In Part 1 of this episode, we covered supporting your health through mindfulness practices, targeted nutrition, and avenues of self-exploration. This week, we’ll talk about how the menstrual cycle impacts your mood (and vice versa), depression and your cycle, birth control’s impact on your mental health, PMS vs. PMDD, and herbal support for depression and anxiety.
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The transcript for this blog post has been edited for length and clarity.
The layers of your mental health
We’ll start with a brief recap of what we talked about last week — the gut-brain connection and how food and mental health can be linked.
The general conversation about how food impacts us is largely focused on the external — how your body is shaped, how your skin looks, how your hair shines. But the external is not the only thing that food can influence, of course. Food impacts your hormone health, menstrual cycle, and mental health.
The food you eat influences the brain, which in turn influences your mental wellbeing, emotional stability, and hormones (because hormone production begins in the brain).
But food isn’t the only thing. Mental health requires a holistic approach, and that includes having a better understanding of how your body works at its foundation.
That’s where it starts for me — the education about the basics of your body’s inner workings, the pillar of mental health that’s about biochemical reactions, and your nature.
Layered on top of that is your personal design, your astrology, your human design. All the things that are unique to you.
On top of that are more external influences, the other pillar of mental health — lived experiences, trauma, perceptions, beliefs, socioeconomic status, systemic oppression. The things that contribute to your perception of the world.
How the menstrual cycle impacts your mood
Progesterone and estrogen, which are the primary hormones involved in the menstrual cycle, impact the parts of our brains that influence mood and behavior.
If you menstruate, your brain changes by up to 25% during your cycle thanks to the fluctuations of estrogen. That’s a pretty significant difference, yet we push ourselves to be able to do the same things day after day. And we can do it all, but it’ll feel a lot better if we can organize the things we need to do based on when in our cycle we’re able to do them best.
In the follicular phase
The follicular phase starts out with good spatial skills, imagination, memory, and socializing as you move towards ovulation. However, you’re more prone to anxiety in this phase.
Estrogen rises in this phase, and serotonin along with it, so as you move towards ovulation and you’re in alignment, you’re feeling like you’re in a great mood, motivated, social.
It’s also scientifically proven that we are more attractive at this time, we are more magnetic and appealing to others, and in turn that makes us feel pretty good about ourselves. More positive and confident.
One of estrogen’s effects is making you feel more receptive to other people. It makes you want to care for and be around others. It helps you better communicate and collaborate. It’s the hormone of community. The first half of your cycle tends to be pretty positive.
Estrogen has a mood-elevating effect that makes us feel outgoing and optimistic. It’s a great time to embrace your social life and pack your calendar, and you’ll probably feel pretty motivated to exercise more too, which has its own mood-boosting benefits. What feels easy-breezy right now might actually stress you out in a couple weeks, but peaking estrogen lets you brush things off a lot more easily.
If you have low estrogen in the first half of your cycle, it can lead to irritability and anxiety. But on the flip side, if your estrogen is high and you don’t know what to do with that energy, you can feel on edge, jittery, and irritable. If you’re dealing with estrogen dominance, these feelings may be even stronger.
In the luteal phase
The luteal phase is generally calmer thanks to progesterone.
Estrogen begins to lower in this phase, and so does your serotonin. This is when we start to turn inward, stop caring so much about being around others, and focus more on self-care and rest. With progesterone having a calming effect, you’ll notice your energy wane, too.
If you’re not aligned with these changes, it can manifest as moodiness and depression. You might not realize what’s happening in your body, that things are naturally winding down, so things feel a lot harder and you get down on yourself for not being able to copy-and-paste that peppy attitude you had in your ovulatory phase.
But then your period comes, and all those feelings suddenly make sense. This is one way that tracking can be helpful, so if you know you’re in your luteal phase, you can better understand where certain feelings are coming from, and how to manage them, or work with them instead of against them.
For instance, maybe you notice that you’re getting close to your period and you know that around this time, you’re really not very outgoing and have low patience for people. So maybe that week you plan to take it easy on social invitations, or you avoid meetings if at all possible.
If you experience anxiety more before your period there are a few reasons why this might be happening:
- You may be low in progesterone and are missing out on that calming effect.
- Progesterone impacts the amygdala in the brain, which is responsible for our fight-or-flight response. Research has shown that progesterone can regulate anxiety, but if things are out of balance, it might actually exacerbate it by increasing amygdala activity and your feelings of stress. If you experience a severe version of this, it may be a symptom of PMDD, which we’ll discuss in a bit.
- Your calorie needs increase in the luteal phase, so if you’re not eating enough food, anxiety could be the result of low blood sugar from not eating enough.
In the menstrual phase
At the end of the luteal phase, when your body recognizes there is no pregnancy to maintain and so there’s no need for the uterine lining that it just built up over the last few weeks, progesterone drops and that triggers menstruation.
