The Menstrual Cycle And Mental Health: PCOS, and PMDD 

The link between your menstrual cycle and mental health. Every month, sometimes even twice, women are forced to endure 5-7 days (If your period follows the regular cyclical patterns) of feeling like strangers in their own bodies. There are so few that regale pleasant experiences of their time menstruating. Most women I have interacted with have stories that would put horror-film writers to shame, not to mention the blood. I am always pleasantly surprised that many are still unaware of what exactly is taking place within their own bodies that causes them to feel like the antagonist of their own horror movie called life.

Then I remember: we’ve been raised in a society that has not been conducive to an open discussion about this topic until recently, not unlike the topic of mental health. Thankfully, we are making waves in research that better enables us (particularly women of color) to better understand the inner-workings of our bodies.

Firstly, it is important to acknowledge that our experience of a period is a notable aspect of our menstrual cycle, but the cycle certainly does not end there. Our menstrual cycle takes place for twenty-eight to thirty days (give or take, an entire month). Our resulting period is significantly influenced by several phases characterized by a number of hormonal changes that occur throughout our bodies.  Our body spends weeks preparing for potential fertilization, and once it is clear that this did not happen during the cycle, menstruation is the result.

Overall, each stage in our cycle is governed by these hormonal changes –  hormonal changes that not only influences your physical state but also your mental well-being. Globally, there seems to be entrenched a flippant attitude, usually from our male counterparts, that regularly churns out stale jokes and blanket assumptions about women’s experience of mood swings, intense cravings, bloating, and other symptoms that come along with a monthly cycle.

Understanding Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS) often becomes the butt-of-jokes (or used to diminish the ability of women to effectively fulfill roles of authority – I’m looking at you sexism) rather than actually being considered an illness that may need treatment beyond popping a couple of Midol caplets or ibuprofen tablets with a nagging reminder to “calm down”.

Premenstrual Syndrome (PMS) is defined by the Office on Women’s Health as

“The combination of physical and emotional symptoms that many women get after ovulation and before the start of their menstrual period.” They attribute the symptoms of PMS to the rapid decline of two hormones, estrogen, and progesterone. In some cases, PMS can be so severe that it prevents women from performing their usual daily routines. The importance of estrogen and progesterone does not end with the menstrual cycle.

In fact, research has shown that they are both actively involved in regulating the release of serotonin and monoamines: serotonin mediates mood and behavioral disorders in which depression and irritability are prominent, while monoamines are implicated in anxiety disorders. Unfortunately, the research to further understand the effects of these hormones on human behavior is still ongoing, but the link has already been made.

The more severe cases of PMS are classified under premenstrual dysphoric disorder (PMDD). It is typically characterized by a more severe mood disturbance. Many women who experience PMDD actually experience clinical levels of depression or anxiety in that phase before their menstrual cycle (as such, women who suffer from PMDD should experience periods of being symptom-free between ovulation and menses). Researchers have begun to delve deeper into how best ways that PMDD and PMS should be handled, treated and classified in the world of psychological disorders.

Disorders Associated With The Menstrual Cycle

As women, we are faced with more than just the biweekly threat of hormonal changes when dealing with our menstrual cycle. There is also the possibility of developing Polycystic Ovarian Syndrome or Disorder (PCOS/D), Uterine Fibroids (Fibroids), or Endometriosis (to name a few of the diseases that result from having an active menstrual cycle). As the years have progressed, more young women of color have been diagnosed with these diseases. While they have been around for years, people are now realizing just how detrimental they can be to your mental health.

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders that can affect women. It affects the reproductive, metabolic, and psychological well-being of the individuals who suffer from it. Simply, women suffering from PCOS have a significantly increased amount of male hormones which adversely affects their menstrual cycle. PCOS, as the name suggests, involves the ovary which has the main role of releasing an egg for fertilization. With PCOS, the egg that is released is either underdeveloped or not released at the right point of the cycle. As such, it is labeled one of the leading causes of female infertility.

Its damage does not stop there. While it affects the reproductive cycle, it can also spur the development of other illnesses, such as diabetes and cardiovascular disease. It also increases the potential for experiencing anxiety and depression. PCOS will affect every aspect of a young woman’s life. Similarly, Uterine Fibroids, which is the development of growth from the uterine wall made of smooth muscle cells and other tissues, is said to be caused by an imbalance of the ovulating hormones.

Fibroids, until recently, were thought to have no effects on the menstrual period, however, it has been said to increase cramping during periods as well as induce heavier flows and cause abnormal bleeding to occur outside of the typical menstrual period. Where there is physical pain, psychological effects are likely to follow. Researchers have acknowledged that the location of the fibroids on the uterine wall can lead to either no pain or severe pain that can affect the bladder, lower back, and pelvic region.

Endometriosis produces similar results as well. It differs from fibroids in that the lining of the uterine wall is developing outside of the uterine cavity. Most commonly it is found developing behind the uterus, near to the bladder. Women with endometriosis highlight in different studies that prior to their diagnosis, their symptoms were written off as something that would pass with their menstrual period. Only thereafter when it appeared obvious that those symptoms were not going anywhere, was further analysis conducted to make an appropriate diagnosis.

Researchers also identify that even after receiving treatments for the pain, women were most likely still suffering from intense pains at inopportune moments which compromised their quality of life. While of the three diseases, PCOS is the only only one with direct empirical evidence provided, it is concluded that the pain associated with fibroids and endometriosis negatively affects the female psyche during their menstrual cycle. With women who suffer from either of these diseases characterized by an increase in experiencing intense pain, it was found that suicidal ideation may be common.

Stress Management For Premenstrual Syndrome

Stress-Management is cited as the number one way of trying to manipulate PMS and PMDD. In cases where women suffer from PMDD or PCOS, speaking to your health care provider (a Gynaecologist or Psychiatrist) about possible treatment options to aid with depression or anxiety may be necessary. Endometriosis and Fibroids require surgery in order to permanently remove the problem, but research has found that dieting, exercising, and some contraceptive methods do help to slow the growth and manage the pain in times of flare-ups.

Personally, I find that meditation, journaling, and the use of essential oils to clear my mind, helps to regulate the pain and episodes as they happen. Each cycle is different, much like our fingerprints. It is hard to anticipate what they will bring before they occur. As such, it is important to maintain healthy lifestyle practices as much as possible. Meanwhile, being hopeful that the research being done will one day free us from constantly battling our inner Freddy Krugers.

If you haven’t recently seen your gynecologist or have a fear of gynecologists (this happens from time to time; this is a judgment-free zone), I am imploring you to get your check-ups regularly. Be in the know with your body. Find a gynecologist that makes you feel comfortable and unjudged. The more you know about your body, the better equipped you will be to help yourself in your time of need.

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