mental health and the menstrual cycle

For many of us the menstrual cycle is a recurring part of life. Yet, its emotional and psychological toll often flies under the radar. We’re quick to acknowledge physical premenstrual symptoms such as bloating and cramps, but what about the mood swings, emotional lows, or moments when everything feels overwhelming? These emotional shifts are not a weakness, but symptoms of a systemic blind spot in healthcare and public understanding. These shifts, which can range from mild irritability to severe depressive episodes, are more than “just hormones”. They are legitimate challenges that impact mental health, relationships, and daily functioning in profound ways (Dennerstein et al., 2012).

If your cycle has ever made you feel like you’re spiralling, you’re not alone. Research indicates that up to 90% of women experience premenstrual symptoms, with nearly half (48%) meeting the criteria for premenstrual syndrome (PMS). For 3-8%, it’s more severe, manifesting as premenstrual dysphoric disorder (PMDD) –a condition linked to significant mental health risks, including suicidal ideation and attempts (Sattar, 2014; Prasad et al., 2021).

Despite this, stigma and silence persist, especially around asking for help, and menstrual mental health is often dismissed (Winchester, 2021). Societal expectations urge women to “push through”, while healthcare systems often fail to provide adequate support (Osborn et al., 2020; Matthews et al., 2023).

A recent study by Funnell et al. (2024) sheds light on this issue, revealing the growing reliance on informal solutions, such as online resources. But is scrolling through symptom checkers and Reddit threads really enough support for conditions as serious as PMDD? Should we be settling for this, or should we demand more?

Despite being a common experience, the mental health impact of the menstrual cycle is often minimised or dismissed, leaving many to silently struggle.

Methods

To explore how menstrual cycles affect mental health, the researchers ran an online survey across the UK. The study aimed to examine the relationship between premenstrual symptoms and mental well-being while exploring help-seeking behaviours.

A total of 578 participants were recruited via social media platforms including Facebook, Instagram, Twitter, Reddit, and the Cambridge Centre for Neuropsychiatric Research. The inclusion criteria were:

• 18 years or above
• UK resident
• Not pregnant or breastfeeding
• Menstruating and self-identify as premenopausal
• Reporting mental health issues linked to cycle.

After data screening, 530 responses were analysed. Participants provided demographic details, completed assessments of their mental health (using the Premenstrual Symptoms Screening Tool and Warwick Edinburgh Mental Wellbeing Scale), and shared their help seeking habits and preferences for using digital technology to manage cycle-related mental health concerns. This focus on both formal and informal support pathways offers valuable insight into how people navigate care in the absence of adequate clinical recognition. Based on their scores, participants were classified into three groups: No/Mild PMS, Moderate to severe PMS, and PMDD. Researchers then analysed group differences to uncover trends and insights.

Results

Prevalence and impact of symptoms

The findings revealed that premenstrual symptoms were universal among participants, with 97.17% reporting that these symptoms interfered with their daily lives. Fatigue stood out as the most reported severe symptom (36.23%), while functional impairments were more widespread but most pronounced in work (83.4%) and romantic relationships (15.85%).

Mental health characteristics

Participants’ overall mental well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale, averaged 40.95, with significantly lower scores in the PMDD group (36.62). A one-way ANOVA confirmed substantial group differences (p<.001 physical="" symptoms="" such="" as="" breast="" tenderness="" and="" headaches="" were="" reported="" by="" of="" participants="" while="" psychological="" including="">anger and irritability were noted by 95.85%.

The PMDD group faced the most severe challenges, experiencing symptoms like depression, tearfulness, and heightened sensitivity to rejection (70.91%). This group also reported the greatest functional impairments, especially in romantic and intimate relationships (58.18%). Moderate to severe PMS caused significant disruptions but less debilitating than PMDD. The following table highlights key differences between groups.

Help-seeking characteristics

Symptom severity strongly influenced help-seeking behaviours, with 64.91% of participants seeking help through formal healthcare providers (HCP), online resources, or a combination of both. While 35.09% consulted HCP for cycle-related mental health concerns, 57.7% turned to online resources. This may suggest that for many, digital spaces have become the first (or only) form of support. Blended help-seeking was most common among the PMDD group (55.45%), compared to moderate to severe PMS (12.79%) and no/mild PMS (25.81%). Notably, 52.33% of the no/mild PMS group did not seek any help.

