Mental health and your cycle

Symptoms of depression and anxiety can get harder to manage before or during a period. If you already live with a mental health condition, tell your clinician about this pattern. You can ask about the timing without assuming hormones explain everything you feel.

When an existing condition gets harder

Premenstrual exacerbation means a mental health problem you already have gets worse in the days before a period. The symptoms are already part of your life, but may get harder at this time. Depression or anxiety can overlap with the symptoms people call PMS.

PMS means symptoms in the weeks before a period. If a condition you already have gets worse around your periods, ask to talk about that separately from PMS. Describe your symptoms at other times too, including days when they’re still hard after bleeding has started.

Research hasn’t found the same pattern for every condition or every person. A systematic review found mixed evidence that mental health conditions get worse around periods. If you notice a possible link, look into it with your clinician.

Record the whole picture

The NHS suggests keeping a symptom diary for at least 2 menstrual cycles when looking into symptoms before periods. A clinician may also ask when symptoms started, how often they happen and how they affect your usual activities. Ask whether they have a diary form you could use.

Next to your bleeding dates, write a few words about your mood and how it affected your day. “Anxious on the bus and couldn’t stay at work” says more than a label on its own. You might add sleep, stressful events and any medicine changes you’ve already agreed with your prescriber. These give the conversation context.

Include days when symptoms ease, as well as days when they get worse. If you miss days, leave them blank rather than filling them in from memory. Start with one 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, what you prefer and your medical situation. Tell the clinician about the symptoms you have all the time, as well as any that get worse around your cycle.

Don’t stop a prescribed medicine without talking to your doctor. If you think there’s a link between your treatment, your bleeding and your mood, ask your prescriber to review it. Bring the names of your medicines and explain what you’ve noticed. Don’t change your treatment based on a predicted phase of your cycle.

Sleep, being active and support from people you trust can be part of your care too. The Office on Women’s Health says exercise on its own doesn’t usually treat or cure a mental health condition. But 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 get in the way of daily life, or depression or anxiety gets worse around your periods. You could start with, “This is happening on top of the symptoms I already have, 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’re in crisis. In England, call NHS 111 and choose 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. Don’t wait for your period to come or your diary to be finished.

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 can’t keep yourself safe, have seriously harmed yourself or someone’s life is at risk. If there’s immediate danger, use emergency services rather than waiting for a listening service.