Illustration by Emma Günther
Mood changes and the menstrual cycle - PMS and PMDD
PMS is real, but it doesn’t change your entire personality
Top things to know about your mental health throughout your menstrual cycle:
You’re not alone if you experience noticeable physical and emotional changes during your cycle.
These changes can happen throughout the cycle, but most research has focused on premenstrual experiences.
People with cycles are not generally emotionally volatile before their periods, but hormone changes may increase or change pre-existing mental health conditions.
Mental Health Throughout the Menstrual Cycle
If you feel like a different version of yourself during the days leading up to your period, you’re not alone. Most people who have periods experience some changes in the week before menstrual bleeding happens (1). These changes might be physical, like bloating (2,3) or headaches, or emotional, like irritability or depressed mood (4). These experiences are commonly lumped together under the umbrella term premenstrual syndrome or PMS for short (4).
It’s common to throw around the term “PMS'' as though it’s a major affliction that renders people with periods incompetent for a week every cycle, but that’s just not true. While roughly 8 out of 10 people say they experience one or more premenstrual symptoms before their periods, only 1 out of 10 people experience premenstrual changes significant enough to meet the clinical definition of premenstrual syndrome (5). Sometimes, though, changes in how you feel are just a part of day-to-day life and not because of hormonal changes. Things like stress, what you eat, and changes in sleep patterns are more likely to be responsible than PMS (6).
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Does PMS cause mood swings?
Because bodies are unique, so are people’s individual premenstrual experiences. It’s common to have different premenstrual experiences from cycle to cycle (7). This might be because physical and emotional changes in the week before your period can be affected by what you eat, how much you exercise, and anything else you go through that could stress your body (7). This means that you could feel depressed and bloated before your period this cycle, but anxious and irritable the next cycle, while you felt nothing unusual the last cycle.
For most people with cycles, there’s no time during their cycle when changes in mood or behavior are so serious that they would cause a major personality change – but there is a small percentage of people whose severe premenstrual experiences might interfere with daily functioning, month after month (8).
According to The American College of Obstetricians and Gynecologists (ACOG), this is when a person meets the criteria for PMS (4).
Common Emotional Experiences of PMS:
Feeling depressed
Feeling anger
Being easily irritated
Crying more than usual
Feeling anxious
Feeling confused
Withdrawing from friends and family
Difficulty concentrating
Common Physical Experiences of PMS include:
Cravings
Pain or tenderness in the breasts
Bloating
Headaches
Swollen hands and feet
Unusual aches and pains
Tiredness
Changes in skin like new acne or sudden dryness
Digestive problems like constipation or diarrhea
Cramping
Trouble sleeping
PMS is an interesting concept because there isn’t a certain type of person who experiences it. Factors like age, education, and employment don’t seem to impact who reports PMS (9). There’s also not a clear pattern in how long most people experience PMS (9).
One study found that only about a third of people who were diagnosed with PMS could still be diagnosed with the condition one year after the initial diagnosis (9). In this study, people were more likely to experience PMS if they’d been through a stressful event within the past year (9).
The menstrual cycle and your mood
When we talk about “mood” or “mood swings” that change throughout a person’s cycle, what we are really talking about is a person’s mental health. This could be anything from depression to anxiety to irritability and a million other changes to how a person feels. But here’s the thing – when people report severe mood swings in the days before and during the period, these changes do not come out of nowhere. Instead, they usually reflect a change in an already occurring mental health experience (10). This means that a person who has never experienced depression isn’t going to suddenly wake up the day before their period with extreme depressive symptoms, but a person with a history of depression is more likely to (10).
This is called premenstrual magnification or premenstrual exacerbation. People who live with some conditions like psychosis, mania, depression, suicidal thoughts or attempts, and alcohol use disorder have reported sharp increases in symptoms of their condition in the days before and during the period (11). People who have never experienced these concerns are unlikely to have a sudden new onset of a mood that is unusual to them (11). Some science supports the idea that anxiety, stress, and binge eating might be more noticeable or severe during the luteal phase, or the second part of the menstrual cycle, between ovulation and menstruation (11).
How hormones change throughout the menstrual cycle
The menstrual cycle is more than just the period – it starts on the first day of the period and ends the day before the next period. People think of the average menstrual cycle as 28 days long, but cycles are unique to every person and can be shorter or longer (12). The uterus and ovaries both change throughout each cycle thanks to changes in the levels of hormones in the body (11). The uterus gets thicker and thinner and the ovaries go through the process of ovulation (11). Hormones instruct the brain to send messages to the ovaries and uterus to make changes throughout the cycle (11).
While there are a number of hormones that change throughout the menstrual cycle, for the purpose of this article we are primarily discussing the reproductive hormones estrogen and progesterone (11). Throughout the cycle, levels of estrogen and progesterone go up and down (11). During menstruation, levels of estrogen and progesterone are typically at their lowest. Estrogen peaks just before ovulation happens (11), then drops right after. After ovulation, if the egg and sperm connect, a hormone called progesterone is produced to support early pregnancy (11). If there isn’t a pregnancy, progesterone will peak and then drop sharply. Next, menstrual bleeding (the period) and a new cycle begins, with estrogen and progesterone at their lowest again (11).
How hormones impact mental health and mood
The fluctuations of estrogen and progesterone are believed to impact physical and mental well-being in some people throughout the cycle. The sharp drop in progesterone, in particular, is one theory that some scientists support as the cause of the physical and emotional changes before, during, and after the period, commonly called PMS (13,14). Other academics believe this theory has been disproven as taking progesterone during this phase does not prevent symptoms (14, 15).
