Photography by Natalie Rose Dodd. Art direction by Marta Pucci.
The brain, emotion, and the menstrual cycle: What science tells us
We spoke to Anne Marieke, a researcher of hormonal contraceptives and the menstrual cycle, about how hormonal changes affect your mood
You may have noticed that how you’re feeling changes over the course of your cycle. If you’ve been tracking with Clue, you might have already discovered some patterns.
There are also people researching how our feelings change across the menstrual cycle, and how the brain itself is changed by the hormones released during the cycle.
We spoke to Anne Marieke Doornweerd, a PhD candidate at Utrecht University, to learn more about emotions and the brain. Anne Marieke researches the role of the menstrual cycle and hormonal contraceptives in emotions and psychological well-being. Having worked as a psychologist and scientist, Anne Marieke is passionate about advancing research and making information about hormone-related mental health more accessible.
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Hi Anne Marieke, nice to meet you! Tell us a little bit about yourself and your research.
Hi there! My curiosity about the mind-body connection started during summers working in nursing homes, where I saw how the brain can affect how we feel, think, and act. This led me to study biology, neuroscience, and psychology at university. In my current PhD position, I am studying the effects of hormonal contraceptives and the menstrual cycle on emotions. We have looked at how depression and anxiety symptoms develop throughout puberty, and we have also measured participants in the lab using psychophysiological measures that respond to emotions (such as brain waves, sweat, and heart rate), as well as daily hormones and symptom ratings.
The mind-body connection is especially relevant when it comes to the mental health of people with cycles. We have been taught from an early age to ignore and downplay our bodily signals, to just deal with the pain during our periods, and have been exposed to endless negative messages about being "hormonal".
It's particularly fascinating to study reproductive hormones in this context because they affect the brain as well as the rest of the body. From the start of my project, I've been surprised by how little science-based information on this topic exists and how little those whose mental health is affected by a monthly cycle know about it. I’m hoping that my research can help fill in some of the gaps in knowledge and bring attention to the link between hormones and mental health.
So reproductive hormones, which are responsible for my menstrual cycle, can also impact how the brain processes emotions. Could you tell us how someone might notice mood changes during their menstrual cycle?
The menstrual cycle is regulated by several reproductive hormones, particularly estradiol and progesterone. Many women and people with cycles report that their well-being (mental and physical) gets worse during the progesterone-dominant luteal phase, which is when they experience premenstrual symptoms (PMS). It’s thought that these PMS symptoms are triggered by your body’s response to the changes in hormones (1).
Research has traditionally focused on the physical symptoms associated with the menstrual cycle, especially during menstruation. PMS symptoms, which usually show up about a week before your period starts and then subside after a few days of bleeding, include not only physical symptoms like bloating, sore breasts, and tiredness but also behavioral and mood changes like irritability, mood swings, anxiety, and food cravings (1,2). However, the menstrual cycle also has positive effects; around ovulation, you may experience increased pleasure, assertiveness, positivity, and sexual desire (3–6). Psychological well-being is complex, with hormones playing a small part for most people, influenced by factors like stress and sleep. There’s also an indirect effect your hormones can have on your mind through your body; feeling tired can make you feel worse mentally. Understanding the relationship between hormones and mental health is crucial for understanding overall well-being.
But why is it that one person can experience severe mental health changes during their cycle, and another may barely notice anything?
It's important to note that most people who are ovulating don't notice major issues related to their menstrual cycle. About 50-70% of those with a menstrual cycle do experience PMS symptoms (7–9), but clinically significant effects are experienced by a subset of only 7%. They suffer from severe emotional, cognitive, and behavioral changes as part of premenstrual dysphoric disorder (PMDD) (10).
We're still not sure why some people are more "hormone-sensitive" than others. While hormone levels may be similar, some people’s brains respond more intensely to hormonal fluctuations. Factors like personality disorder traits, life stress, and a history of abuse or childhood trauma (11–14) are associated with an increased risk for PMDD. However, more research is needed to fully understand hormone sensitivity.