Online resources and HCP experiences

Online help-seeking was common, with participants searching for information on mental health symptoms related to the menstrual cycle (85.57%), treatment options (39.67%), mental health tests (34.43%), and apps (33.44%). The PMDD group was notably more active in seeking online support. However, only 21.5% of participants who consulted HCP felt adequately supported, and 45.16% reported feeling dismissed. Despite these findings, there were no significant differences in the perceived quality of HCP consultations.

Nearly all participants reported life disruptions due to premenstrual symptoms, with fatigue and functional impairments being most common.

Conclusions

This survey study reinforces the significant link between premenstrual symptoms, reduced mental well-being, and disruptions in daily functioning.

It also highlights the growing reliance on online resources for managing menstrual mental health concerns, presenting opportunities for developing effective tools. Yet it also warns of the risks of relying on unregulated digital content, especially when formal care leaves so many feeling unheard.

Barriers to help-seeking, whether through HCP or online searches, remain a concern, as many participants refrained from seeking support. Additionally, negative care experiences with HCP, as noted in prior research (Osborn et al., 2020), reveal a need for improved awareness, training, and person-centred care in addressing menstrual mental health challenges.

Future solutions must go beyond awareness; they must build accessible, credible, and compassionate pathways to care.

Premenstrual symptoms are deeply linked to mental health challenges, and the rise in digital self-help underscores healthcare system gaps.

Strengths and Limitations

This study delves into the relationship between premenstrual symptoms, well-being, and help-seeking behaviours, addressing a notable gap in research. By examining a wide range of factors including symptom types, severity, functional impairments, and both formal and informal help-seeking pathways, the study improves our understanding of how premenstrual symptoms disrupt everyday life, affecting work, relationships, and household responsibilities, and shaping individuals’ help-seeking behaviours.

One of the standout features is the focus on PMDD, a debilitating yet underdiagnosed and under-researched condition. PMDD’s severe physical and emotional symptoms makes it a key area for further attention. Additionally, the findings provide timely insights into how individuals navigate the digital landscape for mental health support.

However, the study has limitations:

• Absence of a control group: Without participants unaffected by cycle-related mental health issues, it is difficult to isolate the impact of premenstrual symptoms from other life stressors.
• Self-reported data: Reliance on participants’ self-reported symptoms and help-seeking behaviours may lead to recall or social desirability bias, raising concerns about the accuracy of diagnoses and the possibility of under-reporting or over-reporting symptoms.
• Limited generalisability: The sample lacked diversity, as it was predominantly white (94.15%), well-educated (37.74% postgraduates), and higher earning (above £35k). This restricts the findings’ applicability to more diverse populations with different cultural attitudes and access to care. Additionally, the UK setting further limits applicability to countries with different healthcare systems. Recruitment via social media may have further skewed the sample, over-representing individuals who are digitally literate and more likely to seek help online.
• Cross-sectional design: By capturing only a snapshot of experiences via an online survey, the study misses the fluctuating nature of symptoms, which may vary with hormonal phases, stress, or lifestyle changes. For example, participants in the luteal phase often report elevated symptoms like anxiety (Handy et al., 2022). A longitudinal approach would offer richer insights, tracking how symptoms and help-seeking behaviours evolve over time, providing a more comprehensive understanding of these complex experiences.

The study offers vital insights into menstrual mental health and help-seeking but is limited by its lack of diversity, self-report data, and cross-sectional design.

Implications for practice

This study provides insights into the mental health challenges associated with the menstrual cycle, particularly the impact of PMDD and severe PMS. The findings emphasise the significant toll of these conditions on daily life, relationships, and work, while exposing gaps in healthcare support that drive many to rely on informal online resources. This provides actionable insights for improving healthcare interventions.

