Written by therapist Megan Hanafee-Major
“She’s being so crabby, is she PMSing?”
“They must be on their period.”
“Calm down and eat some chocolate!”
Anyone who menstruates has likely heard these, even as jokes. But anyone who menstruates also knows that the cycle is no joke. Media especially loves the trope of a crabby or crazy woman on her period, yelling at everyone while shoving ice cream in her mouth. All at once, there is a desire to revolt against this moody and weak stereotype (“anything you do, I can do bleeding!”) and yet recognize that menstrual cycles do have profound impacts on our lives and wellness. Fear not, fellow menstruators, I stand at this intersection with you!
When we remember that the body’s hormones and their fluctuations impact our moods, behaviors, hunger cues, sleep needs, and just about everything else, it becomes obvious why it can feel like “Aunt Flo” rules our lives. It is an unfortunately common experience that the cycles of hormones cause unwanted symptoms like pain, bloating, worrying, depressed mood, tiredness, and the like. Nearly everyone with a menstrual cycle has had bouts with these. Less common, although more prevalent than we may expect, are more extreme symptoms manifesting in Premenstrual Dysphoric Disorder (PMDD), postpartum depression, and other diagnosable disorders.
It can be hard to tell the difference between common fluctuations in mood along with hormonal changes, and a mental or physical health condition that requires special attention and treatment. If you suspect your symptoms are beyond what could be typical, the best way to start this process is to learn about what menstruation-related disorders are, track your cycle, and enlist the help of your mental and medical health team.
Knowledge is Power!
There are typical side effects and symptoms we can expect from a fluctuation in hormones. Throughout the month, menstruators are likely to notice shifts in mood, energy levels, sex drive, and other things. There are also symptoms that go above and beyond what one would expect which may impact and even impair daily functioning. Unfortunately, it can be difficult to tell the difference, especially if you have had an “abnormal” experience your entire life.
One of the most common experiences is Premenstrual Syndrome (PMS), which often happens just before and/or at the beginning of your period. For many people, the symptoms of PMS (irritable mood, food cravings, abdominal discomfort, etc.) are manageable and more inconvenient than anything. But for others, this experience can prohibit activities of daily living and be extremely painful. Although pain before and during one’s period is common, it is not something that should be overlooked. There are many things that can be done medically and mentally to ease this pain, and in some cases, bad PMS can be a sign that there is a larger or more serious medical issue. My doctor once told me, “if you have to cancel plans, work, or school because of your period, something is wrong.”
For some, the week before their period brings mood changes like depression beyond what is expected, resulting in Premenstrual Dysphoric Disorder (PMDD). These mood changes impact a person’s ability to complete daily tasks and may also become more extreme like suicidal ideation. With PMDD, symptoms can appear nearly identical to depression. The primary difference is that the depressive mood is only present the week or two before one’s period. During the other weeks of the month, the symptoms are not present and this pattern is present over many months. There are medical, psychological, and behavioral treatments that can help alleviate PMDD, so working with a healthcare team can help.
The body goes through expected hormonal changes during pregnancy, after pregnancy, and during menopause as well. These times can bring about symptoms like PMS such as changes in appetite, sleep, and mood. Similar to menstruation, these symptoms (although typical) can become beyond what is expected and impair functioning. For example, when depressive symptoms are elevated after giving birth, Postpartum Depression can result. For many new parents, these symptoms end in a few weeks, but if they endure, medical and therapeutic attention might be necessary.
4 Phases of the Menstrual Cycle
Like many during puberty, I learned that a typical cycle lasts about 28 days but only knew that for about 7 days of that, I should expect to bleed. It took me until adulthood to learn that there are four phases of the menstrual cycle, and each affects us differently.
Menstrual Phase – This phase is most recognizable since it is when most people get their period. This phase lasts about 7 days, although that can vary from person to person.
Follicular Phase – This phase overlaps with the menstrual phase and starts on the first day of your period and lasts for an average of 16 days.
Ovulation Phase – This is the shortest phase, only lasting about 24 hours, and occurs in the middle of the menstrual cycle (so about day 14 of a 28-day cycle).
Luteal Phase – This is when the uterine lining thickens in anticipation of a fertilized egg. This cycle lasts about 14 days but can range from 11 to 17 days. This is when PMS symptoms like bloating, food cravings, sleep changes, etc. will occur.
When I began tracking my cycle, I only knew to track the menstrual phase. This is a common practice among menstruators but may not reveal the entire picture. There are many ways to track one’s cycle, and no one way is better than the next, it just depends on each individual. Many people who have regular and predictable periods are able to track all four phases using their period as an anchor. However, if your period isn’t regular for any number of reasons, this may not work for you.
In those cases, we have to rely on other indicators and tools to help us. Sometimes merely tuning into your body is enough. Noticing changes in your energy level, food cravings, sleep habits, breast tenderness, vaginal discharge, and sex drive can (for some) map out when each phase begins and ends.
Tools like apps, thermometers, and ovulation tests can assist in these efforts. For example, many people experience a rise in basal body temperature during the ovulation phase. Using these tools can make it easier to notice small changes in your body and over time, see the larger patterns. Some health apps integrate menstrual tracking in addition to monitoring exercise, sleep, etc., but there are also apps specifically for tracking periods and other menstrual symptoms. My personal favorite is Flo, which helps you track periods, ovulation, medication, sleep, weight, temperature, and a host of other things. It uses data from many different aspects of your overall health to predict when ovulation and menstruation are likely to happen. It also allows users to track symptoms like cramping, bloating, fatigue, and the like so that patterns for each individual can be easier to notice. Understanding our own bodies (not “average bodies” or “ideal bodies”) is the key to adjusting our lives and expectations to best serve our health and wellness. To best understand your own body, it may be beneficial to try different ways of tracking your cycle until you find the best and most accurate one for you.
Know Thyself and Discuss with Others
This journey doesn’t have to be in solitude! Although talking about periods and everything that comes with them might feel embarrassing, this experience is hardly unique. Reading books, visiting reliable websites, talking with friends, and being open with your health care providers can not only provide useful information and validate these experiences, but help break down the stigma associated with menstrual cycles.
Menstrual cycles shouldn’t be sources of distress, we can care for and work with our bodies to support its phases rather than fight against them. If any of the mentioned symptoms sound familiar, or you begin to notice patterns in your cycle that cause you to worry, bring them up to your therapist and other health care providers.