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How to look after your mental health during your menstrual cycle

Self-care is important at all times, but it could be even more valuable when you have your period. The impact that your menstrual cycle can have on your overall mental well-being is often underestimated, but there are steps you can take to manage your stress levels and reduce the chance of existing mental illnesses being exacerbated during your menstrual cycle.

Periods and mental health

More than half of menstruating people experience some pain around their period, with some estimates saying this statistic is as high as 84%. Another study found 32-40% of people who have periods report this pain is so severe that they have to miss work or school.

But it's not just the physical symptoms of a period that can cause discomfort and distress.

The fluctuating hormones during your cycle can directly impact your mood, with some people suffering from premenstrual dysphoric disorder (PMDD). Between 5-8% of women globally suffer from PMDD - a very severe form of premenstrual syndrome which causes both emotional and physical symptoms and in some cases can, concerningly, result in suicidal thoughts.

"Most people who menstruate will experience some symptoms of premenstrual syndrome (PMS), including mood swings and headaches, depression, anger, stress and anxiety," says Hannah Samano, founder of the UK's first cycle care platform.

However, she explains how some individuals can develop more severe symptoms. These symptoms - which make going about everyday life extremely difficult - include:

  • Problems concentrating.
  • Self-doubt.
  • Paranoia.
  • Fatigue.
  • Tearfulness.
  • Heightened sensitivity to the environment and people.
  • Emotional outbursts.
  • Difficulty with social interaction.

"The hormonal changes during your menstrual cycle may affect your mental health, but your mental health can also have an impact on your menstrual cycle. Stress can shorten or stop your period. It can also make it more painful," explains Samano.

A study found that there is "a significant association between stress and the incidence of dysmenorrhoea," or painful menstruation, usually manifesting as cramps. It found those with high stress were twice as likely to go through dysmenorrhoea.

Similarly, studies have found a link between people with stressful jobs and shorter menstrual cycles. The average cycle is around 28 days and anything less than 24 days is deemed short.

Here are some tips to care for your mind throughout your cycle.

Track your cycle

If you experience PMS, you'll feel it during the luteal phase before ovulation. During this week your oestrogen levels are low, a hormone change that causes a dip in mood.

The rise and fall of oestrogen and progesterone over a cycle can affect mood, emotions and mental health. This is because hormones change the chemistry of your brain.

Oestrogen and (to a lesser extent) progesterone levels rise during ovulation to prepare your body for pregnancy. If you don't conceive, these levels drop to prepare for menstruation. This rise and fall can take a real toll on you mentally.

Two key mood-related hormones that fluctuate are neurotransmitters serotonin (named the happy hormone) and gamma-aminobutyric acid (which relieves anxiety).

Of course, the effects of these hormonal changes differ from person to person, and very disruptive changes to your mental health might point to a hormonal imbalance.

Tracking your cycle can help you build a connection with it, and recognise patterns in your mood. Once you are aware of changes in your mental state and can see them coming, you know to take extra care of yourself during this time and implement coping strategies.

If you already struggle with a mental illness, this can be especially important since you may notice a spike in symptoms as your period approaches. This is known as premenstrual exacerbation (PME) and can affect both mental and physical illnesses, such as anxiety, depression, asthma, and inflammatory bowel disease (IBD).

Tracking your menstrual cycle needn't be complicated or time-consuming, as there is a range of apps that do all the work for you, right on your phone. Some apps are Clue, Flo and Moody Month. You should keep track of the day your cycle begins - the first day you bleed being day one - and how your mood is. As you continue to do this, you'll develop a better understanding of why your mood is fluctuating and be able to identify the most appropriate approach for self-care.

Try exercising

"Research suggests that regular aerobic exercise can lessen and help to improve PMS symptoms, such as depression and fatigue," explains intimate health specialist, Dr Shirin Lakhani.

"It's normal to not feel like working out at this time of the month. However, exercise releases chemicals called endorphins. These interact with the receptors in your brain that reduce your perception of pain, and trigger a positive feeling in the body. Therefore, gentle exercise can reduce the cramps and pains associated with PMS."

The chemicals released when exercising include serotonin and dopamine, which not only boost your sense of well-being, but can suppress hormones that cause anxiety.