Like many reproductive health issues, though, researchers still can’t say exactly why PMS happens. It is important to understand that even science sometimes makes assumptions about the connection between hormones and mood. Here are some possible explanations that have been used in scientific research:
Physical pain can impact mood: Periods can cause physical pain and intense discomfort. Some people have cramps, sore breasts, and joint pain. Any of these types of pain could impact a person’s mood, causing irritability and lower self-esteem (16).
Social isolation: Some studies have shown that during adolescence, having your period might cause a person to socially isolate. Whether this is because of physical or emotional factors is unclear. Social relationships are very important to teens, and one study showed that this disruption might be associated with suicide attempts in teen girls (17).
Poor memory and brain fog: Estrogen is believed to be associated with increased activation of the hippocampus, the part of the brain that takes things a person learns and stores them in their long-term memory. Decreases in estrogen might result in poorer memory, making it harder to learn new things. It might also be harder to remember things, resulting in brain fog (18).
Anxiety: Studies have shown that progesterone might improve anxiety, which means when there are lower levels of progesterone, you might feel more anxious (19).
Feelings of panic: If a person is feeling especially stressed, progesterone can be converted into cortisol, a hormone known as “the stress hormone” (20). Increased levels of cortisol can make your body feel like it is in danger, creating a sense of panic.
Researchers think all of these factors might combine together to create a snowball effect, creating PMS.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are two terms you’ve probably heard. Some people consider them controversial concepts because as we mentioned earlier, they may be more cultural than medical (21). Some researchers believe that PMS and PMDD are just variations in human reproductive patterns instead of illnesses or diseases (22). It is interesting that hormonal fluctuations throughout the cycle are largely reported to be negative experiences, and much research hasn’t been done on the positive changes that happen throughout the cycle.
In general, PMS is a very broad umbrella term that doesn’t have much specific meaning because it has been used in so many contexts over time. It can be used to refer to physical symptoms, emotional symptoms, or just changes that are mostly neutral or don’t impact life that much. Since the majority of people with cycles experience these changes throughout their cycle (23), PMS is not an accurate term for what seems to be just “experiencing life as a person who menstruates.”
Premenstrual dysphoric disorder (PMDD), on the other hand, is a severe emotional reaction to the expected and common hormonal changes of the menstrual cycle. It’s experienced by up to 7 in 100 people with cycles (24).
PMDD is a cluster of more severe and uncomfortable experiences like depression, irritability, and stress. The changes are so severe that a person might miss work, cancel plans, or be unable to engage with loved ones. It’s believed that people with PMDD have a brain that is particularly sensitive to the changing levels of estrogen and progesterone throughout the cycle (23).
Does ovulation make you emotional?
Ovulation is a major event in the menstrual cycle that occurs when hormones cause the release of an egg from one ovary, into your fallopian tube (25). Like your period, the timing of ovulation can vary from cycle to cycle and differ between people (26). You can get all the details of the hormonal changes surrounding ovulation, including how and why they happen in our Ovulation 101 article.
Hormonal changes are believed to contribute to premenstrual symptoms and the majority of research around cycles and mood focuses on the time before and during the period. However, it has been found that a small proportion of people with PMS may experience a burst of symptoms around ovulation (23). Other research has found that more people may experience positive mood changes around ovulation. One study that looked at mood during the different menstrual cycle phases found that ovulation was linked with good mood (29). Another small study reflected the same results (28). Interestingly, one study found that people feel more attractive during ovulation (30). How you feel during ovulation is probably unique to you, and how you respond to the changing hormones during this time of your cycle. More research on mood during ovulation is needed.
Am I really so emotional on my period?
So, to sum things up, while a small percentage of people may experience severe premenstrual symptoms, not everyone experiences mood changes before or during their period. Not everyone experiences PMS. People who do experience period or premenstrual mood swings are not volatile and are likely experiencing an exacerbation of something they are already dealing with. Why is this an important distinction? Unfortunately, medicine has a history of pathologizing the female reproductive system (15). Some scholars believe that PMS is a construct that promotes the idea that women and people with cycles are irrational because their hormones are out of control (15). This sets up the myth that women and people with cycles are overly emotional and aren’t able to reason as well as men (15). In fact, one study found more evidence of similarities than differences between women and men, and between naturally cycling women and those using oral contraceptives; any differences were reported as likely being small, suggesting that ovarian hormones do not significantly influence emotional variability in women compared to the factors that affect men's daily emotions (31).
This doesn’t mean that PMS or PMDD aren’t real, though. Every body is unique and has unique experiences. Overall, more research is needed to truly understand the connections between hormones and mood. You can track your feelings, social life, sleep, and any physical changes throughout your menstrual cycle in the Clue app, to find out if you experience premenstrual changes, and determine what is true for you.
How Clue helps you better understand your feelings
Clue reminds you to check in on your feelings each day so you can better understand how your feelings change throughout your menstrual cycle. When you subscribe to Clue Plus, you can find out when you typically experience each feeling in your menstrual cycle in the Analysis Tab. This will help you identify patterns and know what to expect, at each phase of your cycle. You can also learn more about what else you’ve tracked, together with these feelings to help identify influencing factors. For example, you might feel happy and energetic on days you practice yoga.
Remember, you’re not alone if you experience noticeable physical and emotional changes during your cycle. If you feel like your mental health is impacting your personal and/or professional life, reach out to a healthcare provider to discuss your options.
