Menstrual Cycles and Hormones

Menstrual cycles play a pivotal role in the everyday experiences of people who have them, and those they spend time with. As a foundational element of the ability to create new life, it is no surprise that life can seem to revolve around this phenomenon for so many people. Yet it is often not talked about, or considered, in the therapeutic relationship. For many, this may be to do with fear, shame or negativity that might be associated with menstrual cycles and periods.

This article will explore some of the ways in which we can start to understand the menstrual cycle and it’s potential impact on our everyday lives. I hope it can also offer some different ways to approach this natural experience, with curiosity and compassion.

What is the menstrual cycle?

The menstrual cycle is the series of changes that a person’s body goes through each (approximately) month, in order to prepare for the possibility of a pregnancy. If pregnancy does not occur, menstruation follows, also known as a period. A person can have their first period on average at around the age of 12 and may experience them until they are in their 50’s, but this can vary greatly between people.

How does it work?

The menstrual cycle is governed by a cocktail of hormones that tell the body how to prepare for the potential of a pregnancy, and if pregnancy does not occur, these hormones signal the onset of the menstrual period or ‘monthly bleed’.

The above graph gives a visual of the rise and fall of some of the hormones that act on the body during the menstrual cycle and that can impact thought processes and emotions. Cycles are on average 28 days, but can be a little shorter or longer for seem people. The menstrual cycle can be split into two halves - the follicular phase, and the luteal phase.

Follicular Phase

The follicular phase begins on day 1 of the cycle, which is also the first day of the menstrual period when bleeding begins. It ends generally around day 14, when ovulation is triggered and an egg is released to be made available for fertilisation and pregnancy. During this time, the body is working hard to create a nice, safe environment in the uterus for a pregnancy by developing the lining of the uterus and thickening its walls. The hormone oestrogen rises during this time.

Ovulation

Ovulation usually occurs mid-cycle, around day 14. However, this can vary between people and between cycles for the same person, depending on a great many factors. Oestrogen peaks just prior to ovulation, and testosterone is also abundant at this time.

Luteal Phase

This is the second half of the cycle, whereby the hormone progesterone increases in order to keep building on the uterine environment for a potential pregnancy following ovulation. Testosterone and oestrogen begin to fall and, if pregnancy does not occur, progesterone starts to fall as the period nears, when the lining of the uterus falls away due to no longer being needed.

Hormones and mood.

The hormones involved in the menstrual cycle act upon multiple systems in the body. They impact our physical experience, and have the potential to influence our cognition (the way we think), and our mood (the way we feel). Much research is being conducted into this area of health, and there are still many unanswered questions in relation to the exact ways in which our hormonal system interacts with mood and behaviour.

I would like to make mention at this point that symptoms of conditions such as ongoing irregular periods, endometriosis, polycystic ovary syndrome and premenstrual dysphoric disorder, as well as menopausal transition, aren’t discussed here. As these conditions may significantly impact your daily life, if you have concerns, it would be best to contact a medical professional to investigate further for peace of mind.

Oestrogen: There are varied opinions on the role of oestrogen and mood regulation, with research suggesting that oestrogen can both reduce stress, and also that it can increase cortisol levels at different times, speaking to a sensitisation of the stress hormones in the body. There are also studies that show that oestrogen’s impact on insulin in the body improves energy levels. Likewise, oestrogen has been hypothesised by some researchers as having the ability to improve some cognitive functions, such as memory. It is important to remember that researcher’s suggest that the variety of opinions on this issue, highlight the complexity of the hormonal system and the myriad of ways in which hormones can act on the body depending on the internal body state and the external situations we find ourselves in.

Subjectively though, people often report feeling that they have higher energy levels and improved mood and capacity to process information in the first half of their menstrual cycles. This makes sense from a survival perspective - when the body becomes more fertile, however, this may not be everyone’s experience.

Testosterone: Testosterone increase at the time of ovulation is known to heighten sex-drive and energy levels, leading some people to feel more sexually aroused during this time, and more inclined to be physically active. There is also some research that has found cycling people to be more likely to socialise, wear make-up, and place a higher value on clothing and beauty related items at this time of their cycle.

Progesterone: Please note - progestogen is a synthetic form of progesterone found in some contraceptive products and is associated with its own set of mood impacts. Here we will only be discussing the body’s natural hormone, progesterone. Like oestrogen, there are different theories about the ways in which progesterone influences mood, and research suggests that progesterone can impact mood in both activating and calming ways, depending on the situation they find themselves in. Interestingly, some studies have found that women appear to respond more quickly to negative experiences and have a bias towards recalling negative emotional memories rather than positive ones, as well as feeling more tired, when progesterone levels are elevated in the later part of the menstrual cycle. On the other hand, research has also shown that low levels of progesterone are linked with mood swings, anxiety, feelings of depression, and trouble sleeping. These symptoms often occur for women when progesterone drops suddenly before their period emerges.

What does seem most clear, is that the more drastic changes that naturally occur in oestrogen and progesterone in the luteal phase of the menstrual cycle, are often experienced as causing mood changes, such as irritability, emotional reactivity and anxiety, as well as difficulty sleeping and a draw to shopping for, and eating, more sugary, carbohydrate rich foods.

Menstrual cycles and relationships.

You may be starting to wonder, now, how these hormones might wildly impact how you - and others around you - think, feel and behave in the world. It would then follow practically that relationships, whether they be romantic, platonic or professional even, may also be impacted greatly by the dynamics of these cycles. I believe it can be very helpful to develop an understanding about how this feels and looks for you personally during your own cycles, to support deeper and more attuned relationships in your work, home and social life.

