Some days you beam with euphoric happiness, everything’s going your way, and you feel ready to conquer the toughest obstacles. Other times your clothes feel scratchy, your partner is getting on your last nerve, and you swing between sorrow and rage at the smallest provocation.
To people without ovaries, this may sound a bit over the top, but for the rest of us, it’s just another month.
It turns out that your hormones are to blame for some of this drama. “The levels of several hormones vary during [the menstrual] cycle,” says Maureen Cernadas, MD, a gynecologic surgeon with Saint Peter’s Healthcare System in New Jersey.
“Estrogen, progesterone, cortisol, and serotonin levels fluctuate depending on the time of the month,” says Dr. Cernadas, and these fluctuations direct your emotions and physical health like a conductor leading a hormone orchestra.
In perhaps the most infamous stage of the menstrual cycle, PMS appears in over 90 percent of women, causing a long list of uncomfortable symptoms, according to the Office on Women’s Health (OWH).
But while PMS symptoms and resulting behaviors have become the brunt of countless jokes, your hormones actually influence your emotions and behavior throughout the month in a few phases — follicular, ovulatory, and luteal — reports the Cleveland Clinic.
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Feeling Good: The Follicular Phase
The follicular phase of your menstrual cycle begins on the day you start your period and lasts for about 10 to 14 days, according to the Cleveland Clinic.
[3] During this phase, your body secretes follicle-stimulating hormone (FSH).
While FSH doesn’t have a big say in your behavior, it does play a role: stimulating the production of follicles in the ovaries that contain eggs.
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During this time, estradiol (the most potent type of estrogen) begins to rise, cites StatPearls.
[5] “Often, this is when you may feel the most energized, sociable, clear minded, and happy,” says Taylor Hahn, MD, an ob-gyn at HerMD.
“Serotonin, a neurotransmitter, also tends to increase alongside estradiol and plays an important role in mood and emotions. You may be more likely to make progress on work or school projects,” says Dr. Hahn, adding that with this energy boost, you may be more interested in exercise and physical activity, too.
A study published in Brain Sciences found that women were more likely to feel positive emotions during the late follicular phase than emotions like anger.
[6] With all those happy feelings flowing, it’s easy to see why the follicular phase is a fan favorite.
Feeling Frisky: The Ovulatory Phase
“During ovulation, estrogen levels peak,” says Cernadas. When estrogen levels get high enough, your body releases luteinizing hormone (LH), usually around the 13th day of your cycle, StatPearls cites.
LH tells your ovaries to release an egg into the nearby fallopian tube so it can travel to the uterus and be fertilized, according to the Cleveland Clinic.
[8] With high estrogen levels (and perhaps in response to impending egg release), many women report feelings of happiness, attractiveness, and sexual desirability during this phase, research says.
“Testosterone rises around the ovulatory phase and is closely linked to improved mood and energy,” says Hahn, adding that as a result, “sex drive and desire may increase.”
Some experts believe that this timing has a biological basis to naturally encourage sexual activity around the time of ovulation and increase the likelihood of pregnancy, Hahn adds.
Feeling Crappy: The Luteal Phase
After you ovulate, the follicle left behind by the departing egg secretes progesterone, a hormone that gets the uterus ready to accept and maintain a fertilized egg. “Progesterone can initially improve sleep and lower anxiety, however, some may experience bloating, constipation, fatigue, and fluid retention,” says Kahn. It may also increase cravings for junk food and less-nutritional dietary habits, she adds.
If your egg remains unfertilized, your progesterone levels fall, according to the Cleveland Clinic.
[2] At this point, estradiol, progesterone, and testosterone may be at their lowest, says Kahn, paving the way for PMS symptoms like cramps, increased acne, breast tenderness, and headaches.
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PMS Mood Swings
Beyond the physical symptoms, this hormone dip in the luteal phase can feel like an emotional roller coaster, the Cleveland Clinic reports, with symptoms such as the following:
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- Libido changes
- Feelings of anxiety, sadness, or depression
- Difficulty concentrating
- Change in appetite
- Insomnia
“For some, these symptoms may be mild, almost nonexistent, or generally go unnoticed. But for others, the symptoms can be significant and distressing,” says Kahn.
What Causes PMS?
While experts don’t fully understand what causes PMS, they have some leading suspects:
Serotonin A chemical neurotransmitter, serotonin carries messages between your brain and body, and can help regulate mood. One study found that serotonin levels dip during the luteal phase, possibly contributing to PMS symptoms.
Cortisol A rise in the stress hormone cortisol may be partially responsible for PMS emotional fluctuations, says Cernadas. A study published in the International Journal of Molecular Sciences suggests that it can also cause weight gain, flushing, and fatigue.
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Lifestyle Habits Some experts have pointed to lifestyle habits as worsening factors for PMS, says Kahn, and they may play a part in PMS symptom intensity. For example, one study found that women who smoked noticed more mental health symptoms during this stage, and women who ate a diet high in fat, sugar, and salt had more physical symptoms.
[12] “But successful management of PMS can be much more complex than just changing diet and exercise,” says Kahn.
Ways to Manage PMS
Experiencing PMS symptoms does not necessarily mean something is wrong, according to Kahn: “Every person who experiences menstrual cycles could potentially experience PMS symptoms, but the severity and how they are able to manage those symptoms may vary widely.”
For mild PMS symptoms, Hahn recommends these tips:
- Make sleep a priority. “Sleep allows both your body and mind to rest, repair, and re-energize during a time when daytime fatigue can be a major issue,” says Hahn. Try to get a full eight hours during this time.[1]
- Focus on a balanced diet. “Try and avoid giving into those cravings. The junk food and high-sugar sweets can taste good for a moment, but they don’t help with PMS and can often worsen symptoms like bloating, nausea, and cramping,” says Hahn, who adds that eating smaller, more frequent healthier meals may also lessen PMS symptoms.
- Engage in low-impact activity. While exercise may feel like the last thing you want to do in the midst of PMS symptoms, movement increases endorphins and can improve and stabilize mood, tamper food cravings, and decrease pain and discomfort, says Hahn. “Choose something as easy as walking around your block or just stretching in your living room,” she adds.
Sometimes premenstrual symptoms are much more severe and point to premenstrual dysphoric disorder. This condition is like PMS but with more severe symptoms like irritability, anxiety, or depression, according to the OWH.
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“Women respond differently to hormonal changes that are out of their control,” says Cernadas. Though your hormone levels may feel beyond your influence, you can use the information to feel empowered about your own menstrual cycle and your behavior changes throughout.
If you’re unsure about your PMS symptoms, your healthcare provider can help you figure out how to address them.
“I would highly encourage a visit with your doctor or trusted healthcare provider to discuss ways to minimize symptoms, particularly if [they] are interfering with your life, relationships, work, or school,” says Cernadas.
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