Menstruation and mental health

Menstruation and mental health are closely connected, as hormonal fluctuations throughout the menstrual cycle influence mood, cognition, and emotional well-being. Many individuals experience mood swings, irritability, anxiety, and depression in the days leading up to menstruation, a cluster of symptoms commonly referred to as premenstrual syndrome (PMS). In more severe cases, individuals may develop premenstrual dysphoric disorder (PMDD), a condition characterized by intense mood disturbances, cognitive impairments, and somatic symptoms that follow a cyclical pattern. Additionally, menstruation can exacerbate preexisting mental health conditions. The interplay between hormonal changes, neurochemical activity, and psychological health has been a growing focus of scientific research and public discourse.

## Premenstrual disturbances

[edit]

The period before menstruation, known as the premenstrual phase, is often linked to emotional distress. Conditions related to the menstrual cycle encompass premenstrual tension syndrome, premenstrual dysphoric disorder, and the exacerbation of another medical condition during the premenstrual phase.[1]

Menstruation is linked to a range of psychopathological symptoms, such as lower self-esteem, increased anxiety, dysphoria, and feelings of being persecuted.[2] Changes in behavior, like decreased social interaction during menstruation, can lead to feelings of loneliness and potentially contribute to the development of depression.[3] Several reviews have reported that psychopathological symptoms and mental disorders, such as psychoses, suicidal tendencies,[4] post-traumatic stress disorder,[5] and addictive behaviors,[6] tend to worsen during menstruation.[7][8] Variations in ovarian hormone levels are also linked to the presence of symptoms related to eating disorders.[9][10][11] Some comprehensive studies have indicated that women might be at a higher risk of suicide during menstruation.[4] The symptoms occurring during menstruation can have a significant impact on mental health and lead to severe consequences.[4][12]

### Premenstrual tension syndrome

[edit]

Main article: Premenstrual syndrome

Premenstrual tension syndrome is a condition marked by particular metabolic, environmental, or behavioral factors that arise during the luteal phase of the menstrual cycle.[13] It results in recurring somatic, behavioral, or affective symptoms that disrupt a person's daily life.[14] While the quality of studies and their findings in this area can vary, it's common for women to report symptoms like mood swings, depression, tension, irritability, and anger occurring before their period.[4]

### Premenstrual dysphoric disorder

[edit]

Main article: Premenstrual dysphoric disorder

Premenstrual dysphoric disorder is an affective disorder characterized by emotional, cognitive, and somatic symptoms that consistently occur in the days leading up to menstruation and improve shortly after it begins. These somatic symptoms encompass joint pain, overeating, and lethargy, while cognitive symptoms involve forgetfulness and difficulty concentrating. Mood-related symptoms consist of irritability and depression.[15] Studies evaluating the use of combined oral contraceptive pills containing both progesterone and estrogen have demonstrated their effectiveness in alleviating the symptoms of premenstrual dysphoric disorder.[16]

### Comorbidity

[edit]

Premenstrual disorders are usually comorbid with many psychiatric conditions, suich as anxiety and personality disorders. Psychotic symptoms tend to worsen when estrogen levels drop during the premenstrual period, leading to increased psychiatric admissions for women with schizophrenia just before and during their menstrual cycles.[17] Estrogen may have a neuroprotective role by influencing neurotransmitters such as serotonin, dopamine, and norepinephrine. These are all associated with mood regulation, which is how psychotic symptoms could worsen.[18][19] Another contributing factor to the higher incidence of schizophrenia onset in midlife women may be the reduced estrogen levels associated with menopause.[17] In women with bipolar disorder, especially bipolar II disorder, premenstrual syndrome and premenstrual dysphoric disorder are common.[17] For those women who experience these premenstrual conditions, bipolar affective symptoms and mood swings may be more severe.[17]

## Menstrual psychosis

[edit]

Menstrual psychosis was documented in the mid-19th century and has been extensively discussed in numerous articles. However, it is not widely recognized or diagnosed by modern psychiatrists. The earliest clear clinical descriptions of this condition emerged in French literature around 1850, with most well-documented cases appearing in German literature between 1880 and 1930.[20] As per British psychiatrist Ian Brockington, diagnosing menstrual psychosis requires specific criteria to be met, including symptoms recurring in sync with the menstrual cycle, acute onset against a background of normality, a brief duration followed by complete recovery, and the presence of psychotic features such as delusions, hallucinations, confusion, mutism, stupor, or manic syndrome.[21][20][22] Menstrual psychosis is not formally classified, however, new studies and clinical reports continue to explore how hormonal fluctuations in estrogen and progesterone could trigger symptoms.[23] Management for menstrual psychosis typically focuses on hormonal therapy, antipsychotic medications, and mood stabilizers, although standardized treatment guidelines have not been established.[24][25]