A key implication is the urgent need for better awareness and training among healthcare professionals. The finding that only 21% of individuals seeking formal care felt adequately supported points to critical knowledge and sensitivity deficits in the healthcare system. PMDD, for example, is often underdiagnosed or mistaken for conditions like Bipolar Disorder (Studd, 2012). Equipping HCP with diagnostic tools and targeted education is essential to distinguish menstrual-related mental health issues from other psychiatric conditions, enabling timely and effective care.

The growing role and potential of digital tools to bridge care gaps is another useful finding. Symptom tracking apps, telehealth platforms, and psychoeducational content have the potential to tackle barriers like stigma, geographic limitations, and time constraints (Firth et al., 2017). However, the study raises concerns about the reliability of existing online resources. For instance, the absence of a NHS webpage dedicated to PMDD highlights a critical gap, especially given its trusted status in the UK (Department of Health and Social Care, 2022). Developing accessible, evidence-based online resources could help individuals better understand their symptoms and facilitate informed decisions about seeking care. Nonetheless, digital solutions should complement–not replace–in person-care, particularly for severe cases that require in-person treatment.

Inclusivity is another pressing consideration. The study’s predominantly WEIRD (White, Educated, Industrialised, Rich, and Democratic) sample overlooks the unique barriers faced by marginalised groups, such as stigma, financial constraints, and cultural differences (O’Donnell et al., 2016). Expanding future research to encompass diverse populations is essential for creating culturally sensitive interventions and ensuring equitable access to care.

Finally, the fluctuating nature of premenstrual symptoms calls for ongoing, longitudinal investigation and care rather than one-time interventions. Flexible treatment plans and regular follow-ups are vital to meet individuals’ evolving needs throughout their cycles.

Ultimately, this research is a call to action for systemic change. Addressing menstrual mental health requires a multifaceted approach–one that emphasises comprehensive training, inclusive practices, and digital innovation. Personally, as someone who experiences mental health challenges tied to my cycle, these findings resonate deeply. They not only validate my own experiences but also reaffirm my drive to shape a healthcare system that prioritises understanding and compassionate support. Everyone deserves to feel seen, heard, and cared for. No one should endure these challenges in silence or feel dismissed.

Improving menstrual mental health care demands better clinician training, inclusive research, reliable digital tools, and long-term, flexible support.

Statement of interests

 None.

King’s MSc in Mental Health Studies

This blog has been written by a student on the Mental Health Studies MSc at King’s College London. A full list of blogs by King’s MSc students from can be found here, and you can follow the Mental Health Studies MSc team on Twitter.

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Links

Primary paper

Funnell, E. L., Martin-Key, N. A., Spadaro, B., & Bahn, S. (2024). Help-seeking behaviours and experiences for mental health symptoms related to the menstrual cycle: a UK-wide exploratory survey. Npj Women’s Health, 2(1), 1–11. https://doi.org/10.1038/s44294-023-00004-w

Other references

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Department of Health and Social Care. (2022). Women’s Health Strategy for England. 

Firth, J., Torous, J., Nicholas, J., Carney, R., Pratap, A., Rosenbaum, S., & Sarris, J. (2017). The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry, 16(3), 287–298.

Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard Review of Psychiatry, 30(2), 100–117.

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Liedo, L. (2023). Parents Mag. Colagene Paris.

Matthews, L., & Riddell, J. (2023). The UK Research Agenda. 

O’Donnell, P., Tierney, E., O’Carroll, A., Nurse, D., & MacFarlane, A. (2016). Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: A participatory learning and action research study. International Journal for Equity in Health, 15(1).

Osborn, E., Wittkowski, A., Brooks, J., Briggs, P. E., & O’Brien, P. M. S. (2020). Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC Women’s Health, 20(1).

Prasad, D., Wollenhaupt-Aguiar, B., Kidd, K. N., de Azevedo Cardoso, T., & Frey, B. N. (2021). Suicidal risk in women with premenstrual syndrome and premenstrual dysphoric disorder: A systematic review and meta-analysis. Journal of Women’s Health, 30(12).

Sattar, K. (2014). Epidemiology of Premenstrual Syndrome, A Systematic Review and Meta-Analysis Study. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH, 8(2).

Studd, J. (2012). Severe premenstrual syndrome and bipolar disorder: a tragic confusion. Menopause International,18(2), 82–86.

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