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Menstruation, menopause, and mental health

Hormones can affect a woman's mood throughout her lifetime. Sometimes the impact on mood can affect a woman's quality of life. Many times the symptoms that result can be managed with medicine and/or therapy.

Premenstrual mood changes

Once a young woman starts menstruating, she may begin to experience emotional changes around the time of her period. 75 percent of women with regular period cycles report unpleasant physical or psychological symptoms before their periods. Premenstrual syndrome, or PMS, affects 30 to 80 percent of women. Psychological symptoms of PMS include:

  • Depression
  • Anger
  • Irritability
  • Anxiety
  • Sensitivity to rejection
  • Sense of feeling overwhelmed
  • Social withdrawal

Physical symptoms of PMS include:

  • Fatigue (feeling tired)
  • Sleep disturbance
  • Increased appetite
  • Abdominal bloating
  • Breast tenderness
  • Headaches (sometimes known as menstrual migraines)
  • Muscle aches and joint pain
  • Swelling of extremities

Premenstrual Dysphoric Disorder, or PMDD, is a more severe form of PMS. It affects 3 to 8 percent of women of reproductive age. Symptoms of PMDD include:

  • Severe irritability
  • Depression
  • Anxiety
  • Mood swings

The best way to confirm PMDD is to make a chart (PDF, 104 KB) of your symptoms (for example: cramps, headaches, or weight gain). A woman with PMDD should have symptom-free days between the start of her period and ovulation. Your doctor or a mental health professional can use a prospective scale (the Calendar of Premenstrual Experience and the Prospective Record of the Severity of Menstruation are two examples) to figure out if you have PMDD.

The causes of PMS and PMDD are not known, but research shows that they are based in the body and not just in the mind. Women who experience PMS and/or PMDD do not have higher levels of hormones compared to other women. Instead, women with PMS and/or PMDD may be extra sensitive to normal hormonal changes.

Treatment

Lifestyle changes may help make the symptoms of PMS and PMDD better. Some doctors suggest that women:

  • Eat lesser amounts of caffeine, sugar, and sodium
  • Drink less alcohol
  • Smoke less
  • Get plenty of sleep
  • Exercise more
  • Try talk therapy

Medications or supplements prescribed by your doctor can also help PMS and PMDD. These may include:

  • Calcium (1200 mg per day was shown to reduce PMS symptoms)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Hormonal treatments such as oral contraceptives

For all women, simple lifestyle changes in diet, exercise, and stress management are usually encouraged. These changes do not have risks and may help you.

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Menopause and mood changes

Women may experience a wide range of feelings, from anxiety and discomfort to release and relief, upon menopause. Most adapt to the changes and continue to live well and remain healthy through these transitions.

Depression

Some women, although not all, will experience significant depression before perimenopause. Perimenopause marks the time when your body begins the transition to menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last or how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years. Because of the intense hormone changes during perimenopause, women are more likely to have menopause-related depression before they reach actual menopause.

When women go through menopause, some may feel badly at the loss of their ability to bear children. However, some women look at menopause as a time to expand their work and social activities, and to dedicate more time to their spouse or partner. Having a positive attitude about this life change may help.

However, depression is not just in your mind. It can also be caused by hormonal factors. If you are feeling depressed and are going through menopause, be sure to discuss these feelings with your doctor or a health care professional. You can learn more about talking to your doctor in the menopause section of womenshealth.gov.

Treatment

There are several treatment options for women who have depression during perimenopause.

  • Menopausal hormone therapy – To help control the symptoms of menopause, some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. The use of MHT has been debated a great deal since the Women's Health Initiative (WHI) Hormone Study findings were released in 2002. Long-term use of MHT poses some serious risks. If you decide to try MHT, use the lowest dose that helps for the shortest time you need it.
  • Antidepressants – Antidepressants may be an option for women who are unable or unwilling to take MHT.
  • Talk therapy – Talk therapy may take place one-on-one with a mental health professional or in a group setting.

Once identified, depression almost always can be treated either by therapy, medicine called antidepressants, or both. Some people with milder forms of depression do well with therapy alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with combined treatment: therapy and antidepressants.

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More information on menstruation, menopause, and mental health

Read more from womenshealth.gov

  • Menopause and Menopause Treatments Fact Sheet — This fact sheet answers frequently asked questions about menopause topics, including menopausal hormone therapy (MHT), coping with symptoms, and preventing diseases like osteoporosis and heart disease.
    http://www.womenshealth.gov/publications/our-publications/fact-sheet/menopause-treatment.cfm
  • Menstruation and the Menstrual Cycle Fact Sheet — This fact sheet explains what menstruation is, what happens to a woman's body during a typical menstrual cycle (period), and what problems can interfere with a woman's period, as well as answers common questions such as when to see a health professional and how to use a tampon.
    http://www.womenshealth.gov/publications/our-publications/fact-sheet/menstruation.cfm
  • Premenstrual Syndrome (PMS) Fact Sheet — This fact sheet about premenstrual syndrome (PMS) explains how to tell if you have PMS, how common PMS is, and what treatment is available.
    http://www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.cfm

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Content last updated March 29, 2010.

Resources last updated March 29, 2010.

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