Premenstrual Exacerbation: Does the Menstrual Cycle Impact Mental Health for Women?

We often hear that the premenstrual experience is inherently negative. It’s not only a cause of shame, but also a myriad of mental and physical symptoms that bring nothing but discomfort. Yet the way we’re taught culturally to think about our cycles, and the way we talk about them socially, can have an adverse impact on the way a woman identifies with herself.  

We certainly can’t dismiss the link between hormones and mental health since women are twice as likely to suffer from depression than men. But this suggests there’s a linear relationship between our behaviors and our biology. Each individual will experience her menstrual cycle differently, and this can be a positive experience that allows for greater personal alignment.

What’s more, a diverse range of factors, and not just hormones, can influence the way each woman processes and understands her unique experience. Lifestyle, work-related stress, relationships, poor physical health, and past experiences of trauma or depression can all play their part in making menstruation more painful, emotionally and mentally, as well as physically.

Most of the ‘trouble’ we talk about begins and ends with the luteal phase, which lasts from ovulation through to the start of your period. It’s during this time that our hormones fluctuate rapidly, and many women ‘suffer’ cramps, skin problems, disrupted sleep, and changes to appetite and mood.

How Do Hormones Impact Women’s Mental Health?

Estrogen and progesterone are both involved in regulating two neurotransmitters: serotonin and gamma-Aminobutyric acid. The first supports our ability to feel happy and the second relieves anxiety. During the first half of the luteal phase, ovulation triggers the production of high levels of estrogen and progesterone in preparation for pregnancy.

If conception doesn’t take place, levels drop dramatically in preparation for menstruation. As these hormones seesaw, so do our moods, although some women can be more sensitive to the fluctuations than others, especially those who have suffered from mental health problems in the past.

How Do You Know If It’s PMS or PMDD?

Premenstrual Syndrome (PMS) is a combination of physical, emotional and behavioural changes that take place before menstruation. These include bloating, fatigue, and headaches. Symptoms vary in length and severity from cycle to cycle, but will only last for the duration of the luteal phase. If the symptoms interfere with your relationships, and your ability to go about your day-to-day life, however, you might need a different diagnosis.

Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that typically begins one week before menstruation and ends one week after. In order to diagnose PMDD, the same or similar symptoms must occur regularly over the course of several cycles. But if issues persist throughout the whole cycle, hormones alone may not be the cause.

What Is Premenstrual Exacerbation?

Pre-existing mental and physical conditions can be magnified or exacerbated when our hormone levels drop and inflammatory levels rise in the run-up to a period. While the production of inflammatory proteins is a normal part of the menstrual cycle, it’s possible that we can have too many, which has the potential to trigger existing inflammatory disorders, such as arthritis or asthma.

When this happens in tandem with the drop in our mood-regulating neurotransmitters, other existing conditions, such as depression, panic disorders, and anxiety, may also become inflamed. But while the hormonal and inflammatory activity in the body is the trigger, it’s not always the cause. When you experience PMS-like symptoms to extreme levels during the luteal phase, they can illuminate an ongoing issue that you haven’t necessarily known to look for during other phases of your cycle.    

Tracking emotional and behavioral patterns throughout all phases of your cycle, and over the course of several cycles, helps to identify conditions that linger for more than a couple of weeks. To improve accuracy, record the severity and timing of each symptom as you experience it, rather than waiting until it has passed. You can also make a note of daily activity to give your symptoms context and provide insight into your true menstrual experience—allowing the crucial separation of lifestyle factors from hormonal.

Taking these steps doesn’t mean a visit to the doctor is inevitable, however. Instead, it gives you the information you need to make the right decisions about your own mental and physical wellbeing. Differentiating between PMS, PMDD, and premenstrual exacerbation will go a long way towards shifting our social and cultural perceptions of female hormones and women’s mental health.

Featured image by Christopher Campbell

Get our weekly digest for advice on sex, periods, and life in a female body


Continue the conversation


  • I am an advocate in the PMDD/PME (premenstrual exacerbation) community and feel the term premenstrual magnification should be changed to premenstrual exacerbation as the latter time is more widely accepted and used by researchers, clinicians, and patients.

    • Thank you, Brett! Our team dug into this and “exacerbation” does seem to be the more apt term. Thanks for reading and sharing your knowledge!


Leave a Reply

Your email address will not be published. Required fields are marked *