## Daily life impact

[edit]

Menstruation affects many individuals' daily lives beyond certain mental disorders. A survey conducted with over 42,000 women found that common menstruation symptoms, such as stress and fatigue, caused women to be impacted significantly in their daily lives.[26] These symptoms meant that individuals had to prepare for their lives in advance because of the possible challenges that could be experienced by them. In high-pressure environments such as the workplace or school, menstruation can cause extra stress and affect productivity and engagement.[27] Menstruation can present daily challenges that affect how someone may do their usual routine.

Furthermore, menstruation causes additional stress because of the access that someone may have to menstrual products and healthcare.[28] Socioeconomic factors have a major role in the access to these products and whether someone has the proper means to deal with their menstruation-related symptoms and menstrual disorders.[29] People may experience heavier menstrual flow or migraines and may lack the access to treatment if they are from a lower socioeconomic status, which is shown in period poverty. These disparities show how menstruation-related mental health challenges can be affected by social and economic status.[29][30]

## See also

[edit]

* Miscarriage and mental disorders
* Psychiatric disorders of childbirth

## References

[edit]

1. ^ Yonkers, Kimberly Ann; Simoni, Michael K. (2018). "Premenstrual disorders". American Journal of Obstetrics and Gynecology. 218 (1): 68–74\. doi:10.1016/j.ajog.2017.05.045. ISSN 0002-9378. PMID 28571724. S2CID 21125434.
2. ^ Brock, Rosalind; Rowse, Georgina; Slade, Pauline (2015-08-11). "Relationships between paranoid thinking, self-esteem and the menstrual cycle" (PDF). Archives of Women's Mental Health. 19 (2): 271–279\. doi:10.1007/s00737-015-0558-4. ISSN 1434-1816. PMID 26260035. S2CID 9161510.
3. ^ van Iersel, Kirsten C.; Kiesner, Jeff; Pastore, Massimiliano; Scholte, Ron H.J. (2016-03-24). "The impact of menstrual cycle-related physical symptoms on daily activities and psychological wellness among adolescent girls". Journal of Adolescence. 49 (1): 81–90\. doi:10.1016/j.adolescence.2016.03.007. hdl:2066/157226. ISSN 0140-1971. PMID 27017504.
4. ^ a b c d Jang, Daisung; Elfenbein, Hillary Anger (2018-05-14). "Menstrual Cycle Effects on Mental Health Outcomes: A Meta-Analysis". Archives of Suicide Research. 23 (2): 312–332\. doi:10.1080/13811118.2018.1430638. ISSN 1381-1118. PMID 29461935.
5. ^ Nillni, Yael I.; Rasmusson, Ann M.; Paul, Emilie L.; Pineles, Suzanne L. (2021-01-06). "The Impact of the Menstrual Cycle and Underlying Hormones in Anxiety and PTSD: What Do We Know and Where Do We Go From Here?". Current Psychiatry Reports. 23 (2): 8. doi:10.1007/s11920-020-01221-9. ISSN 1523-3812. PMC 8819663. PMID 33404887.
6. ^ Joyce, Kayla M.; Good, Kimberley P.; Tibbo, Philip; Brown, Jocelyn; Stewart, Sherry H. (2021-01-06). "Addictive behaviors across the menstrual cycle: a systematic review". Archives of Women's Mental Health. 24 (4): 529–542\. doi:10.1007/s00737-020-01094-0. ISSN 1434-1816. PMID 33404701. S2CID 230783638.
7. ^ Handy, Ariel B.; Greenfield, Shelly F.; Yonkers, Kimberly A.; Payne, Laura A. (2022). "Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review". Harvard Review of Psychiatry. 30 (2): 100–117\. doi:10.1097/hrp.0000000000000329. ISSN 1465-7309. PMC 8906247. PMID 35267252.
8. ^ Barron, Mary Lee; Flick, Louise H.; Cook, Cynthia A.; Homan, Sharon M.; Campbell, Claudia (2008). "Associations Between Psychiatric Disorders and Menstrual Cycle Characteristics". Archives of Psychiatric Nursing. 22 (5): 254–265\. doi:10.1016/j.apnu.2007.11.001. ISSN 0883-9417. PMC 2588420. PMID 18809118.
9. ^ Edler, Crystal; Lipson, Susan F.; Keel, Pamela K. (2006-10-12). "Ovarian hormones and binge eating in bulimia nervosa". Psychological Medicine. 37 (1): 131–141\. doi:10.1017/s0033291706008956. ISSN 0033-2917. PMID 17038206. S2CID 36609028.
10. ^ Klump, Kelly l.; Gobrogge, Kyle l.; Perkins, Patrick s.; Thorne, David; Sisk, Cheryl l.; Breedlove, S. Marc (2005-12-12). "Preliminary evidence that gonadal hormones organize and activate disordered eating". Psychological Medicine. 36 (4): 539–546\. doi:10.1017/s0033291705006653. ISSN 0033-2917. PMID 16336745. S2CID 15401026.
11. ^ Klump, Kelly L.; Keel, Pamela K.; Racine, Sarah E.; Burt, S. Alexandra; Neale, Michael; Sisk, Cheryl L.; Boker, Steven; Hu, Jean Yueqin (2013). "The interactive effects of estrogen and progesterone on changes in emotional eating across the menstrual cycle". Journal of Abnormal Psychology. 122 (1): 131–137\. doi:10.1037/a0029524. ISSN 1939-1846. PMC 3570621. PMID 22889242.
