Have you ever been having a bad day and someone had the audacity to ask you if you were getting your period? As insulting and dismissive as that question may feel there may in fact be some validity to asking it. It turns out that mood disturbances from menstrual cycle related hormonal fluctuations are not limited to simply experiencing mood swings but may extend to more severe emotional disturbances such as anxiety and depression. This article is intended as food for thought and not intended as a substitute for medical advice for anyone suffering with anxiety and/or depression.
The first portion of this article is my personal experiences with hormone related anxiety and how I came to find an interest in this subject. If you are not interested in this, please skip ahead to ‘Once I was sure of what I was seeing’.
I’ve suffered with anxiety for most of my life so I never thought too much about experiencing it rather regularly. I stumbled upon the distinct correlation between my menstrual cycle and my anxiety by accident. I am becoming a bit of a data nerd thanks to my husband and I have a huge spreadsheet that I use to keep track of many life variables such as calories, training, sleep, weight, digestion etc. In addition to those variables I started tracking my menstrual cycle in order to observe it’s effect on them. Along the way, I began adding little notes about mood and energy into the spreadsheet just for the sake of it. After a few months I began noticing patterns forming across each month. Some were expected such as scale weight increases the week before my period but I also started noticing distinct patterns with bouts of anxiety and depression at specific times of the month (I noticed other things too but let’s stick with the subject of this article.) As I kept up with these observations it got to the point where I could start predicting when my anxiety would peak almost to the day. We’ve all heard the mumblings about hormones making women acting crazy when they are on their period but I never made the connection to an actual increase in my anxiety symptoms. In my mind I associated getting my period with moodiness but not anxiety or full on depression. It turns out that it’s pretty well documented that women are more likely to report anxiety and depression during premenstrual periods along with postpartum and perimenopausal periods.
Once I was sure of what I was seeing I wanted to understand exactly why my menstrual cycle was affecting me this way. After digging into the literature it appears to be the result of fluctuating estrogen levels.
I’ll give a very brief mapping out of estrogen during the menstrual cycle. You are free to skip to the summary if you are not interested but I would recommend reading this for any female interested in tracking her cycle for anxiety management purposes.
At the beginning of your cycle (the first day of your bleed) estrogen levels are at baseline. From here, estrogen levels slowly rise as your follicles produce estradiol (a form of estrogen) in order to encourage one dominant follicle to mature. When the follicle is fully mature is when estrogen levels are at their highest and this is when ovulation occurs. The follicle bursts, to release an egg which makes it’s way into the uterus. That ruptured follicle also starts producing progesterone at this point. This is where estrogen levels start to drop (minus a small peak when progesterone levels reach their highest.) Granted that you don’t get pregnant, the burst follicle produces less and less progesterone as it slowly dissolves. Both progesterone levels and estrogen levels are plummeting at this point and once progesterone levels get to a certain low the uterine lining will shed which will be the start of your period.
***THIS IMAGE IS NOT MINE***
Copyright © 2013 Canadian Medical Association [1]
In summary: estrogen levels slowly rise up until ovulation (this is your follicular phase) and then they slowly decline back to baseline from there (luteal phase).
I noticed a small increase in anxiety on the days of my cycle where estrogen levels were dropping post-ovulation (usually around days 15-17 of my 27-29 day cycle) and a significant increase starting around day 22-24 of my cycle when both estrogen and progesterone would be plummeting together. If I were also to experience bouts of depression it would more often than not be around days 24+ of my cycle as well.
Many studies appear to mirror my personal findings.
As I mentioned above, women are more likely to report anxiety and depression during premenstrual ,postpartum and perimenopausal periods and are at a higher risk of developing mood disorders and depression especially in later years.[2-5] This increased risk is associated with fluctuating estrogen levels that occur throughout the menstrual cycle. Women are particularly susceptible to this during menopause due to the dramatic fluctuations in estrogen levels at this time in their lives [6]
Why estrogen levels affect our moods this way isn’t fully understood but it’s been observed that areas of the brain involved in mood regulation have demonstrated sensitivity to fluctuating levels of estrogen. The amygdala is one of those brain regions suspected to play a significant role in the effect of estrogen on anxiety and depression along with the hippocampus and hypothalamus.[6]
Brain imaging studies showed that women had greater activation of parts of their brain involved in fear response when they were at parts of their cycle where estrogen levels were lowest. [7] It was also shown that women had a harder time with ‘fear extinction’ (getting rid of conditioned fear responses to specific triggers) when estrogen levels were lower. [1,8]
Estrogen may also have a positive effect on serotonin regulation and when reduced may negatively impact mood as low serotonin levels are associated with disorders like depression and anxiety. [6}
So what all of this is telling us is that though the mechanisms involved still need further research there does seem to be a clear association between times when our estrogen levels are fluctuating or low and being more susceptible to anxiety and depression. If you are someone that struggles with either of these it could be worth keeping track of your menstrual cycle in order to see if your own pattern emerges over time. It’s not going to take away your anxiety or depression but knowing ahead of time can put you in a place of power and help you to manage those difficult emotions. It gives you an opportunity to mentally prepare yourself and potentially stay mindful in the midst of intense emotions because you know it’s ‘normal’ for you to be feeling this way at this time of the month. Knowing when you may be more prone to emotional upheaval can also protect you from ‘buying in’ to the emotions and the negative outlook they may be projecting on your life on a whole. This can potentially lead to better decision making or being mindful not to make any important decisions until you are in a better emotional, and in this case hormonal, state.
