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Anxiety and the Menstrual Cycle

Anxiety is a normal part of our lives. It comes at moments of stress and when we face something new and unfamiliar. Anxiety can present as anything from mild feelings of unease to severe distress—impaired breathing, increased heart rate, an anxiety attack.

It’s normal to experience feelings of stress and nervousness when facing challenges, but in some of us, anxiety strikes frequently and severely and needs to be addressed. But what to do when you feel anxious only a week or days before your period? That can signal hormonal imbalances and reproductive health issues.

What is anxiety?

Anxiety is a normal part of our lives as human beings. Many things can cause us to feel stress—at work, in our personal lives, or when dealing with social issues. Anxiety manifests in feelings of unease, fear, overthinking, and obsessive thoughts. It can also show up as physical symptoms such as trembling, sweaty palms, rapid heart rate, shallow breathing, nausea, and dizziness.


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Anxiety varies from mild to severe. Mild anxiety is a natural reaction to stressors, such as dangerous or unfamiliar situations. Severe anxiety or an anxiety disorder can affect a person to the point where daily activities and socialising become challenging. When someone is dealing with anxiety, they are more easily agitated and irritated and may also suffer from depression. A person suffering from severe anxiety may experience an anxiety attack in the form of a rapidly increased heart rate, difficulties breathing, and feelings of nausea and dizziness.


Anxiety disorder commonly affects people who have experienced childhood trauma or some kind of abuse, suffer from post-traumatic stress disorder (PTSD), social phobia, or other fears.

It can be challenging to live with this condition. Many people cope with anxiety through therapy and/or medication.

However, sometimes people with no history of trauma or phobias experience periods of heightened anxiety. In some cases, this can be linked to hormonal fluctuations in the body and the menstrual cycle.

The menstrual cycle and hormonal fluctuations

A menstrual cycle typically lasts for 28–35 days. During this time, our bodies prepare for conception. But if there’s no impregnation during the fertile window, the uterus lining is shed, and the cycle begins again. While most women notice only their periods, the hormonal fluctuations that occur throughout the cycle affect our reproductive health and our overall health.

You see, hormones act as triggers for different systems in the body. The female sex hormones oestrogen and progesterone affect our skin, liver, and other organs; our metabolism; and neurological function, which is why many women experience related mood changes. Let’s dive a little deeper.

The menstrual (or ovulatory) cycle can be thought of as consisting of three stages—the follicular stage (10 to 17 days including menstruation), the ovulatory stage (24 to 48 hours), and the luteal stage (about 14 days). Each stage is regulated by certain hormones that trigger aspects of the reproductive cycle and affect mood and energy levels. We typically use the visible shedding of the uterine lining—the menstrual period—to mark the beginning and end of a three-stage menstrual cycle.

The follicular stage begins on day one of your period, which is also day one of the full cycle. Levels of oestrogen and progesterone are low for the 4 to 7 days you are menstruating. Over the next few days following your period, oestrogen rises, making you feel more energetic. One of its reproductive functions is to trigger the release of FSH (follicle-stimulating hormone), which activates several of the follicles in your ovaries to develop the eggs they contain, one of which will develop more fully and become dominant. As the oestrogen in your system reaches its peak, you probably feel outgoing, frisky, and attractive.

The ovulatory stage happens mid-cycle, beginning when a peak in oestrogen triggers a brief surge in LH (luteinising hormone), causing the ovaries to release the egg from the dominant follicle into the fallopian tube, where it can become fertilised by male sperm if present. Sperm is typically viable for up to three days, while an egg is viable for just one day. This is why the days leading up to ovulation are considered a woman’s most fertile days. Ovulation can be predicted using a number of indicators. Learn more in our article How Do Hormones Affect You During Your Cycle?

Another function of oestrogen is to promote the growth of the uterine lining. After ovulation, the luteal stage begins. Oestrogen recedes, and progesterone becomes the dominant hormone. Its function is to maintain the uterine lining for the potential implantation of a fertilised egg. The corpus luteum, or the remains of the follicle that released the egg, is responsible for stimulating progesterone production. Levels peak about one week after ovulation, which would be about the time the egg would implant itself into the uterine wall if fertilised. If the egg is not fertilised, the corpus luteum is reabsorbed into the body, progesterone levels drop, the uterine lining is shed as menstrual blood, and the body prepared to begin a new cycle. Many women suffer from mild-to-moderate changes in mood during the luteal phase, including anxiety, irritability, and depression.


Why do you feel anxious during your cycle?

Hormonal-induced anxiety is most common at the end of the cycle, a week or two before your period begins. It’s often accompanied by other symptoms of premenstrual syndrome (PMS) or, in about 5% of women, premenstrual dysphoric disorder (PMDD) such as bloating, headaches, irritation, mood swings, insomnia, fatigue, tender breasts, constipation or diarrhoea. PMDD is more severe than PMS to the level it can impair your daily life.

Another condition is called premenstrual exacerbation (PME). It is similar to PMDD, but it manifests in intensifying mental disorders such as anxiety, depression, emotional eating.


Women who suffer from PME feel more depressed, anxious, have suicidal thoughts before their period starts.