12. ^ Saunders, Kate E. A.; Hawton, Keith (2006-03-30). "Suicidal behaviour and the menstrual cycle". Psychological Medicine. 36 (7): 901–912\. doi:10.1017/s0033291706007392. ISSN 0033-2917. PMID 16573848. S2CID 32453613.
13. ^ Gudipally, Pratyusha R.; Sharma, Gyanendra K. (2025), "Premenstrual Syndrome", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32809533, retrieved 2025-04-11
14. ^ "ICD-11 for Mortality and Morbidity Statistics. GA34.40 Premenstrual tension syndrome". ICD-11. Retrieved 2023-09-05.
15. ^ "ICD-11 for Mortality and Morbidity Statistics. GA34.41 Premenstrual dysphoric disorder". ICD-11. Retrieved 2023-09-05.
16. ^ Lopez, Laureen M; Kaptein, Adrian A; Helmerhorst, Frans M (2012-02-15). "Oral contraceptives containing drospirenone for premenstrual syndrome". Cochrane Database of Systematic Reviews (2): CD006586. doi:10.1002/14651858.cd006586.pub4. ISSN 1465-1858. PMID 22336820.
17. ^ a b c d Diagnostic and statistical manual of mental disorders: DSM-5-TR. Washington, DC: American Psychiatric Association Publishing. 2022. pp. 119, 148, 160. ISBN 978-0-89042-575-6.
18. ^ Mu, Eveline; Gurvich, Caroline; Kulkarni, Jayashri (2024-12-01). "Estrogen and psychosis — a review and future directions". Archives of Women's Mental Health. 27 (6): 877–885\. doi:10.1007/s00737-023-01409-x. ISSN 1435-1102. PMC 11579214. PMID 38221595.
19. ^ Nombora, Odete; Rodrigues, Tânia; Felgueiras, Pedro; Silva, Beatriz Fonseca; Venâncio, Ângela (2024-06-01). "Menopause-associated psychosis: A case report and literature review". Psychiatry Research Case Reports. 3 (1): 100210. doi:10.1016/j.psycr.2024.100210. ISSN 2773-0212.
20. ^ a b Brockington, Ian F. (2011-03-19). "Menstrual Psychosis: A Bipolar Disorder with a Link to the Hypothalamus". Current Psychiatry Reports. 13 (3): 193–197\. doi:10.1007/s11920-011-0191-5. ISSN 1523-3812. PMID 21424263. S2CID 23188834.
21. ^ Ahern, E.; Cohen, D.; Prior, C.; Raji, E. (2019-09-10). "Menstrual psychosis". Irish Journal of Psychological Medicine. 39 (1): 103–105\. doi:10.1017/ipm.2019.36. ISSN 0790-9667. PMID 31500681. S2CID 202406398.
22. ^ Brockington, Ian F. (February 2005). "Menstrual psychosis". World Psychiatry. 4 (1): 9–17\. ISSN 1723-8617. PMC 1414712. PMID 16633495.
23. ^ Alalmaei Asiri, Waddah M. (2021). "Menstrual psychosis - From myth to reality: A case report of periodic psychotic symptoms associated with the menstrual cycle". The South African Journal of Psychiatry. 27: 1650. doi:10.4102/sajpsychiatry.v27i0.1650. ISSN 1608-9685. PMC 8252155. PMID 34230868.
24. ^ Reilly, Thomas J.; Sagnay de la Bastida, Vanessa C.; Joyce, Dan W.; Cullen, Alexis E.; McGuire, Philip (2020-01-04). "Exacerbation of Psychosis During the Perimenstrual Phase of the Menstrual Cycle: Systematic Review and Meta-analysis". Schizophrenia Bulletin. 46 (1): 78–90\. doi:10.1093/schbul/sbz030. ISSN 1745-1701. PMC 6942155. PMID 31071226.
25. ^ Thippaiah, Srinagesh Mannekote; Nagaraja, Soumya; Birur, Badari; Cohen, Arnold W. (2018-03-13). "An Interesting Presentation About Cyclical Menstrual Psychosis with an Updated Review of Literature". Psychopharmacology Bulletin. 48 (3): 16–21\. ISSN 0048-5764. PMC 5875363. PMID 29713101.
26. ^ Schoep, Mark E.; Nieboer, Theodoor E.; Zanden, Moniek van der; Braat, Didi D. M.; Nap, Annemiek W. (2019-06-01). "The impact of menstrual symptoms on everyday life: a survey among 42,879 women". American Journal of Obstetrics & Gynecology. 220 (6): 569.e1–569.e7. doi:10.1016/j.ajog.2019.02.048. ISSN 0002-9378. PMID 30885768.
27. ^ Weon, Hee Wook; Son, Hae Kyoung (2023-06-20). "An Analysis of Menstrual Symptoms, Menstrual Attitudes, Physical Stress and Psychological Stress According to the Menstrual Cycle Phase". Iranian Journal of Public Health. 52 (6): 1161–1169\. doi:10.18502/ijph.v52i6.12958. ISSN 2251-6093. PMC 10362827. PMID 37484149.
28. ^ Jaafar, Hafiz; Ismail, Suraya Yasmin; Azzeri, Amirah (2023-07-20). "Period Poverty: A Neglected Public Health Issue". Korean Journal of Family Medicine. 44 (4): 183–188\. doi:10.4082/kjfm.22.0206. ISSN 2092-6715. PMC 10372806. PMID 37189262.
29. ^ a b Ramaiyer, Malini; Lulseged, Bethlehem; Michel, Rachel; Ali, Fiza; Liang, Jinxiao; Borahay, Mostafa A. (2023-12-01). "Menstruation in the USA". Current Epidemiology Reports. 10 (4): 186–195\. doi:10.1007/s40471-023-00333-z. ISSN 2196-2995. PMC 10810236. PMID 38275000.
30. ^ Sommer, Marni; Sahin, Murat (September 2013). "Overcoming the Taboo: Advancing the Global Agenda for Menstrual Hygiene Management for Schoolgirls". American Journal of Public Health. 103 (9): 1556–1559\. doi:10.2105/AJPH.2013.301374. ISSN 0090-0036. PMC 3780686. PMID 23865645.