So how do reproductive hormones communicate with the brain?
Exactly how reproductive hormones contribute to psychological well-being is still unclear, but we know they have widespread effects beyond the reproductive system, impacting the brain. There are different ideas of how these effects may happen.
Firstly, reproductive hormones can bind to receptors in brain regions tied to emotions, such as the amygdala, cerebral cortex, hippocampus, and hypothalamus. It’s been shown that reproductive hormones are linked to changes in brain shape and function in these brain regions, and could theoretically lead to changes in emotion processing, emotion regulation, fear, learning, and memory (15–17).
Additionally, estradiol can increase levels of serotonin and dopamine, which are neurotransmitters linked to happiness and pleasure (18,19). This is why you might feel happier around ovulation when estradiol levels are higher. Similarly, progesterone can be broken down in the body into something called allopregnanolone, which acts on GABA, a neurotransmitter that functions like a natural Xanax, and can make you feel calmer and less anxious (20). However, in some people, the sudden surge of estradiol and progesterone in the luteal phase can lead to mood changes, including increased anxiety and mood swings. The drop in these reproductive hormones in the late luteal phase can lead to a reduction in serotonin and dopamine, meaning less pleasure.
How do hormones influence brain structure and function?
The “28andMe” project in Santa Barbara demonstrated how hormonal fluctuations during the menstrual cycle can affect brain shape and function. One researcher’s brain was scanned daily for an entire cycle, revealing that reproductive hormones influence communication between different parts of the brain and alter the shape of the medial temporal lobe (MTL), which is involved in cognition and emotion (17,21). We don’t yet know exactly what effects these changes have and how they might differ between individual people, but it is clear the brain is continuously adapting to a wide range of stimuli, including the menstrual cycle. It’s important to remember that the menstrual cycle is one of many things the brain responds to–it has even shown changes after learning how to juggle (22)!
Why do we know so little about reproductive hormones and mental health?
There hasn’t been enough research on this topic, which is in line with the fact that women's health has been overlooked for a long time. It is well known that women are at greater risk for depression and anxiety disorders compared to men (23). In 2019, only 5% of neuroscience and psychiatry papers examined sex differences, and nine times as many studies focused solely on male participants compared to female-only studies (24). This has resulted in a knowledge gap in understanding how female-specific biological processes like the menstrual cycle affect mental health. The stereotype that the menstrual cycle introduces a lot of “noise” in data has historically led to the exclusion of women from research (25,26), however, recent animal and human studies have shown that this isn’t true (27–30). These studies confirm that for numerous measures, including emotional variability and various neuroscience-related traits, females aren't more variable than males– sometimes, they even show less variability.
Besides the general importance of menstrual cycles for science and society, how can people with menstrual cycles benefit from the research you are working on?
It's inspiring to see how science can validate experiences with often taboo topics like the menstrual cycle and mental health. As more research is done, the negative connotation of the menstrual cycle can be replaced with more nuanced views, recognizing that it clinically affects only a subset of people, and can even have a positive effect on mental well-being. This understanding helps destigmatize the cycle and better support those who are sensitive to hormonal changes. Knowing how your cycle affects you can empower you to manage your mental health better, avoid over-interpreting bodily signals, and make informed decisions. It's fine if you notice that your menstrual cycle doesn't affect you. The point is that everybody is different, and it can be helpful to figure out what the biggest factors are that contribute to your overall well-being, whether they are related to hormones or not. Being human means being hormonal, and we shouldn't forget that this applies to men too. Overall, it's good to see that science is making progress, but there's still a long way to go!
Not sure whether your mental health is affecting your cycle? Clue can help you track how you feel, your stress levels, energy, sleep, and more. Clue reminds you to check in on your feelings each day so you can better understand how they change throughout the menstrual cycle. If you are subscribed to Clue Plus, you can find out when in your menstrual cycle you most frequently experience each feeling in the Analysis Tab. This can help you identify patterns and know what to expect, at each phase of your cycle. You can also learn more about what you’ve tracked, together with these feelings, to help identify influencing factors.
