Here is our myth-busting guide to help you know the difference between ‘normal’ and problematic mood changes.

What mood changes are normal?

Let’s start with the type of mood we are talking about in relation to the menstrual cycle. There are five main ones to watch out for [1]:

1. Joyful– feeling happy, positive, energetic, productive, creative, and content.
2. Sensitive– feeling moved by beautiful music, a soppy TV show or advert, increased empathy for others and/or more easily frustrated or upset. This is often expressed as tearfulness regardless of the reason!
3. Irritable– feeling annoyed, frustrated, angry, typically directed at other people and is often combined with increased sensitivity to things like sound, smell, light, and being touched.
4. Anxious- feeling worried, nervous, unsettled, like something bad might happen, or overwhelmed. Often accompanied by increased heart rate, shallow breathing, and muscle tension or digestive changes.
5. Low– feeling sad, upset, negative, low energy, typically internalised – self blame, low self-esteem, self-loathing.

I’m guessing that most of you were surprised to see ‘joyful’ in there? Well, society has done a great job of positioning the menstrual cycle as an entirely negative experience (despite its crucial role in the continuation of our species and reproductive health). We hardly ever hear accounts of people experiencing cyclical joy because it simply doesn’t fit into this story, even though it is a common menstrual cycle-related experience [2].

ikewise, the tearfulness that some people experience just before menstruation is generally equated with a low or irritable mood- the fact that tearfulness is also caused by beautiful, joyful, or plain old empathetic (feeling moved by the experiences of others) triggers is nearly always overlooked [1].

So long as these mood changes are mild-moderate and do not significantly disrupt your life in any way, they are perfectly normal experiences. As they are for every single human on the planet, regardless of sex or whether or not that person menstruates.

Contrary to popular opinion, people who menstruate are not more likely to experience significant negative mood changes during the premenstrual (luteal) phase of the menstrual cycle (unless suffering from Premenstrual Dysphoric Disorder (PMDD)- a condition outlined below) [3]. As previously discussed, a high quality systematic review of all of the existing prospective research (up to 2012) conducted on negative mood changes and the menstrual cycle, found no evidence of a specific ‘premenstrual mood pattern’ in the general menstruating population [3]. Indeed, in the studies that included male participants as a control population, day of the week was more likely to cause negative mood changes in both male and female groups (usually Sundays & Mondays!), than any particular phase of the menstrual cycle – and this is obviously due to an external social factor (the working week) rather than any biological cause [3].

Now then. This does not mean that the menstrual cycle does not affect mood in any way. It just means that the vast majority of menstruating people do not experience moderate-severe cyclical mood changes, and in the vast majority of people who menstruate, mood changes are not restricted to the premenstrual phase only. As we have mentioned before, the review makes no comment on the experiences of people with PMDD, except to imply that what they experience is not merely a ‘more severe’ version of typical menstrual cycle-related mood changes i.e. that there is something fundamentally ‘different’ happening in this condition [4].

What is not normal?

In short, any mood symptoms that are regular and severe enough to prevent or disrupt daily activities, impact on interpersonal relationships, or threaten your wellbeing.

This even includes ‘joyful’ moods, if they are so extreme as to perhaps indicate the ‘mania’ associated with bi-polar disorder.

For people who menstruate, ‘negative’ mood changes most commonly involve irritability, followed by anxiety, then low mood- and it is not uncommon to experience two, or all three, negative moods together [6].

If you menstruate and are experiencing debilitating mood changes, it is CRUCIAL that you track your symptoms on an app or calendar. Where in the cycle you experience such changes can indicate different conditions (listed in order of prevalence, from most common to least likely);

1. Chronic mental health disorders e.g. depression, anxiety, bi-polar disorder, or borderline personality disorder– (if moderate- severe mood symptoms occur throughout the cycle)
2. Cyclical worsening of a chronic mental health issue (if symptoms are only a problem during certain parts of the cycle but occur at a mild level throughout
3. Premenstrual Dysphoric Disorder (if severe mood symptoms only occur in the luteal phase of the cycle)A diagnosis of PMDD currently involves the presence of at least five out of eleven symptom types with at least one of the main symptoms being; severe irritability, depressed mood, or anxiety. These symptoms should only occur in the two weeks before menstruation and stop completely between menstruation and ovulation. In order to meet the criteria for diagnosis, the symptoms should be tracked for at least two consecutive cycles in order to confirm the cyclical nature of symptoms [7].

Source: Menstrual-matters