In the menstrual phase, both estrogen and progesterone are very low. Since both of these have such an impact on your mood and behavior, it’s sort of like a liminal time where you just don’t know how to feel. All you know is energy is low, you want to be quiet, and rest feels really good.
Depression, anxiety, and your cycle
Going back to those two pillars of mental health, depression can fit in either category. It can be a biochemical reaction that influences your perceptions and how your nervous system handles the outside world, or it could be brought on by those external influences.
Depression can be a mental and physical stressor — stress is a major factor in hormone imbalance and cycle-wise, it can cause delayed ovulation and missing periods because it can suppress the function of the hypothalamus, which is the part of the brain that’s responsible for managing the cascade of hormones that flow throughout your cycle.
Tracking your cycle can give you insight into the frequency of your symptoms, which will be helpful when discussing with your doctor.
Nutrition for mental health support
All the foods we always talk about here — whole foods, fruits, vegetables, whole grains, legumes, meat and fish for some, nuts, seeds — all these foods and the elements of balance contribute to your mental and emotional wellbeing.
Also, plant foods contain lots of fiber that are important for your gut health and for the bacteria in your gut, which produces 95% of our serotonin and 50% of our dopamine (our feel-good hormones). Studies show that imbalanced gut bacteria is linked with psychiatric disorders, so it goes back to the gut-brain connection and how important it is to maintain good gut health through our diet. The gut is actually sometimes called our “second brain” because of its ability to influence our mood.
These whole foods also contain key vitamins and minerals for supporting your brain and mental health, including omega-3s — a deficiency of which is linked to depression, because it both regulates the release of serotonin and regulates serotonin receptor function.
But it’s not always a deficiency of omega-3 that causes problems. Oftentimes it’s an imbalance of omega-3 to omega-6. They are naturally anti-inflammatory when they’re in balance, but too much omega-6 can actually cause inflammation, and the Standard American Diet is high in omega-6 from different oils like safflower oil, sunflower oil, corn oil, soybean oil — so to keep inflammation at bay you’ll want to stock up on things like walnuts, chia seeds, flax seeds, and hemp seeds to balance it out. Fatty fish is a good source of omega-3s as well. You may want to discuss supplementation with your doctor too.
Gut health is key. One thing you might want to track is if you’re pooping every day and if it’s good quality. You eliminate excess estrogen through your stool. If you’re not going every day, if you’re constipated and the waste is just sitting there in your digestive tract for too long, the estrogen can be reabsorbed and recycled in the body. That can lead to estrogen dominance and as we discussed, too much estrogen can make you feel anxious, among many other hormonal symptoms.
PMS vs. PMDD
If depression and anxiety are severe for you each cycle, you may have what’s called PMDD, or premenstrual dysphoric disorder.
Research says that anywhere from 3-8% of menstruators experience PMDD. Even though it affects a relatively small percentage of menstruators, it’s still a significant issue.
While PMS is usually just a few days before your period, PMDD can impact people for half of their cycle and can have severe versions of typical PMS symptoms. The difference is in the severity of symptoms, the frequency of symptoms, and how long they last.
It is difficult to get a diagnosis, it’s often dismissed because hormone tests can come back normal. You might feel like it’s all in your head or be told that when you know it’s not.
How PMS and PMDD are diagnosed
PMS is diagnosed when you have 1-4 symptoms, which can include a long list of things like mood swings, irritability, cravings, low energy, cramps, breast tenderness — you know the drill, and those symptoms happen 5-7 days before menstruation and resolve when your period comes.
PMDD is diagnosed when you have 5 or more symptoms and they are extreme enough to interfere with your daily work life, school life, or relationships — not just kind of interfering, but actually damaging these things because it’s so bad.
Doctors use the DSM-5 to diagnose PMDD — so this is seen as a mental health issue as related to your cycle. At least 5 of those symptoms must be present in your luteal phase, and four of them MUST include:
- Anger or irritability
- Mood swings
- Depression or hopelessness
So you have to have these four symptoms, plus at least one more, in a severe manner. That might look like extreme irritability, anxiety, suicidal thoughts, feeling overwhelmed, panic attacks, bouts of crying.
These also must resolve when your period arrives in order for it to be classified as PMDD.
As for a cause, research is still limited in this area but there is a biological component, and studies have found that PMDD may be caused by a genetic sensitivity to estrogen and progesterone.
One thing I want to note here is that while I always recommend food first before supplementation, in the case of medication, it’s okay to take medication. I want you to do what helps you feel better, and I also think it’s important to understand the root cause and work towards a solution, rather than relying only on the medication.
Sometimes you might find that medication IS the solution, but oftentimes there are other factors at play. I just want to emphasize that I’m not stigmatizing medication for mental health, because I know there are a lot of practitioners out there who are fully anti-meds for everything, and I’m not trying to shame you for doing what you need to.
Birth control and your mental health
The medication I do want to discuss is birth control pills. Another example of something I’m not against if you need it, but in this case, I do believe it’s overprescribed and used as a go-to solution for all things cycle-related, when it can cause more harm than good in this area.
