The Art Of Being A Woman: The Stages Of The Menstrual Cycle And How They Affect Energy And Mental Health.

Calender showing the period days marked surrounded by period products

Being a woman is an interesting journey. Understanding how our bodies and hormone cycles work can make that journey easier.

The Anatomy Of The Uterus.

Before we can start to understand how our hormonal cycles work, we need to understand the anatomy of the uterus.

What Is The Uterus?

The uterus is a pear-shaped organ of people assigned female at birth. It is part of the reproductive system.

What Is The Function Of The Uterus?

The main functions of the uterus are as follows:

Pregnancy: the uterus can stretch to grow a baby during pregnancy and contract to help push the baby out during birth.
Fertility: the uterus is where the egg implants during contraception.
Menstrual Cycle: the uterine lining is where the blood and tissue comes from during your period.

What Does The Uterus Look Like?

The uterus looks like an upside-down pear-shaped organ connected to the cervix. It has two horn-shaped organs at the top, known as the fallopian tubes.

It has four main sections:

Fundus: this is the uppermost and widest part. This section is connected to the fallopian tubes.
Corpus: this is the main body of the uterus.
Isthmus: the part of the uterus between the corpus and the cervix. This is where the uterus starts to narrow.
Cervix: the lowest part of the cervix. This opens to the vagina.

Where Is The Uterus Situated?

The uterus is situated between the bladder and rectum. It’s supported by the pelvic floor muscles and perineal body. The ligaments in the pelvis, lower back and hips also help hold the uterus in place.

What Is The Uterus Made Of?

The uterus is made of three main layers:

Perimetrium: the outmost, protective layer.
Myometrium: the highly muscular middle layer. This is the layer that expands during pregnancy and contracts during birth.
Endometrium: the inner lining of the uterus (uterine lining). This is what is shed during menstruation.

How Big Is The Uterus?

The uterus is about 7.6 cm long and 5 cm wide. It is about 2.5 cm thick and weighs about 28 grams.

If you are struggling to picture what the uterus looks like, here is a great website with some 3D images of the uterus: What happens during your period | Anatomy Snippets

The Menstrual Cycle And Its Different Phases.

The menstrual cycle is a complex but natural cycle of changes that the body goes through each month to prepare for possible pregnancy. It is made up of 4 stages. As for length, everyone’s cycle is different so it can be 28 days but as a teenager, it can be as long as 45 days and in your 20s to 30s it can be anywhere between 21 to 28 days.

Stage 1: Menstrual Phase.

The menstrual cycle is the 1st day of the menstrual cycle. This is your period and is because the egg from the previous cycle wasn’t fertilised. Levels of progesterone and estrogen drop and the thickened lining, which is no longer needed for pregnancy, is shed. A mixture of blood, mucus, and tissue is released from the uterus out of the vagina. The average length is 3 to 7 days.

Period symptoms may include:

Cramps.
Lower back pain.
Tender breasts.
Bloating.
Mood swings.
Irritability.
Headaches.
Tiredness.

Stage 2: Follicular Phase.

This phase starts on the 1st day of your period. Therefore, there is some overlap in the menstrual phase, and ends when you ovulate.

The hypothalamus signals the pituitary gland to release follicle-stimulating hormone (FSH). FSH signals your ovaries to produce 15 to 20 sacs called follicles and each follicle contains an egg. Only one, maybe two eggs will mature and the rest of the follicles will be reabsorbed. The maturing of the follicle triggers a surge in estrogen which leads to the thickening of the uterine lining which creates a nutrient-rich environment for the embryo to grow.

The follicular phase can range from 11 to 27 days with the average being 16 days.

Stage 3: Ovulation Phase.

The rising of estrogen levels during the follicular phase triggers the pituitary gland to release luteinizing hormone (LH) which starts ovulation.

Ovulation is the stage of the menstrual cycle when you can get pregnant. Ovulation happens at the 14-day mark if you have a 28-day cycle or 2 weeks before your period. After a day the egg will die or dissolve if the egg isn't fertilised. You can know if you are ovulating if you have the following symptoms:

A slight rise in basal body temperature. (Body temperature at rest)
Thicker vaginal discharge that has the texture of egg whites.

Stage 4: Luteal Phase.

Once the follicle releases the egg, the follicle becomes the corpus luteum. Its main job is to release hormones, mainly progesterone and estrogen. This rise in hormones keeps the uterine lining thick and ready for pregnancy.

If you are pregnant, your body will produce the human chorionic gonadotropin (hCG) hormone. This is the hormone that shows up on pregnancy tests and helps maintain the corpus luteum and keep the uterine lining thick.

If you don’t get pregnant, the corpus luteum will be reabsorbed which leads to a decrease in progesterone and estrogen. This will cause the onset of your period. At this point, you may experience the symptoms of PMS which could include:

Trouble sleeping.
Bloating.
Breast swelling, pain, or tenderness.
Mood changes.
Headaches.
Weight gain.
Changes in sexual desire.
Food cravings.

The luteal phase can last between 11 to 17 days with the average being 14 days.

The Phases Of The Menstrual Cycle And How They Affect Energy.

The release of hormones throughout the cycle is what directly affects energy levels. The changes in energy level can affect things like sleep, work, exercise, and socialisation.

Menstrual Phase.

At the end of the luteal phase, the progesterone levels will fall. Likewise, estradiol, progesterone, and testosterone may be at their lowest as well.

The drop in hormones along with the loss of blood and other symptoms of PMS usually led to the feeling of fatigue. This is the end of the luteal phase so you may feel the worst of all the symptoms.

Follicular Phase.