* v
* t
* e

Menstrual cycle

Events and phases|

* Menstruation
* Follicular phase
* Ovulation
* Luteal phase

Life stages|

* Menarche
* Menopause

Tracking|

| Signs|

* Basal body temperature
* Cervical mucus
* Mittelschmerz

|

Systems|

* Fertility awareness
* Calendar-based methods
* Billings Ovulation Method
* Creighton Model

Suppression|

* Extended cycle combined hormonal contraceptive
* Lactational amenorrhea

Disorders|

* Amenorrhea
* Anovulation
* Cryptomenorrhea
* Dysmenorrhea
* Hypomenorrhea
* Irregular menstruation
* Menometrorrhagia
* Menorrhagia (hypermenorrhea)
* Metropathia haemorrhagica
* Metrorrhagia
* Oligoamenorrhea
* Oligomenorrhea
* Oligoovulation
* Polymenorrhagia
* Polymenorrhea (epimenorrhea)

Related events|

* Folliculogenesis
* Menstrual synchrony
* Premenstrual water retention
* Sexual activity

Mental health|

* Premenstrual syndrome
* Premenstrual dysphoric disorder
* Menstrual psychosis

Hygiene|

* Menstrual hygiene management
* Feminine hygiene
* Menstrual pad
* Cloth menstrual pad
* Tampon
* Menstrual cup
* Menstrual pad
* Period underwear
* Menstrual Hygiene Day

In culture and religion|

* Chhaupadi
* In Islam
* Menstrual leave
* Menstrual stigma
* Menstrual suppression
* Menstrual taboo
* Menstruation celebration
* Menstruation hut
* Niddah
* Period poverty
* Sustainable menstruation
* Tampon tax

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template