Birth control pills are hormonal contraceptives, meaning they influence your hormones in a way that impacts your ability to get pregnant.
The pill has been linked to an increased risk of depression and has been found to actually cause depression. Research has also shown that it’s linked to structural, neurochemical, and mood-related changes in the brain.
We’ve discussed before how the pill is associated with various nutrient deficiencies, and that includes nutrients needed to make serotonin. What it seems to do is interrupt the tryptophan pathway, which is how you produce serotonin — it’s made from tryptophan. The pathway is the amino acid tryptophan, which converts to serotonin, which ultimately converts to melatonin. There isn’t a ton of research on why, but I’m going to share with you something that Dr. Jolene Brighten shared, she’s the author of Beyond the Pill. She said:
“For some people on the pill, their tryptophan can instead go down the quinolinic acid pathway, which is a neurotoxin. There is strong evidence between the association of hormonal birth control and poor moods, but we don’t have enough studies to help us completely understand why. It’s really concerning that for as long as we’ve had the pill we have had women complaining about this side effect, but science has neglected to invest substantial resources into helping us understand why.”
And that is part of the reason you’re here, right? Because you’re navigating a world that wasn’t designed for your body or with your body in mind. So this is a conversation worth having with your doctor.
You can decide to use it knowing this risk and possibly planning for it by keeping up with the nutrients that support your mental health, to help avoid any imbalances, or you could decide to use another method of birth control instead. Up to you.
Herbal support for depression and anxiety
The following are recommended herbs to discuss with your doctor. This information is for educational purposes only and it’s really important that you discuss any diet and lifestyle changes, and herbal remedies with a trained practitioner who is knowledgeable not just about these herbs and nutrients but also about your individual situation.
- St. John’s Wort is helpful for depression. It is said to increase the activity of neurotransmitters like serotonin and norepinephrine, and research has shown that it is as effective as antidepressants for mild to moderate depression, and results in fewer side effects. Important to note with this one, do not use it in conjunction with any pharmaceuticals since it can break those down in the liver and make them less effective. So if you’re taking any kind of medication, St. John’s Wort may not be for you.
- Kava is another option, this one is used for anxiety and insomnia, helping you to unwind and to relax. It has comparable effects to Valium and Xanax; it is sedative-like but without the dulling feeling that other substances can have. It’s important to understand that, like ibuprofen, excessive use can lead to liver damage, so it should not be taken as a daily tonic or anything like that.
- Holy basil: Also known as tulsi, this one is an adaptogen and a mood-lifter. It is generally safe for most people, but if you are taking a medication for lowering your blood sugar, it may amplify the effects. Tulsi can be found in teabags, in loose tea form, in tinctures, it’s pretty accessible at most health food stores and herb shops, though it may be harder to find in a supermarket unless they have a pretty good tea section. Trader Joe’s carries it.
- Some other mood elevators are cinnamon, lavender, and rose. These are all great in their herbal forms but also have aromatherapy benefits that can help with anxiety and depression as well, so you can look for an essential oil from somewhere reputable and use a diffuser. I like the brand Living Libations for essential oils, or Whole Foods also has a decent selection.
That’s a wrap on mindfulness and mental health. I know it’s a lot of information, but to recap this episode and the last, the main things we want to pay attention to when it comes to managing our mental health and thus our menstrual health are:
- Blood sugar balance — having protein, fat, and fiber in your meals to keep blood sugar stable, and ultimately your moods stable. Blood sugar regulation is also fundamental to keeping your menstrual cycle in balance as well.
- Food and herbal support — incorporating certain nutrients and herbs into your rotation to support your brain and hormones. For food, remember we don’t have to be too strict about remembering which foods, it comes down to the basics like nuts and seeds, healthy fats, protein, whole grains, fruits, and vegetables. It doesn’t need to be complicated.
- Practicing mindfulness — using your intuition around food, eating intentionally, understanding and acknowledging how your body naturally functions, and honoring what you need. If you’re on birth control, being mindful about how it makes you feel and deciding how you want to move forward, whether you want to discuss a plan with your doctor to transition off or how to stay in balance if you stay on the pill.
- Practicing self-compassion — keeping in mind that perfection is not the goal, we’re looking more for progress and/or resilience. This also encompasses the self-exploration we talked about — understanding your personal astrology, human design, personality type, and recognizing your inherent qualities so you can develop a stronger relationship with yourself and learn how to work within your gifts and challenges.
- Asking for help when you need it — Medication if you need it, therapy, setting boundaries, protecting your energy and your process. All of these things are so valuable. And I know therapy is not super accessible to everyone, but look into your health insurance to check if anything is covered. If not, there are options like Open Path Collective, which connects you with therapists who offer sessions between $30-60. There are also online options like Talkspace and BetterHelp with semi-affordable plans, there’s also a site called 7 Cups of Tea, which is a free resource where you can connect with trained active listeners, if you just need someone to talk to.