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What is the connection between mental health and periods?

CW: This article discusses topics of mental health, depression, suicide, and anxiety which could be distressing to some readers.

For those who regularly bleed, you likely suffer from symptoms of premenstrual syndrome (PMS). Between people who menstruate, the symptoms can vary massively, as well as individuals’ symptoms differing month to month. According to the NHS, the most common symptoms include mood swings, feeling upset, anxious or irritable, tiredness or trouble sleeping, headaches, spotty skin, greasy hair and so forth. It’s estimated that as many as 3 in 4 menstruators experience some sort of PMS.

Alongside the more frequent PMS, a small number of women may also experience more severe symptoms known as premenstrual dysphoric disorder (PMDD). PMDD can be classed as an amplified version of PMS and one that can have a much greater negative impact on daily activities and quality of life. Mind charity explains that:

Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal thoughts.

Whilst the emotional and behavioural experiences of PMS and PMDD sufferers do see some overlap; it can be noted that PMDD is much more severe. Unfortunately, PMDD is defined, or limited, by its endocrine status, meaning that it is a hormone-related disorder. However, those who experience more acute motions of period-related depression can have their symptoms categorised and diagnosed as a mental health problem.

Due to the hormonal nature of periods, suggested treatment varies from person to person. Still, the NHS advises that GPs could recommend: hormonal medicine, cognitive behavioural therapy (CBT), antidepressants or dietary supplements. Without stating the obvious, the first three suggested treatments are more than likely to affect one’s mental health. But what exactly is the connection?

How can periods worsen your mental health?

According to the Cleveland Clinic, researchers have found that the link between mental health and PMS/PMDD is caused by low serotonin levels. Serotonin is a chemical that carries messages between nerve cells in the brain and throughout your body. Serotonin is more widely known as a neurotransmitter that mediates satisfaction and happiness.

When we have low serotonin levels, our ability to remain optimistic and control our moods, sleep, and pain is often limited. This triggers hormonal changes in the way we act, think, and feel about ourselves and our relationships. Furthermore, as we near the bleeding phase of our menstrual cycle, we may notice that emotional symptoms worsen, thus increasing the likelihood of depression, anxiety and irritability. This itself can place additional stress on our mental and emotional health.

Hormonal medicines – contraceptives

For those looking for a treatment to ease PMS/PMDD symptoms, you will likely be offered some form of contraceptive. Most, if not all, contraceptives use hormones to keep you from getting pregnant.

Countless literature spanning almost 60 years continues to reveal how contraceptives boast numerous adverse side effects, including the fact that users, in contrast with non-users, are more likely to have higher rates of depression, anxiety, and additional mental health issues.

Whilst the natural side effects of periods, PMS or PMDD, are already detrimental to our health, the suggested treatments can potentially worsen it.

Cognitive behavioural therapy (CBT)

CBT is a relatively new method of dealing with menstrual-related mental health issues. A form of therapy, CBT has been shown to be an effective treatment for many moods and anxiety disorders. However, in an article published in the Archives of Women’s Mental Health, results showed statistically insignificant changes amongst participants receiving CBT in comparison to those who were not.

Despite offering a non-hormonal alternative to dealing with PMS-associated issues, CBT can be timely, costly, and difficult to coincide with your menstrual cycle. Furthermore, therapy as a form of hormone control is still largely stigmatised, and research is limited.


Based on personal experience, and conversations with friends, antidepressants seem to be offered relatively easily as a means of controlling your mental health. Regardless of what you are struggling with, antidepressants may seem like a cop-out – especially when their side effects have the potential to worsen your symptoms.

According to the NHS, one of the most common side effects of antidepressants is feeling agitated, shaky or anxious. Now, for those struggling with their anxiety, the idea of amplified unease and worry would only deter their decision to try this form of treatment.

In rare cases, the NHS further states that some people may experience suicidal thoughts or a desire to self-harm upon taking antidepressants. This is quite clearly the undesired effect but one that some would be willing to risk if it helped in the long term.

Overall, it seems as though menstrual-related mental health issues have no ideal outcomes and largely require a shift in the way they are handled. But what more could we expect? With the stigma around period bleeding still at large, why would we be granted with suitable suggestions?

If you are someone who struggles with mental health-related issues as a result of your period, then it is worth consulting your GP to see what options are available. Similarly, it is worth conducting individual research into the efficacy, safety and side effects of the suggested treatments when making your decision.


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