Mental health and your cycle

Depression and anxiety symptoms can become harder to manage before or during a period. If you already live with a mental-health condition, mention this pattern to your clinician. You can ask about the timing without assuming that hormones explain everything you are feeling.

When an existing condition gets harder

Premenstrual exacerbation means an existing mental-health problem gets worse around the time before a period. The symptoms are already part of your life, but may become more difficult around this time. Depression or anxiety can overlap with symptoms described as PMS.

PMS refers to symptoms in the weeks before a period. If an existing condition worsens around periods, ask to discuss that separately from PMS. Describe symptoms at other times too, including days when they remain difficult after bleeding has started.

Research has not shown the same pattern for every condition or every person. A systematic review found mixed evidence for worsening around menstruation across mental disorders. If you notice a possible connection, explore it with your clinician.

Record the whole picture

The NHS suggests a symptom diary for at least 2 menstrual cycles when investigating premenstrual symptoms. A clinician may also ask when symptoms began, how often they happen and how they affect usual activities. Ask whether they have a diary form you could use.

Alongside bleeding dates, write a few words about your mood and how it affected your day. “Anxious on the bus and unable to stay at work” says more than a label alone. You might add sleep, stressful events and any medicine changes already agreed with your prescriber, to give the conversation context.

Include days when symptoms ease as well as days when they worsen. Leave gaps marked as gaps rather than filling them from memory. Start with a sentence at a time if that feels manageable. Bring what you have to an appointment.

Discuss care for the underlying condition

For depression, treatment can include talking therapy, medicines or both. The choice depends on your needs, preferences and medical circumstances. Tell the clinician about your ongoing symptoms as well as any worsening around your cycle.

Do not stop a prescribed medicine without talking to your doctor. If you suspect a link between treatment, bleeding and mood, ask your prescriber to review it. Bring the medicine names and explain what you have noticed, rather than changing treatment according to a predicted cycle phase.

Sleep, physical activity and support from people you trust can be part of your care too. The Office on Women’s Health says exercise alone does not usually treat or cure a mental-health condition, though it may help symptoms when combined with treatments such as therapy or medicine.

Ask for help at the level you need

Book a GP appointment in the UK, or see your doctor or mental-health clinician in the US or elsewhere, if symptoms interfere with daily life or depression or anxiety worsens around periods. A useful opening is, “This is happening on top of my existing symptoms, and I need help managing it.”

Get urgent support now if you have thoughts of suicide, even if you feel able to keep yourself safe. Get urgent mental-health help now if you are in crisis. In England, call NHS 111 and select the mental health option, or ask for an urgent GP appointment. Elsewhere in the UK, contact an urgent GP service; outside the UK, contact your local crisis service. Do not wait for a period to arrive or a diary to be complete.

In the UK, you can call Samaritans on 116 123, free, day or night. In the US, call or text 988 for crisis support, day or night.

Call 999 now in the UK, 911 in the US, or your local emergency number if you cannot keep yourself safe, have seriously harmed yourself or someone’s life is at risk. Use emergency services for immediate danger rather than waiting for a listening service.