Have you ever dismissed your feelings because you’re “just feeling hormonal”? In an extract from her new book, The Female Factor, Dr Hazel Wallace unpacks the science behind how the menstrual cycle impacts our emotions. 

Isn’t it funny (read: not funny at all) how we automatically assume changes in a woman’s mood or behaviour are down to hormones or the time of the month? Many of us would be insulted if a man turned around to ask us if we are on our period simply because we got upset or angry over something, and yet we often do it to ourselves.

Think back to the last time you cried out of the blue or found yourself getting highly irritated by your work colleague. I’m sure you blamed it on hormones or questioned, either to yourself or out loud, if your period was due.

Let me just say that you don’t need a biological excuse for feeling the feels. Life has its ups and downs, which can have an effect on how we feel on any given day. That said, our hormones and our menstrual cycle can indeed influence our mood, no matter what we’re living through at the time. 

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On (almost) a monthly basis, many women report changes in mood, including anger, irritability and tearfulness, in the days leading up to their period and, as if that wasn’t enough, can also experience a worsening of pre-existing mental health conditions, such as anxiety and obsessive-compulsive disorder (OCD). On top of this, our sex hormones fluctuate enough to further influence our mood and mental health around puberty, pregnancy and perimenopause. So, I want you to be compassionate with yourself and stock up on ways to cope through these shifts.

Mood across the menstrual cycle

Bloated tummy, tender boobs and a blubbering mess – sound familiar? If you have a menstrual cycle, it’s likely you’ve experienced premenstrual symptoms at some point. In fact, it is estimated that 80-90% of women experience some premenstrual symptoms (there are over 150 of them!) including bloating, breast tenderness, headache, acne, constipation and mood changes. 

A recent study of 40,000 Dutch women found that abdominal pain (or cramping) was the most common experienced premenstrually. The second-most common symptom was psychological complaints, such as low mood or irritability, experienced by over 77% of women. Premenstrual symptoms occur on a spectrum and, for most women, they are relatively mild and do not disrupt day-to-day activities. 

However, some women have symptoms so severe that they stop them from getting on with their daily lives, which is diagnostic of premenstrual syndrome (PMS). This collection of physical and emotional symptoms can occur in the two weeks before you have your period, usually gets better once your period starts and often disappears by the end of it.

A smaller number (3-8%) of women get an even more intense form of PMS known as premenstrual dysphoric disorder (PMDD). The symptoms of PMDD are similar to those of PMS, but are more severe and often have more psychological than physical symptoms, including feelings of hopelessness, depression, extreme anger, anxiety and irritability. If you are getting severe symptoms (physical, mental or emotional) in the days leading up to your period and it is interfering with your day-to-day life, do speak to your doctor. 

However, like PMS, symptoms should resolve when the period starts – if not, there could be something else causing them, such as depression (which can be exacerbated premenstrually) or another cyclical mental health condition, such as bipolar disorder. 

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As with many things related to female health, due to a lack of scientific research, we don’t know exactly what causes PMS or PMDD, and why some women are affected and others are not. Based on the research we do have, we think it’s largely due to the rise and fall of oestrogen and progesterone, which influence mood-enhancing neurotransmitters in the brain, such as serotonin (often dubbed ‘the feel-good hormone’). Compared to women who don’t suffer from intense PMS, those who do have similar levels of oestrogen and progesterone but appear to be more sensitive to these hormonal fluctuations.

Interestingly, global rates of PMS reporting vary quite drastically by country, which begs the question: can it be purely down to hormones if it varies so much by social environment? 

I was surprised to read that a review from 2012 (inclusive of 47 studies) measuring links between mood and women’s menstrual cycles found that only 15% of studies provided evidence of a link between the premenstrual phase and negative mood. This was followed up by a study of women (aged 18-49) exploring the extent to which women’s daily moods are influenced by their menstrual cycles. The participants were asked daily questions about their mood over six months via a smartphone questionnaire but were not told that this had anything to do with mood and the menstrual cycle, which helped to reduce bias. 

They were also asked about other things such as physical health, perceived stress and days of their menstrual cycle. What the study found was that only one in 20 showed any clear variation in mood based on where they were at in their cycle, and actually, physical health, perceived stress and social support were much stronger predictors of mood.

So does this mean that our mood isn’t influenced by our menstrual cycles and it’s all a myth? I don’t think so, and I think that suggesting PMS is ‘all in your head’ minimises the lived experiences of many women who are sensitive to these hormonal changes. However, I do think – again – that we shouldn’t be so quick to always assume it’s our hormones and, when it comes to changes in mood, considering that other factors in our life – such as our relationships, the stress we are under and our overall wellbeing – are just as, if not more, important.

I’m a big advocate of tracking your mood, in addition to physical symptoms, when tracking your menstrual cycle. This will give you a useful insight into the patterns that you experience and allows you to better understand your body and needs. 

The Female Factor: Making Women’s Health Count And What It Means For You by Dr Hazel Wallace is available now (£22, Yellow Kite).

Images: Getty / Yellow Kite

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