Unmasking the cycle: Premenstrual and menstrual exacerbation of psychiatric disorders and impact on female mental health

Table 1 Hormonal secretion and mood effects across the menstrual cycle

Phase	Hormone	Hormone level	Secretory role	Impact on mood and mental health
Menstrual (days 1-5)	Estrogen	Low	Shedding of endometrial lining due to hormonal withdrawal	Low mood, irritability, fatigue, depressive symptoms in some individuals
	Progesterone	Low	Minimal activity	Can contribute to emotional instability due to hormonal drop
	LH	Low	No active secretion; LH levels declined after previous cycle	No direct mood effect at this stage
Follicular (days 1-13)	Estrogen	Rising	Stimulates endometrial proliferation; supports follicle maturation	Improves mood, energy, cognitive function; neuroprotective and antidepressant-like effects
	Progesterone	Low	Not significantly secreted yet	May be associated with increased energy and mental clarity
	LH	Low to moderate	Stimulates theca cells to produce androgens; preparing for ovulation	Indirect effects on mood via estrogen production
Ovulatory (day 14 ± 1)	Estrogen	Peak	Triggers LH surge via positive feedback	Often associated with elevated mood, increased libido, cognitive sharpness
	Progesterone	Begins to rise	Prepares for potential implantation	Generally stable mood; for some early signs of anxiety
	LH	Surge	Induces ovulation (release of mature oocyte)	LH surge itself has limited direct mood effects; mediated via estrogen/progesterone shifts
Luteal (days 15-28)	Estrogen	Moderate	Supports endometrial maintenance with progesterone	Mood may remain stable early; may worsen in late luteal phase
	Progesterone	High	Dominant hormone; supports endometrial differentiation and potential implantation	Can cause mood swings, irritability, anxiety, especially in PMS/PMDD; modulates GABA receptors
	LH	Returns to baseline	No further significant role post-ovulation	Minimal direct mood effects
Premenstrual (late luteal)	Estrogen and progesterone	Rapidly declining	Corpus luteum regresses if no implantation	Hormonal withdrawal may trigger low mood, anxiety, emotional sensitivity (notably in PMDD)

LH: Luteinizing hormone; PMS: Premenstrual syndrome; PMDD: Premenstrual dysphoric disorder; GABA: Gamma-aminobutyric acid.