I find that a supportive way to frame this is to consider a ‘needs-based’ approach to your menstrual cycle. That is, paying attention to your symptoms as signals that your body is giving you to tell you about what you might be needing more of. At different times of your menstrual cycle, some of these needs might be: intimate but non-sexual connection with a loved one, rest, sex, particular nourishing foods, firmer boundaries, creative projects at home or work, big social outings, quiet time to yourself, physical support for discomfort or sleeplessness, or space to feel your changing emotions, among many others.

But, how do I know what I need?

It can be daunting to sit with this question. It might seem strange and new to begin to pay more attention to your menstrual cycles, and to discuss this with those around you may feel even more confronting. With some support, practice and mindfulness, it will hopefully become much easier to sense where you are at in your cycle and what your body is trying to tell you.

A practical place to start…

1) Using a menstrual cycle app or a simple calendar can be a good place to start building awareness of your cycle and its unique pattern of signals. There are many apps on the market, such as Kindara and Clue, that can help guide you through this process. Charting your cycles in this way can also be a great ice breaker to share with those you trust and to help initiate a conversation about what you are experiencing.

2) Journalling. If you don’t write or journal yet, that’s ok! Journalling down some of your thoughts, feelings and physical body sensations when you get a spare moment can be a really nice tool to gently develop some mindful awareness. If you do already have a journalling practice, it can be really interesting to make a quick note of what day you are at in your menstrual cycle at the beginning of your entry. This brings awareness to your body and your cycle at the start of your writing and can also be a really nice reflective tool to notice physical and emotional patterns, and needs that might be present for you throughout each month.

3) Take 5 to feel. Experiment with taking 5 minutes (or even one if that’s all you can find!) each day to check in with your body, mind and menstrual cycle. It might be easiest to start this at the beginning of your next menstrual period. Pause, take a deep breath into your belly, and exhale through your mouth. It might help to place your hand on your chest, belly and womb area and just take note of what physical sensations are happening for you in these places, and whether there’s some emotional feeling to them, or thoughts that come from those places. This information doesn’t need to be ‘fixed’ or ‘go away’, rather, it can just be present and noticed.

4) Share with others. You may be surprised to find that those you spend time with might actually find relief in knowing more about your cycles with you, so that they can be more equipped to relate with you in a way that feels good and safe for them too. If this is too much to consider right now, just developing your own deeper relationship with your cycles can be an extremely empowering and useful tool to navigate your relationships and needs on a daily basis. If you would like to read more about this topic, keep an eye out for my upcoming journal entry “Menstrual Seasons - A need’s based persepctive”.

I imagine you might also see that the literature on this topic can be a little confusing and conflicting- this spectrum of perspective and information however, is also validating of the range of emotional, social and physical impacts of the menstrual cycle on our individual everyday experience.

This suggests that in order to better understand the way we think, feel and act in the world, we may need to consider the role of hormones in relation to each other, our environment and our cultural context. Greater understanding from an individual and social and emotional context of our hormones may support us in awareness of our own experience and encourage more supportive choices.

If you would like to explore this area of your life in a safe and supported way, feel free to contact me using the button below.

With kindness,

Megan.

References

Almeida, O. FX, and Vladimir K. P. Oestrogens: Structure, Mechanisms of Action and Role in Mood and Cognition. eLS 1: 156-166 (2020). DOI: 10.1002/9780470015902.a0029144

Green, S.A., Graham, B.M. Symptom fluctuation over the menstrual cycle in anxiety disorders, PTSD, and OCD: a systematic review. Arch Womens Ment Health 25, 71–85 (2022). https://doi.org/10.1007/s00737-021-01187-4

Handy, Ariel B., Shelly F. Greenfield, Kimberly A. Yonkers, and Laura A. Payne. Psychiatric symptoms across the menstrual cycle in adult women: A comprehensive review. Harvard Review of Psychiatry (2022).

Krishnan, Sridevi, Rebecca Tryon, Lucas C. Welch, William F. Horn, and Nancy L. Keim. "Menstrual cycle hormones, food intake, and cravings." The FASEB Journal 30 (2016): 418-6. https://doi.org/10.1096/fasebj.30.1_supplement.418.6

Nillni, Y.I., Rasmusson, A.M., Paul, E.L. et al. The Impact of the Menstrual Cycle and Underlying Hormones in Anxiety and PTSD: What Do We Know and Where Do We Go From Here?. Curr Psychiatry Rep 23, 8 (2021). https://doi.org/10.1007/s11920-020-01221-9

https://www.medicalnewstoday.com/articles/327490

Prado, Raul Cosme Ramos, Rodrigo Silveira, Marcus W. Kilpatrick, Flávio Oliveira Pires, and Ricardo Yukio Asano. "Menstrual Cycle, Psychological Responses, and Adherence to Physical Exercise: Viewpoint of a Possible Barrier." Frontiers in Psychology 12 (2021). https://doi.org/10.3389/fpsyg.2021.525943

Saad, Gad, and Eric Stenstrom. "Calories, beauty, and ovulation: The effects of the menstrual cycle on food and appearance‐related consumption." Journal of Consumer Psychology 22, no. 1 (2012): 102-113. https://doi.org/10.1016/j.jcps.2011.10.001

Sundström-Poromaa, Inger, Erika Comasco, Rachael Sumner, and Eileen Luders. "Progesterone–Friend or foe?." Frontiers in Neuroendocrinology 59 (2020). https://doi.org/10.1016/j.yfrne.2020.100856