The mental challenges of living in a menstruating body

Many different challenges come with living in a menstruating body. We commonly hear of the physical challenges, but the effects of female sex hormones on mental health are often forgotten. In this blog post, I'll share three mental health challenges that can arise throughout a woman's life; all of which are related to her reproductive hormone levels.

Premenstrual Dysphoric Disorder (PMDD) is one such challenge. PMDD is a severe form of premenstrual syndrome (PMS) that affects mood, causes physical symptoms and impacts a person’s ability to thrive during the weeks leading up to their menstruation (American Psychiatric Association, 2013). Perinatal depression is another challenge and is a form of depression that can arise as a result of pregnancy. Perinatal depression includes both post-partum depression which occurs after childbirth and prenatal depression which begins during pregnancy (American College of Obstetricians and Gynecologists, n.d.). Another mental health challenge related to a woman’s hormonal cycles is perimenopausal depression which occurs in the time leading up to menopause and is marked by changes in menstrual cycle regularity and hormonal fluctuations (American College of Obstetricians and Gynecologists, 2021).  

Hormonal Fluctuations and Their Impact on Mental Health

Premenstrual Dysphoric Disorder (PMDD), perinatal depression, and perimenopausal depression can be characterized as diseases of the nervous system and the body because they involve physiological components that are deeply influential in their development. These disorders are not solely mental health issues but are primarily influenced by hormonal fluctuations and their effects on the brain and body. PMDD, for example, is linked to hormonal shifts during the menstrual cycle that impact neurotransmitter systems, contributing to severe mood changes, irritability, and physical symptoms (American College of Obstetricians and Gynecologists, 2023). Similarly, perinatal depression is rooted in the complex interplay between hormonal changes after childbirth and alterations in brain chemistry which occur during pregnancy (American College of Obstetricians and Gynecologists, n.d.). Perimenopausal depression occurs as a result of hormonal changes associated with menopause which causes both mental and physical symptoms (American College of Obstetricians and Gynecologists, 2021). In each case, the nervous system is directly impacted by hormonal changes, while the body experiences sometimes vivid discomfort.  

Shared Symptoms and Distinctions Among PMDD, Perinatal, and Perimenopausal Depression

Premenstrual dysphoric disorder (PMDD), perinatal depression, and perimenopausal depression share several similarities; primarily in how they affect mood and emotional regulation due to hormonal fluctuations. All three conditions are strongly influenced by changes in reproductive hormones, though at different life stages. They involve a combination of mood disturbances, cognitive changes and physical symptoms. All three challenges include fatigue, sleep disturbances, mood swings, and cognitive difficulties (e.g., trouble concentrating or brain fog). They also include physical symptoms as well; such as headaches, joint pain, or changes in appetite. However, since they happen at distinctly different stages of life they are not likely to be mistaken for each other. The existence of pregnancy tests and the use of hormonal testing can allow healthcare providers to differentiate between the three with relatively little risk of misdiagnosis.  

The History of Misdiagnosis and Stigma in Women’s Health

While the recognition of these disorders by the medical establishment is fairly new, women have been living with these disorders for millennia. The label "hysteria" was common from the 19th century through the early 20th century (Hooley, 2019), and it often led to hospitalization or institutionalization for people who were experiencing a range of symptoms, some of which may certainly have arisen from PMDD. In the past, postpartum psychosis (a rarer, more severe form of perinatal depression) could lead to hospitalization (Friedman, 2017). Perimenopausal depression may have sometimes been diagnosed as “nervous exhaustion” or “neurasthenia,” in the past and women experiencing these challenges may have been placed in mental health institutions for "rest" (Friedman, 2017). The recognition of these diseases as arising from hormonal fluctuations and not from women’s “weakness” or “volatility” has helped individuals suffering from these diseases to be treated with greater respect and has drastically improved treatment options (Friedman, 2017).  

A key component of this change has come as a result of women’s greater participation and power within the medical establishment. For generations, following the establishment of misogynistic medical organizations created to gate-keep the medical profession, women were excluded from any role in research or treatment of these diseases. As women have more agency both in society as a whole and within the medical and mental health professions, they can advocate for more accurate research, diagnoses, and treatment.  

Sources: 

American College of Obstetricians and Gynecologists. (2021, September 29). Mood changes during perimenopause are real: Here’s what to know. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/experts-and-stories/the-latest/mood-changes-during-perimenopause-are-real-heres-what-to-know#:~:text=You%20might%20feel%20irritable%2C%20have,known%20as%20perimenopausal%20mood%20instability 

American College of Obstetricians and Gynecologists. (n.d.). Summary of perinatal mental health conditions. American College of Obstetricians and Gynecologists. https://www.acog.org/programs/perinatal-mental-health/summary-of-perinatal-mental-health-conditions  

American College of Obstetricians and Gynecologists. (2023, December 27). ACOG guideline: Management of premenstrual syndrome and premenstrual dysphoric disorder. The OB/GYN Project. https://www.obgproject.com/2023/12/27/acog-guideline-management-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder/  

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. 

Friedman, S. M., & Gelfand, D. M. (2017). The history of women's mental health: From antiquity to the present. Cambridge University Press. 

Hooley, J. M., Nock, M. K., & Butcher, J. N. (2019). Abnormal Psychology (18th ed.). Pearson Education (US). https://mbsdirect.vitalsource.com/books/9780135191033