For those of us who menstruate, getting our periods can be a moody time. Occasionally, those lows go beyond irritability or discomfort to the point at which it’s tough to put on clothes, look in the mirror, or even leave the house — a state of self-dissatisfaction that is sometimes referred to as premenstrual body dysmorphia. But how exactly do hormones cause that, and is there anything to be done about it?
“There are so many symptoms related to periods under the umbrella of premenstrual syndrome (PMS), and for want of a better expression, they just make you feel crummy,” says Dr. Charis Chambers, an OB/GYN who is also known as “the period doctor.” Premenstrual body dysmorphia isn’t officially recognized as a diagnosis; body dysmorphia is a mental disorder where someone spends a lot of time worrying about their appearance and obsessing over flaws others do not notice. But if you already have slight tendencies toward body dysmorphia, those symptoms “can very easily be exacerbated by monthly hormonal changes,” says Chambers.
In other words, it’s unlikely that your period will conjure up entirely new issues that you’ve never seen before. But hormonal fluctuations may push you toward existing negative thought patterns that you can normally shake off. “Mood disorders and eating disorders most commonly arise during adolescence, which is a time of high hormonal fluctuation,” says Chambers. “So it makes perfect sense that monthly hormonal fluctuations could also bring up similar feelings of body dissatisfaction.”
A quick refresher on the menstrual cycle and its most notable hormones: When your period begins, your estrogen levels are at their lowest, and your progesterone levels have also just dropped. After that first day of your period, your estrogen levels start to slowly climb back up again, peaking around ovulation, when a new egg is released by your ovaries, usually about halfway through the month (or two weeks after your period begins). Once that happens, progesterone begins to rise, as it is an important hormone for maintaining pregnancy. If the egg isn’t fertilized, your progesterone drops again, your period begins, and you’re back to day one.
While there isn’t a specific hormone that’s associated with body dysmorphia per se, Chambers says that the biochemical changes that accompany the menstrual cycle can absolutely affect mood and, in turn, your self-image. When estrogen and progesterone dip, they can drag down levels of serotonin and dopamine, two brain chemicals that are tied to mood, sleep, and motivation. For most people, this hormonal and chemical shift manifests as feeling blah and sad, but for some, it can bring on a very severe version of PMS known as premenstrual dysphoric disorder. Patients suffering from PMDD may be prescribed a class of antidepressants known as SSRIs (selective serotonin reuptake inhibitors), which can help relieve these symptoms.
You may have heard you’ll feel at your most attractive around ovulation because of the spike in estrogen. Chambers says this is technically true (for evolutionary reasons, it makes sense for us to feel alluring at our most fertile window), but it’s all relative. For example, supplementing more estrogen wouldn’t extend those benefits month-round. “It’s about how the hormones interplay with each other,” she says. “If you increase your estrogen above the healthy range, it could have the opposite effect and make you feel bloated or even decrease your libido.”
Of course, menstruation can also bring on some physical changes, like breakouts and bloating, that may not have you feeling your best. And usually, things improve after a few days (exercise and rest also help). But if your body image goes into a tailspin every time you get your period, Chambers says you should bring it up with your health-care provider. “Mood symptoms are very common with menstruation, and some of them can be normal. But if they’re affecting your ability to do the things you need to do, then you shouldn’t feel you have to suffer through it.”
Sometimes, hormonal-birth-control options can temper those mood swings, she adds. But also, the issues may go beyond what medicine can do. “Mental health is very complex, and throughout our reproductive years, the ways our bodies interact with our hormones can change with age. For many patients, just setting them up with a counselor and giving them space to talk about their mood is hugely validating and can really help.”