Hormones for Life
Updated: Sep 18, 2021
We recognize that not all people who menstruate identify as women. I'll be using phrases like "people who menstruate" to honor all experiences. We welcome all experiences and people while also acknowledging that we tend to center the feminine experience of women and femmes.
"The hormones created and released by the glands in your body's endocrine system control nearly all the processes in your body. These chemicals help coordinate your body's functions, from metabolism to growth and development, emotions, mood, sexual function and even sleep." - Cleveland Clinic
If you attended public school in the U.S., you likely learned the very basics of how to use products during menstruation, perhaps later you even got a biology lesson on sex, STDs, and how babies are made.
This snapshot of information, at an age when we're not likely to remember, is insufficient. In the spirit of being on the same page, I'm going to do a review of the foundations of hormonal cycles for those who menstruate.
The Hormone Path
Between puberty and menopause, most menstruating bodies will experience a cycle of hormone shifts every 28-30 days. Depending on personal medical history, family history, biology, and social factors, menstrual cycles can include a variety of symptoms and experiences.
The menstrual cycle includes two primary phases: follicular phase (day one of bleeding until ovulation/day ~14) and luteal phase (from post-ovulation to the day before bleeding begins). The chart above shows a line graph representation of how the three main hormones, estrogen, progesterone, and testosterone, fluctuate throughout the monthly cycle.
Follicular Phase: Days 1 - 14ish. If no fertilized egg is present, hormones drop to signal to the uterus to release the uterine lining (aka your period starts). In the last couple of days of your period your estrogen climbs. This is when many folks will experience a boost in energy and focus.
Ovulation: Day 14ish - the release of an egg from the ovaries is accompanied by peak estrogen and a little bump in testosterone. You may feel a little more social around ovulation.
Luteal Phase: Days 15-28. As soon as an egg is released estrogen decreases while progesterone increases to help build up the lining of the uterus for a potential pregnancy. Progesterone makes us feel sleepy, weepy, and foggy. This two-week window is often a source of struggle.
FUN FACT: “Period” is rooted in the Greek words “peri” and “hodos” (periodos) meaning “around” and “way/path.” This eventually turned into the Latin “periodus” meaning “recurring cycle.” Use of the English term “period” to describe menstruation began in the early 1800s (1). These euphemisms are found in texts spanning millennia. source: HelloClue
Estrogen plays a key role in the production of norepinephrine, which converts to dopamine. For those of us who already experience inconsistencies with memory, focus, mood, and energy, the decline in estrogen can be especially noticeable.
There is some thought that those of us with ADHD are more prone to Pre-Menstrual Dysphoric Disorder (PMDD), a more intense version of PMS. Some people benefit from a small dose of a mood stabilizer (SSRI) during the luteal phase.
These recurring hormonal shifts have been known to contribute to false diagnoses of major mood disorders or wondering if medications are working.
Additionally, major hormonal events, like puberty, pregnancy, and childbirth, and menopause, are linked to higher occurrences of depression, anxiety, and even suicidal ideation.
In the words of my psychiatrist, "Hormones play an enormous role in the mental health of those who menstruate. If medications for other things are feeling less effective, hormonal fluctuations should be investigated."
For those using birth control, there are still hormonal fluctuations if the method does not prevent ovulation, like in the case of IUDs. Just because you don't menstruate doesn't mean you're not ovulating and dealing with hormonal shifts.
Likewise, menopause may be the end of menstruation, but it is not always the end of all hormonal fluctuations. Many folks experience signs of menopause indefinitely.
We just do not know enough about our bodies.
There may be agreement that hormones play a key role in how we function, but there still is not enough research and innovation in the care we receive.
So, what can we do?
If we know we'll have some better energy days every month, then perhaps tracking them and leveraging them is a good place to start.
When we feel the shifts happening in our mood or energy, we can proactively care for ourselves by turning down expectations and tuning into what we need.
You can begin by just tracking the first day you spot or bleed (if you still menstruate). If you have an IUD, you can track your mood and any PMS symptoms, like breast tenderness, breakouts, intensely emotional days, etc., and over the course of a couple of months, you may see a trend.
At the very least, start noticing the shifts and being gentler with yourself. This is a great act of self-compassion.
***unsolicited advice*** If you're over the age of 35 and notice recurring changes in your period (duration, flow/heaviness, timing, etc.), then chances are you're beginning the journey toward peri-menopause. Peri-menopause is simply the lead-up to menopause (the final menstrual cycle). As you experience shifts, be sure to bring it up to your providers often. Ask about hormone tests for baselines and continue to bring it up as you notice more changes. If you're not comfortable talking about your mental health with your medical provider, consider finding a new one. :)
What reflections or reactions do you have to this information?
Growing up, what did you learn about what to expect from your hormones as you age?
How do your hormone fluctuations affect you currently?
What has worked to help you manage the ebb and flow?
Your Menstrual Cycle is More Than Just Your Period (YouTube) Your Menstrual Cycle Is More Than Just Your Period
How to Work with Your Period, Not Against It, Healthline (graph above is from this piece)
Our Bodies Ourselves (book & website full of resources)
What Fresh Hell is This: Perimenopause, Menopause, Other Indignities, and You by Heather Corinna (book)