This is known as the feel-good phase. Alongside the release of FSH, estradiol (the most potent form of estrogen) begins to rise. This is when you will feel the most sociable, energised, clear-minded, and happy.

Serotonin also rises at this point. This boost plays a large role in you feeling more positive during this period.

Ovulation Phase.

This phase is when a lot of women feel frisky. With high estrogen levels and the impending release of the egg, you can feel happy, attractive, and sexually desirable during this phase.

Testosterone also increases during this phase. This hormone is closely linked to improved mood, energy, increased sex drive, and increased desire.

Luteal Phase.

Known as the “crappy” phase, this is the phase where alongside the menstrual phase is the phase where women feel the most fatigued.

With the sharp drop in hormones, fatigue and lack of libido set in. Serotonin levels also drop at this point which can also lead to feelings of depression. There can also be a rise in the stress hormone cortisol which may lead to stress symptoms.

How To Manage Low-Energy Days.

Even though you may feel overwhelmed on the low days, there are some ways to deal with your symptoms:

Listen to your body: if you wake up feeling tired, try not to push yourself too hard.
Prioritise good sleep: aim to get to sleep and wake up at the same time each day. If you're overtired, try having a nap rather than disrupting your sleep schedule.
Try relaxation techniques: try breathing techniques, yoga, and warm baths to help with stress and sleep problems.
Don’t skip exercise: this might sound like a lot but exercise can help with energy levels. Swap out strenuous exercise for something more gentle like yoga or swimming.
Eat regularly: try to eat several smaller meals throughout the day as well as some healthy snacks to maintain energy.
Don’t rely on caffeine: even if feeling tired, don’t rely on caffeine. Caffeine can affect sleeping patterns and stress levels.

The Menstrual Cycle And How It Affects Mental Health.

Alongside affecting energy and basic mood, the menstrual cycle can affect mental health more seriously. Here are the most common mental health conditions related to the menstrual cycle:

Premenstrual Syndrome (PMS).

An estimated 3 out 4 women or people assigned female at birth have experienced some form of premenstrual syndrome. What causes PMS is unknown but some contributing factors include:

Cyclic changes in hormones: symptoms of PMS change with hormonal fluctuations and disappear with pregnancy and menopause.
Chemical changes in the brain: fluctuations of serotonin could trigger PMS. Insufficient levels of serotonin can lead to PMS depression, as well as sleep problems, fatigue, and food cravings.
Depression: sometimes undiagnosed depression can lead to severe PMS although it doesn't always lead to all symptoms.

While the intensity and symptoms of PMS vary from person to person the main signs and symptoms are as follows:

Emotional and Behavioral Symptoms.

Tension and anxiety.
Depressed mood.
Crying spells.
Mood swings.
Irritability.
Appetite changes and cravings.
Insomnia.
Social withdrawal.
Poor concentration.
Change in libido.

Physical Signs and Symptoms.

Joint or muscle pain.
Headache.
Fatigue.
Weight gain linked to fluid retention.
Abdominal bloating.
Breast tenderness.
Acne flare-ups.
Constipation or diarrhoea.
Alcohol intolerance.

Treatment is symptomatic and can include the following:

Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) have been successful in reducing the mood symptoms of PMS.
Nonsteroidal anti-inflammatory drugs (NSAIDs): taken at the onset of your period these medications can ease cramping and breast discomfort.
Diuretics: when exercising and lowering salt intake isn’t helping with bloating, taking diuretics can help shed excess fluid through your kidneys.
Hormonal contraceptives: the medications stop ovulation which may bring relief to PMS symptoms.

Premenstrual Dysphoric Disorder (PMDD).

PMDD is a severe form of PMS where the sufferer has symptoms of severe anxiety, depression, mood changes, and even suicidal thoughts. Between 3% to 8% of women or people assigned female at birth can experience this condition. Much like PMS, the causes of premenstrual dysphoric disorder are unknown, however the following are the risk factors of PMDD:

Anxiety or depression.
PMS.
Family history of PMS, PMDD, or mood disorders.
Personal history of trauma, abuse, or highly stressful events.

Other than normal PMS symptoms, the symptoms of PMDD may include:

Anger and irritability.
Feeling on edge, overwhelmed, or tense.
Anxiety and panic attacks.
Depression and suicidal thoughts.
Difficulty concentrating.
Fatigue and low energy.
Food cravings, binge eating, and changes in appetite.
Headaches.
Insomnia.
Mood swings.

Treatment of PMDD is the same as PMS along with talk therapy and other supportive therapies. For more in-depth information about premenstrual dysphoric disorder, read our previous blog which focuses solely on the topic: https://www.laurikarossouwpsychologist.com/post/premenstrual-dysphoric-disorder-pmdd-what-is-it-and-how-is-it-different-from-pms

The End Of The Menstrual Cycle: Perimenopause And Depression.

Perimenopause is the transition that women and people assigned female at birth go through before reaching menopause. At this point, they may experience irregular periods, mood swings, insomnia, hot flushes, and sometimes emotional changes.

In about 35% of cases, these emotional changes can lead to depression known as perimenopausal depression. The signs and symptoms are as follows:

Signs of perimenopausal depression.

Fatigue and lack of energy.
Slowed cognitive function.
Innativentivess.
A lack of interest in once-enjoyable activities.
Feelings of worthlessness, hopelessness, and helplessness.

Symptoms of perimenopausal depression.

Mood swings.
Irritability.
Crying for no reason - tearfulness.
Heightened anxiety.
Profound despair.
Sleep problems related to hot flashes or night sweats.

The treatment for perimenopausal depression is antidepressants as well as symptomatic. We will go into more detail about the risk factors and treatment for perimenopausal depression in our next blog about Perimenopause and Menopause.