One study in particular showed that, over a period of eight weeks, three sessions of 60 minutes of exercise significantly reduced symptoms of PMS in women aged 18-25.

If you're someone who struggles to get any rest while on your period, gentle exercise might help there too, since it can support your sleep patterns. Exercise can even help keep bloating and water retention under control.

Remember to do what is comfortable for you and don't push yourself too hard. Dr Lakhani adds that the possibilities for exercise are endless now, so you shouldn't feel put off if exercising on your period isn't something you've tried before. As well as aerobics, you might prefer a low-intensity Pilates class, an aqua aerobics session, or a weights session.

Practise stress management

Everyday life comes with its stressors which, combined with the unpredictability of a period, can cause everything to become very overwhelming very quickly. It's therefore important to practise stress management techniques throughout your menstrual cycle.

PMS alone can be stressful enough, especially when the symptoms interfere with your daily routine - whether that's cramps making it hard to get out of bed or mood swings affecting relationships. When you're stressed, your body produces more cortisol and corticotropin-releasing hormones (CRH). These are also known as the stress hormones. When stress has a particularly dominant influence on your hormones, it can lead to late or missed periods.

"Finding little ways to take the pressure off and give yourself a breather is so important. Stress is the number one factor for aggravating difficult menstrual symptoms as it interferes with our hormones and can deregulate our cycle," explains Samano.

Some simple ways to manage stress during your cycle

  • Healthy eating - sugar can exacerbate stress in your body. So, while it's normal and perfectly fine to crave sweet food/drink and carbohydrates during your period, try to substitute pieces of fruit or dark chocolate, which are lower in sugar and contain antioxidants.
  • Avoiding alcohol - while there's nothing wrong with an occasional glass of wine, alcohol will likely make you feel worse in the long run. Alcohol can impact your ability to get quality sleep, and acts as a diuretic so can be dehydrating. This means it can cause digestive upset and cramping in the lead-up to and during your period. Instead, try herbal tea or water to reduce bloating, cramps and stress-related anxiety.
  • Sleeping well - getting plenty of sleep can be a major route to combatting stress anyway, but especially during your menstrual cycle. We are supposed to get between 7-9 hours of sleep each night, and several studies suggest sleep will naturally reduce the stress levels in the body. Organising a structured bedtime and waking routine, winding down before going to bed and avoiding caffeine and electronic gadget use at night can help you build a better relationship with sleep.
  • Relaxation techniques - these can include a range of techniques, from massages, to breathing exercises, to meditation. You can also try yoga, as there are certain poses that may aid bloating and PMS. You should avoid poses such as headstands and handstands for the first days of your period when your flow is heavy, as these can be very strenuous. However, poses like the wide squat, supported shoulder stand, plow pose, seated forward bend and fish pose can engage your pelvic floor and help with general relaxation.

Venture outdoors

Spending time in nature, otherwise known as ecotherapy, can improve both mental health and physical well-being. Being outside and feeling connected to your natural habit can reduce feelings of stress and anger.

"Fresh air has been shown to help with digesting food more effectively, improving blood pressure and heart rate, and strengthening the immune system. So, it's not surprising that being outdoors makes the mind feel better too. Getting out into the fresh air each day can help you feel invigorated, energised and ready to face the world again," says Dr Lakhani.

Mental health charity Mind says being outdoors and around animals can also:

Studies have also shown that simply going out for a walk can improve your memory, and even just looking at photographs of greenery for less than a minute can give you a mood boost. This suggests ecotherapy might be something to incorporate into your everyday life outside of your menstrual cycle.

Engage in mindfulness

Mindfulness has also been shown to influence the severity of PMS. Meditation specifically has been shown to improve physical and emotional symptoms of PMS, especially in people with severe PMS. It can also ease pain and water retention, and menopausal symptoms such as hot flushes and night sweats.

Practising mindfulness can help you manage unwanted thoughts and reduce stress. It helps you connect with yourself without getting swept up in your thoughts. You can do this by using relaxation and meditation apps such as Headspace or Calm, following a five-minute guided meditation to become more self-aware and in tune with how you're feeling.

Meditation is a low-risk, low-cost and beneficial practice that is worth trying, to reduce your stress and frustration levels while on your period.

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