMC4318673.
SYMONDS CS, GALLAGHER P, THOMPSON JM, YOUNG AH. Effects of the menstrual cycle on mood, neurocognitive and neuroendocrine function in healthy premenopausal women. Psychological Medicine. 2004;34(1):93-102. doi:10.1017/S0033291703008535