So, periods. It’s safe to say that no one is a massive fan of bleeding every month and all the symptoms that come with that. One of the symptoms that can be most debilitating is menstrual depression.

It’s common to experience depression around your period, including anxiety, irritability, low concentration, feeling down, crying and sadness. These symptoms can appear a few days before your period begins and last for a few days afterwards, if not longer.¹

What is the Menstrual Cycle?

Four main menstrual cycle phases make up the period and the time before your next one. These are menstruation, the follicular phase, ovulation and the luteal phase. Here are the stages explained:²

Menstruation

This is when you have your period; the body eliminates the thickened lining of the uterus through the vagina. The menstrual fluid contains blood, cells from the uterus lining and mucus.

Follicular Phase

This begins on the first day of menstruation and ends with ovulation. The pituitary gland releases the follicle-stimulating hormone, which stimulates the ovary to produce around five to twenty follicles which bead on the surface. Each of these follicles houses an immature egg.

Usually, only one follicle will mature into an egg, but it can be more. This is how multiple births that aren’t identical twins occur! This usually happens around day 10 of the cycle (which can differ but is roughly 28 days long). This process stimulates the lining of the uterus to thicken to prepare for pregnancy.

Ovulation

Once that immature egg has matured, ovulation occurs, which releases the egg from the surface of the ovary. It is usual for this to happen around two weeks before menstruation begins. Due to hormone changes, the egg is funnelled into the fallopian tube and towards the uterus. The egg will usually survive for around 24 hours unless a sperm enters the egg.

Luteal Phase

During ovulation, the egg removes itself from the follicle, yet the ruptured follicle does not disappear; it stays on the surface of the ovary. Over the next 2 weeks, the follicle becomes a new structure called the corpus luteum. This structure releases progesterone as well as a tiny bit of oestrogen. These two hormones maintain the thickness of the uterus lining, hoping a fertilised egg will stick to the lining.

If a fertilised egg sticks to the uterus lining, the uterus produces hormones needed to maintain the corpus luteum. This is how urine-style pregnancy tests work - a hormone known as HGC is produced that can be detected! The corpus luteum will then continue to produce progesterone which maintains the thickened line of the uterus.

If a fertilised egg doesn’t appear, the corpus luteum will die off at around day 22 in the cycle. As the progesterone levels drop, the uterus lining is no longer maintained, producing a period. Then, it’s back to step 1 - that’s why it’s called a cycle!

What Causes Menstrual Depression?

More research is needed into menstrual depression and what causes it to occur, but experts believe it is at least partly due to hormone changes during your cycle.¹

Your hormones are impacted during this cycle - an increase in progesterone and oestrogen can affect the body. Our hormones are vital to maintaining mood levels, and any slight change can cause a significant effect.

As well as the ubiquitous PMS, some people suffer from PMDD - Premenstrual Dysphoric Disorder. This condition can present similarly to PMS but is much more extreme and often requires medical attention.¹

Some of the symptoms of PMDD are thoughts of suicide, anxiety, depression, irritability, feeling overwhelmed, physical pain and unusual anger. These symptoms can last for an extended portion of the menstrual cycle, up to 2 weeks before bleeding occurs and lift a few days after the period starts.¹

A condition that needs much more attention in the research field is PME - Premenstrual exacerbation. The symptoms can mimic PMDD but often come along with more physical symptoms. PME can worsen existing conditions such as acne, asthma, epilepsy, IBS, eating disorders, migraines, anxiety, bipolar disorder and schizophrenia.¹

PME can occur at any time in the menstrual cycle, making it notoriously hard to link to the menstrual cycle and get diagnosed. It is related to hormonal fluctuations throughout the entire cycle.¹

How to Treat Menstrual Depression?

Firstly, if you think you may be suffering from PMDD or PME, speak to your healthcare provider about gaining a diagnosis. These can be really debilitating conditions, and a diagnosis is the first step to treatment in these cases.

Therapy can be a handy tool for helping to alleviate menstrual depression. Having a safe space to discuss your feelings and gain tools for helping you deal with the emotions, thoughts and feelings you are experiencing can make a huge difference.

Serotonin plays a really critical role in managing mental health issues - the happy hormone is crucial to having the ability to feel good. 95% of serotonin is made in the gut, so having a healthy gut can make a huge difference in how effective the body's production of serotonin is.

You can be prescribed SSRIs - Selective Serotonin Reuptake Inhibitors to improve your body's use of the serotonin produced. It doesn't allow you to make more serotonin; it simply enhances usage, which can make a massive difference to depression.³

Hormones play a vital role in the menstrual cycle and can significantly impact menstrual depression. In our article Introduction to Gut Health and Hormones, you can read all about how hormones and the gut are connected.

To maintain a healthy gut, it’s essential to have a healthy and diverse gut microbiome. We need a balance between good and bad bacteria so the bad stuff can’t take over and cause issues.

To feed the good bacteria, fibre-rich prebiotic food is the best source. This includes wholemeal bread, whole grains, fruit and vegetables and oats, to name a few.

Probiotics are a fantastic way to increase the diversity of good bacteria in the gut. Probiotics add new species of good bacteria, whilst fuelling the existing ones to grow stronger, thrive and multiply. A probiotic supplement such as our The Gut Co's Gut Care daily supplement can give you all the probiotic goodness you need, or you can spice up your diet with fermented foods.

Final Thoughts

Menstrual depression affects so many of us with a uterus. It can be really challenging to stay on track with goals, self-care and daily living when each month you are affected by hormone changes that make you feel rubbish or worse.

Menstrual depression needs to be researched further to ensure the best treatment options for those suffering. Conditions like PMDD and PME need further research to make diagnosis and treatment more accessible and readily available.

Healing your gut microbiome is a great place to start, but make sure to contact your healthcare provider before making any changes to your diet and let them know that you are experiencing symptoms of menstrual depression. Take it easy on yourself, too - it’s not easy to deal with the menstrual cycle!