Dealing with anxiety and depression is a difficult task and every little bit can count. If tracking your cycle can give you a heads up that there are bumpy roads ahead then it gives you enough time to buckle up and prepare and not get caught off guard.
Note: This article is written with estrogen as the primary focus but it needs to be noted that progesterone is also present in higher concentrations around the points of the menstrual cycle where anxiety and depression are often reported. It has been suggested that progesterone may also impact mood [9] which needs to be mentioned in order to be thorough. Studies using exogenous progesterone have also observed a correlation between progesterone and adverse effects on anxiety and mood. [10-11] However, due to the fact that perimenopausal women are at increased risk for anxiety and depression leads me to the opinion that fluctuating estrogen may still be the major player here as during this phase of a woman’s life progesterone production is declining towards cessation. Of course, the role of testosterone levels at this phase of a woman’s life also needs to be taken into consideration.
For premenopausal women experts have classified experiences of increased anxiety and depression during the luteal phase as symptoms of a specific disorder termed premenstrual dysphoric disorder or PMDD. These symptoms are usually accompanied by physical symptoms such as breast tenderness, abdominal pain, headaches, back pain and joint or muscle aches as well as sleep disturbances and digestive issues. Basically PMDD is a longer, more aggressive PMS experience to the point that it is debilitating.
Whichever hormone is the main catalyst for PMS related anxiety and depression and regardless of whether or not you fit the criteria for PMDD there does seem to be a clear link between anxiety, depression and certain days of the menstrual cycle. If you are not already keeping track of this it may be something that you want to consider as part of your anxiety management routine.
References:
[1]Glover EM, Mercer KB, Norrholm SD, et al. Inhibition of fear is differentially associated with cycling estrogen levels in women. Journal of Psychiatry & Neuroscience : JPN. 2013
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756118/
[2] Women and anxiety disorders: implications for diagnosis and treatment. Proceedings of a conference, November 19-21, 2003, Chantilly, Virginia, USA. CNS Spectr. 2004
https://www.ncbi.nlm.nih.gov/pubmed/15487127/
[3] onkers KA. Anxiety symptoms and anxiety disorders: how are they related to premenstrual disorders? J Clin Psychiatry. 1997
https://www.ncbi.nlm.nih.gov/pubmed/16292022
[4] Rapkin AJ, Mikacich JA, Moatakef-Imani B, Rasgon N. The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Curr Psychiatry Rep. 2002
https://www.ncbi.nlm.nih.gov/pubmed/12441021
[5] Pigott TA. Anxiety disorders in women. Psychiatr Clin North Am. 2003
https://www.ncbi.nlm.nih.gov/pubmed/14563101
[6]Wharton W, Gleason CE, Olson SRMS, Carlsson CM, Asthana S. Neurobiological Underpinnings of the Estrogen – Mood Relationship. Current psychiatry reviews. 2012
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753111/
[7] Goldstein JM, Jerram M, Abbs B, Whitfield-Gabrieli S, Makris N. Sex differences in stress response circuitry activation dependent on female hormonal cycle. J Neurosci. 2010
https://www.ncbi.nlm.nih.gov/pubmed/20071507/
[8] Milad MR, Zeidan MA, Contero A, Pitman RK, Klibanski A, Rauch SL, Goldstein JM. The influence of gonadal hormones on conditioned fear extinction in healthy humans. Neuroscience. 2010
https://www.ncbi.nlm.nih.gov/pubmed/20412837/
[9]Ferree NK, Kamat R, Cahill L. Influences of menstrual cycle position and sex hormone levels on spontaneous intrusive recollections following emotional stimuli. Consciousness and cognition. 2011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126908/
[10] van Wingen GA, van Broekhoven F, Verkes RJ, Petersson KM, Bäckström T, Buitelaar JK, Fernández G. Progesterone selectively increases amygdala reactivity in women. Mol Psychiatry. 2008
https://www.ncbi.nlm.nih.gov/pubmed/17579609/
[11] ndreano JM, Cahill L. Menstrual cycle modulation of medial temporal activity evoked by negative emotion. Neuroimage. 2010
https://www.ncbi.nlm.nih.gov/pubmed/20637290/
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