September 14, 2026 Author : Claúdia Miranda (obstetrics-gynecology) It is not accurate to consider menstruation a cause of depression. However, it is true that the changes associated with the menstrual cycle can have an impact on mental health. Depression is more common in women than in men , and this difference begins to become apparent from puberty onwards, precisely at a stage when significant hormonal changes and brain maturation take place. To understand this relationship, it is important to know what happens throughout the menstrual cycle : In summary, during the different phases of the cycle, the levels of the main ovarian hormones, estrogen and progesterone, undergo fluctuations. Both estrogen and progesterone act on the brain and influence several neurotransmitter systems involved in the regulation of mood and behavior. Estrogen appears to be involved in the regulation of mood, behavior and brain activity. Fluctuations in estrogen levels, particularly estradiol, and especially their decline during certain reproductive phases, have been associated with negative changes in mood. These changes may present as symptoms such as sadness, irritability, anxiety, sleep disturbances and difficulty concentrating. Progesterone and its metabolites also act on the brain and may influence emotional wellbeing. Fluctuations in progesterone levels are associated, in more sensitive women, with symptoms such as irritability, anxiety and mood changes. However, in many women, changes associated with the menstrual cycle are more likely to present as irritability, anxiety or emotional instability than as depressive symptoms in the strict sense. Evidence suggests that it is mainly the hormonal fluctuations throughout the menstrual cycle that matter, rather than the absolute levels of these hormones. Depressive symptoms most commonly emerge or worsen in a cyclical pattern, particularly during the late luteal or premenstrual phase , when there is a marked decline in both estrogen and progesterone levels. It is important to note that these hormonal fluctuations occur in virtually all women, yet only a minority develop depressive symptoms related to the menstrual cycle. What appears to happen is that some individuals, whether adolescents or adults, have a greater cerebral sensitivity to hormonal fluctuations that are otherwise entirely normal. This increased susceptibility seems to result from the interaction of genetic, psychological and environmental factors, among others. Research also suggests that there is no single pattern of response to hormonal fluctuations. Some women may experience a worsening of symptoms during the premenstrual or menstrual period, while others may notice changes during different phases of the cycle. This sensitivity is highly individual. When discussing mood changes related to menstruation, it is also important to distinguish between two different situations: Premenstrual dysphoric disorder (PMDD), a mood disorder in which symptoms repeatedly occur during the premenstrual phase and improve or disappear within the first few days after menstruation begins. An underlying depressive disorder or another psychiatric condition in which symptoms simply become worse during the premenstrual period. In addition to hormonal changes, other gynecological conditions that can significantly affect quality of life and psychological wellbeing in adolescent and adult women include menstrual irregularities, severe menstrual pain and abnormal uterine bleeding. Although premenstrual symptoms are very common, only a minority of women experience emotional symptoms severe enough to significantly interfere with school, work or social life. It is not possible, nor is it desirable in all women, to completely prevent the physiological hormonal fluctuations of a normal menstrual cycle. The most important step is to identify early those who are vulnerable and who show a consistent relationship between depressive symptoms and menstruation. One of the most useful ways of doing this is not through hormone testing, but through symptom tracking. A mood and symptom diary , ideally maintained for three menstrual cycles, can be an extremely valuable tool. Treatment depends on the individual situation and may include lifestyle measures, psychological or psychiatric support and, in selected cases, antidepressant treatment or hormonal strategies aimed at reducing ovarian hormonal fluctuations. However, all treatment options should be tailored to the individual and, ideally, considered within a multidisciplinary assessment. Particularly in adolescents, attention should be paid to warning signs such as: Persistent or intense sadness Loss of interest in usual activities Social withdrawal Marked irritability Significant changes in sleep or appetite Decline in academic performance Difficulty concentrating It is important not to dismiss severe symptoms simply because they occur before menstruation. In summary Depression is a multifactorial condition, and menstruation cannot be considered a cause of depression on its own. However, the hormonal changes that occur throughout the menstrual cycle may act as a trigger or aggravating factor for depressive symptoms in some particularly vulnerable women, whether adolescents or adults. More important than changes in the absolute levels of hormones are the hormonal fluctuations themselves and the brain's individual sensitivity to those fluctuations. Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item. English translation generated with AI and reviewed by the editorial team
