The menstrual cycle, occurring over approximately 28 days, has four phases, characterized by the hormone levels driving the activity in each phase. The phases are: follicular, when ovarian follicles are maturing an egg for ovulation (high levels of estrogen, which helps prepare your uterine lining, and FSH, which stimulates the follicle); ovulation, when a surge of the hormone LH triggers the dominant follicle to release the egg; luteal, when estrogen decreases, and progesterone increases to help prepare the uterine lining for implantation of a fertilized egg; and menstruation, when, in the absence of fertilization, progesterone decreases, triggering the uterus to shed its lining, you get your period, and the follicular phase begins (overlapping with your period).
The luteal phase, which begins following ovulation (14 days prior to your period) is when many women experience symptoms of PMS (premenstrual syndrome). These include a variety of physical and emotional symptoms caused by increasing levels of progesterone. The luteal phase does not present a hormonal imbalance — progesterone is supposed to rise — but it can often have an impact on a woman’s physical and emotional wellbeing.
Every woman experiences the luteal phase differently, some barely at all, others quite severely. These experiences can also change throughout a woman’s life (for example, some women experience physical symptoms most severely in their teens and emotional symptoms most severely in their thirties), so there is a huge range of normal experience. Other stressors or a trauma history can also impact how sensitive the brain is to hormone fluctuations. Even for women who do not experience PMS, the luteal phase can still be characterized by a subtle feeling of sadness, irritability, or feeling “off.” The important thing to remember is that these hormonal fluctuations are actually real. Society tends to joke about women being “hormonal” as if it’s a mental weakness, but these hormone fluctuations are a part of biology; being impacted by them is not a choice.
PMDD (premenstrual dysphoric disorder) occurs in about 1 in 20 women. This is a severe form of PMS characterized by symptoms such as significant depression, irritability, anxiety, or hopelessness. PMDD symptoms are usually disruptive to normal daily functioning. PMDD can occur throughout the luteal phase but often most acutely during the late luteal phase, the week or days leading up to menstruation. Symptoms remit within days 1-2 of menstruation. PMDD can often be treated with a low dose of an SSRI (such as Zoloft, Prozac, or Celexa, or generic equivalents). Unlike treatment for a major depressive disorder, SSRIs can act quickly on PMDD as the underlying mechanism of the disorder is different. Often, SSRIs can be taken on an intermittent basis (during the whole luteal phase, or closer to menstruation) and greatly relieve the symptoms of PMDD (Rapkin & Lewis, 2013). Average age of onset for PMDD is 26. Again — it is a real condition brought on by biological hormone fluctuations, not just you “being hormonal” and not keeping it together.
In general, it is often helpful to track your menstrual cycles and symptoms to find patterns. I hope the information in this post is helpful, validating, normalizing, and maybe useful for you!
Reference:
Rapkin, A. J., & Lewis, E. I. (2013). Treatment of premenstrual dysphoric disorder. Women’s Health, 9(6), 537-556.
