Why Is My Mental Health Affected During My Menstrual Cycle?

Menstrual Calendar and Mental Health
Female experiencing deterioration of mental health symptoms due to menstrual cycle.

Hormone and neurotransmitter levels can impact all females during their menstrual cycle, and women with premenstrual dysphoric disorder have especially severe symptoms.

Albert Hernandez

August 21, 2022
 Medically Reviewed by Tanya Hernandez, PMHNP-BC
Updated on: October 20, 2022
  5 min read

August 21, 2022
 Medically Reviewed by Tanya Hernandez, PMHNP-BC
Updated on: October 20, 2022
  5 min read


Do you ever stop to consider the variety of factors that can impact your mental health and mood? Quality of sleep, amount of exercise, and hydration level are just a few examples of things that can influence feelings of anxiety and depression. The weather affects many patients; for example, a frigid New Mexico winter can be challenging for patients who have seasonal affective disorder. For my female patients, many find that their menstrual cycle has an impact on their behavioral health, as well.

For some of my female patients with Attention Deficit Hyperactivity Disorder (ADHD) or another behavioral health disorder, I have seen this time and again: They are progressing well, their symptoms are very well-controlled, and then all of a sudden they report the meds are not working. Patients think their meds are no longer effective and feel discouraged that we may have to start treatment over from the beginning. Early in my career, I would fall into this trap. However, as I gained more experience, I noticed a pattern emerging. This patient group's symptoms would often resolve when we would not make any changes and do a 2-week follow-up.

At that point, I learned more about the flare-ups of mental health conditions that can coincide with various points in some patients’ menstrual cycles.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder

You’ve likely heard of premenstrual syndrome (PMS), which is a condition that affects up to 75% of females during their regular menstrual cycle. When PMS symptoms are so disruptive that they interfere with a person’s ability to work, attend school, or complete other regular activities, she might be diagnosed with premenstrual dysphoric disorder (PMDD). Approximately 3 to 8% of women could be considered to have PMDD.

It’s generally well known that during a woman’s menstrual cycle, the changing levels of hormones such as estrogen and progesterone can cause physical and behavioral symptoms. What may be less known is that fluctuating hormones can also impact serotonin and other neurotransmitters (brain chemicals) in the brain. Serotonin is a mood-impacting neurotransmitter that is involved in symptoms of depression and anxiety. If serotonin levels are disrupted, it makes sense that a woman experiencing PMS or PMDD might feel irritability, sadness, changing mood, and other behavioral health symptoms. In addition to these mood symptoms, women with PMS or PMDD can also experience breast tenderness, sleep difficulties, low energy, and bloating. These physical manifestations can further contribute to mood changes.

For my female patients in New Mexico and other areas who are already being treated for anxiety, depression, or ADHD, some may find that they have an uptick of their mental health symptoms prior to or during their period.

Taking Antidepressants For the Treatment of PMDD

As I noted before, some of my patients who notice worsening symptoms of their ADHD, anxiety, or depression related to their menstrual cycle see the symptoms recede on their own. These patients are able to manage these cyclical symptoms without medication. For other patients, the worsening of their mental health disorder due to hormone changes during their menstrual cycle can be addressed with medication.

Because the hormone fluctuations that cause PMS and PMDD symptoms impact the brain chemical serotonin, studies indicate that selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Paxil can be effective for the treatment of PMDD. SSRIs are a class of antidepressant medication that can be helpful in treating mood disorders. When serotonin levels are lower in the brain, neurons (brain cells) don’t always communicate the way they should. Lower serotonin levels are associated with nervousness, sadness, and other mood issues. SSRIs help make more serotonin available in the brain, which can improve mood and reduce irritability and sadness. Patients generally find the side effects of SSRIs, which can include headache, nausea, sleeping problems, and decreased sexual desire, to be manageable.

Some patients find that taking their SSRI daily is needed to control the physical discomfort and mental distress that comes with their menstrual cycle.

Other patients are able to only take their antidepressant intermittently, usually from the time of ovulation to when their menstrual flow starts.

Menstrual calendar that depicts females and mood changes during their cycle.

The research for whether or not intermittent SSRI use is valuable can be conflicting. My patients who use this cyclical dosing of their antidepressant feel that it works wonders for them. Whether this is a placebo effect or is actually balancing their serotonin levels, I don’t know for sure. However, as long as it is safe for my patients, I’m willing to assist them with this dosing option. Intermittent dosing of antidepressants is typically a safe option to try if the patient doesn’t have a history of bipolar depression.

If you notice that your mental health symptoms seem to worsen in correlation with your menstrual cycle, bring this pattern to your behavioral health provider’s attention. If you live in the New Mexico area, or in one of the other areas that we serve, and you are looking for treatment for your anxiety, depression, or ADHD, complete our application for treatment. You will find a team of professionals that are experts in behavioral health care. We also understand that you are a person with unique needs and that your stage in life, your family situation, and your menstrual cycle can all impact your mental health. Contact us today for an appointment and get ready to start feeling your best.

Disclaimer: This post is for informational purposes only. It does not replace instructions from your licensed prescriber. Please consult your healthcare provider for guidance on your specific medication regimen.

Tags: mental health, anxiety, depression, pms, pmdd

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