UPDATE: Since I first wrote this blog, further research has refined my position on this topic. It’s worth noting that the menstrual cycle itself is more of a ‘trigger’ of symptoms, rather than the direct cause. For example, research suggests that it is not the level of sex hormones an individual has that influences their health, but their reaction to the changing levels of various hormones, as stimulated by the menstrual cycle. Sex hormone changes seem to influence other hormonal pathways involved in the immune, metabolic, and stress pathways, which may then cause various symptoms in a minority of people who menstruate…
It is well known that the menstrual cycle can affect an individual’s mood and anxiety levels…
However, the potential relationship between sex hormones and anxiety and depression, has largely been ignored within medical practice. This blog post highlights why we ought to pay more attention to the role of the menstrual cycle in the study, diagnosis, and treatment of anxiety and depression, for the benefit of all people suffering from these issues.
The majority of the most commonly experienced menstrual cycle-related symptoms are also those associated with depression and anxiety (see table above). This suggests that they may share a common underlying cause, perhaps directly, or indirectly, relating to changes in ‘female’ sex hormone levels (oestrogen and/ or progesterone).
In fact, it is known that if a cyclical pattern in an individual’s symptoms of anxiety and/ or depression is identified (by tracking symptoms over time), then hormonal therapy can be a more effective course of treatment than antidepressants, or anti-anxiety medication .
Note: All humans have both ‘male’ and ‘female’ hormones, in varying levels. Male humans tend to have much higher levels of testosterone and other androgens, and female humans tend to have much higher levels of oestrogens and progesterone (see point 4 for further information).
Women (or, more specifically, people with a female reproductive system) are statistically more likely than men (people with a male reproductive system) to suffer from a range of mental health issues. In fact, a recent investigation into 12 different national population studies  revealed that:
The authors suggest that while some of these sex differences can be explained by social and environmental factors, the consistent results found across cultures and geographical locations, indicate that there might also be physiological factors (e.g. genetic, or hormonal) at work.
Adding to this evidence base, is a study on transgender mental health, revealing that transgender women (taking oestrogen) are up to twice as likely as transgender men (taking testosterone) to suffer from depression.
These patterns suggest a relationship between fluctuating levels of ‘female’ sex hormones and symptoms of anxiety and depression (among others). This helps to explain why improved hormone balance (through diet, or hormonal therapy) can significantly alleviate these symptoms.
So, there is quite possibly a relationship between [changing levels of] sex hormones, and the symptoms of depression and anxiety.
Considering all that we have learnt above, the menstrual cycle, rather than being a taboo subject, should be seen as offering a plentiful and regular opportunity for researchers to further investigate the underlying causes of anxiety and depression.
Doctors should be more aware of the relationship between the menstrual cycle (and hormonal medications) and the symptoms of anxiety and depression. For example, tracking symptoms over time can help establish if hormones are playing a role in poor mental health.
If so, treatment options can include hormone-balancing dietary changes, and/ or hormonal therapy, rather than the more usual prescription of antidepressant, or anti-anxiety, medication, which may be less effective and more likely to result in unwanted side-effects .