Untangling links between wellbeing and the menstrual cycle

For something that affects millions of people in the UK alone, the effects of hormonal changes during the various stages of the menstrual cycle on psychological wellbeing have been woefully under-studied.

Research shows that a minority of people who ovulate suffer from debilitating premenstrual dysphoric disorder, and that about three quarters experience pre-menstrual syndrome (also known as PMS), with symptoms that include irritability, mood swings, depression, and fatigue.

However, write the authors of a recent study in Psychological Medicine, we have only a "limited understanding" of how changes in hormone levels over the menstrual cycle affect different aspects of wellbeing. This lack of knowledge applies to those who use oral contraceptives as well as those who don't.

In a bid to help plug this knowledge gap, Anne Marieke Doornweerd and Lotte Gerritsen at Utrecht University studied 18 people who were taking an oral contraceptive and 22 people who were not. Every day for 28 days, these participants rated their levels of a wide range of emotional and physical symptoms, including feelings of happiness, sexual desire, and sleep quality. They also gave daily saliva samples, which the researchers analysed for levels of the sex hormones estradiol, progesterone, and testosterone.

The results showed that the participants taking the oral contraceptive reported more similar levels of agitation, risk-taking, feelings of being attractive, and energy levels than those in the other group. The researchers believe that this supports an existing theory that because oral contraceptives stabilise fluctuations in levels of sex hormones across the menstrual cycle, this can lead to a degree of 'emotional blunting'. This may not be welcomed by some, they note, but it might be beneficial for others, particularly those who experience more extreme mood swings during their cycle.

The participants using an oral contraceptive also gave lower overall ratings for happiness, feelings of being attractive, risk-taking, and energy levels. But they did report feeling more relaxed, having more sexual desire, and enjoying better sleep than those who were not on a contraceptive.

When the team considered changes in wellbeing scores over the 28 days alongside variations in levels of the three sex hormone levels, they found that, overall, progesterone had the biggest impact. When progesterone levels were high, the participants felt less happy, more irritable and more stressed, and they reported having less energy and worse sleep.

Higher progesterone was also linked, though, to feeling more attractive and having more sexual desire during two different phases of the cycle: the follicular phase (which starts on day one of the period and lasts for about two weeks) and the periovulatory phase (around the time of the release of an egg). Higher progesterone was also linked to more risk-taking in the periovulatory phase and in the mid to late luteal phase (after ovulation). These results were unexpected, the researchers write. "But," they add, "no prior study has ever looked at daily measurements per menstrual cycle phase."

Their analysis also showed, as expected based on earlier studies, that around the time of menstruation, the participants reported their lowest average scores across a broad range of measures of wellbeing.

Doornweerd and Gerritsen acknowledge that their sample was relatively small. But while some earlier work has found changes in irritability, mood swings, and fatigue over the menstrual cycle, their study's major strength, they write, is that it included a wide range of psychological wellbeing variables that are known to be sensitive to sex hormones. In doing so, it helps to paint a more detailed, nuanced picture of the day-to-day experiences of billions of people.

Read the paper in full:
Doornweerd, A. M., & Gerritsen, L. (2025). 28 days later: A prospective daily study on psychological well-being across the menstrual cycle and the effects of hormones and oral contraceptives. Psychological Medicine, 55, e19. doi:10.1017/S003329172400357X

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