While the precise reason some women suffer from worsening mental conditions in the luteal phase is still unknown, it’s believed to have something to do with progesterone levels.

Progesterone is often called the pregnancy hormone because it becomes the dominant hormone once a woman conceives. However, its benefits go beyond ensuring a healthy pregnancy. Progesterone has a positive impact on neurological function and metabolic features. Unlike oestrogen, it’s much harder to get progesterone from external sources—the primary way we get it is to secrete it ourselves.

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Just because you bleed every month doesn’t mean you produce enough progesterone. The goal of the menstrual cycle is ovulation. If the body doesn’t have access to the resources it needs to create a healthy environment for ovulates, it won’t produce progesterone; this, in turn, might worsen symptoms of PMS or PMDD. Women who have oestrogen dominance and low progesterone are more likely to experience severe PMS symptoms, clothy periods, fibroids, hormonal migraines, mood changes, anxiety, and depression.

Even if you ovulate, your body may not be producing sufficient progesterone for the entire cycle. Hormone levels can be detected in blood (usually done by a lab), saliva, and urine (home tests are available). If you want to check your progesterone, the best time to do it is right after ovulation.

Recognising the issue

Most of the time, anxiety results from trauma, phobias, or a hostile living environment. Hormonal fluctuations can make you feel worse but tend not to be the root cause. If the reason for your anxiety is trauma, you should consult with a specialist to find the best treatment method for you. However, if you feel pretty good during most of the cycle, but your symptoms worsen at the end, hormones might be to blame.

Usually, luteal phase psychological symptoms are followed by accompanying physical symptoms (cramps, abdominal pain, tender breasts, headaches, acne, fatigue, and digestion issues), which can help identify the cause. Either way, checking your hormonal levels will give you the information you need to balance them. You can complement the treatment you decide on with daily habits that help reduce stress and prepare the body for ovulation.

How to improve your hormone levels

One of the leading causes of hormonal imbalance followed by mental disorder is physical and psychological stress  Today we have become attuned to noticing triggers and traumas that comprise psychological stress, but sometimes physical stress can be more difficult to spot.

Some people live for many years without noticing the effects of physical stress until they begin to experience hair loss, irregular or absent cycles, or rapid ageing, or they develop a mental disorder or an autoimmune disease. Women often suffer from anxiety due to physical stressors such as excessive exercising, strict dieting, poor sleep, and other restrictions. But there are ways to reduce your stress levels with a few easy lifestyle changes.

Quality sleep

Good quality sleep is crucial for our well-being. Our bodies recover from the many small traumas of the day and regenerate; this improves healing and reduces stress. Most people need about 8 hours of quality sleep each night to be at their best. If for some reason, you haven’t had enough sleep, a daytime nap can be restorative.

Light exercise

Exercising increases stress. The secret to sustainable exercising is to take breaks between activities to regulate your breathing and heart rate. You shouldn’t do more than 30–40 minutes of heavy cardio several times per week because it increases cortisol (the stress hormone) and might otherwise impair hormone production. Many doctors recommend that women take a break from strenuous exercise during the luteal stage. Moderate exercise, such as walking, yoga, or Pilates, reduces stress and gets the blood flowing to your reproductive organs.

Nutritious diet

The physical processes the body goes through during the various stages of the menstrual cycle require sufficient energy, minerals, and vitamins  When we starve our bodies, we place them under additional stress and further deplete the body of essential nutrients. A fresh, varied, and nutrient-dense diet gives the body what it needs to feel good and perform well. Avoid strict diets, especially during the luteal phase. Instead, strive for small and frequent meals that contain protein, carbs, and fat.

Relaxation techniques

Meditation, breathing exercises, and a hot bath at the end of the day all help release tension and bring your awareness to the present moment. Allow yourself to unwind and shake off your worries from time to time. Your body will thank you. Relaxation techniques are especially beneficial during the second half of the cycle when the body is more sensitive to stress. Even a few minutes of mindfulness each day can help you feel more grounded.

Sunlight

Humans are diurnal creatures—our bodies are at their best when we are awake and spend some time outside during the day to soak up the sunlight and warmth we crave. Give your body what it needs by taking a walk during sunlight hours. At least 30 minutes of exposure to the sun increases serotonin (a hormone responsible for balancing mood and supporting the nervous system) and boosts vitamin D production (responsible for neurological function).

What a woman experiences during her menstrual cycle mirrors her overall health. If you experience anxiety or other adverse psychological states, a hormonal imbalance may be at fault. Support your body during the menstrual cycle, and you are likely to notice an improvement in your physical and mental health.

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Pain, fatigue, headaches, stomach upset… Many women find their bodies are more sensitive and prone to fatigue when they are menstruating as blood flow is often accompanied by many unpleasant side effects. So, should we reduce or stop engaging in physical activities during menstruation? The answer is no. Still, there are some nuances worth considering.
The average menstrual cycle lasts 28 days. Our lives impact our hormones, and therefore our cycles—for example, stress can delay your period. Some variation is to be expected, but bigger fluctuations are reason to investigate.
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