Last week, I received a really great question from a woman who recently finished reading ​my book​:

I think both men and women have observed this experience of emotional and mental whiplash that sometimes comes with our menstrual cycles. So I want this reader to know that she is definitely not alone, and that her questions are really important and welcome here!

I'd like to summarize her email by identifying two big questions:

1. Knowing that our cycle phases can bring out different "flavors" of our personality, how can we harmonize those different aspects of our selves which can feel so disparate?
2. How do we care for our mental health, which can also shift as we go through our cycles?

I want to dive into the second question this week, and will attempt a coherent email-sized reply to the first one next week (wish me luck!)

WOMEN'S MENTAL HEALTH

Let's begin with a few staggering stats, shall we? Fair warning: the next paragraph is sobering and mentions suicide, so if you need to skim down a bit, you're welcome to do so.

When we look at the state of women's health, we have some really difficult issues to contend with: Women are ​almost 2x more likely than men​ to attempt suicide, although the rates of death by suicide among men are significantly higher. Of those attempts by women, ​almost half occurred in the luteal phase​ of the menstrual cycle-- the time after ovulation. ​Psychiatric symptoms​ are more prevalent during this same period and, while hardly conclusive, ​other studies show interesting patterns​ of violent crimes occurring in the premenstrual and menstrual phases (7 days before menses, and during menses). So there is at least a big suspicion here that the late luteal phase and early menstrual phase may be particularly challenging for women's mental health!

I would never assert that women's mental health is more complicated than men's-- I just think it's complicated in different ways, which might make it more difficult to address with our current models of diagnosis and treatment.

Men's bodies work primarily on a circadian rhythm, ​with daily ebb and flow patterns of hormones​. Putting aside the fact that mental health, in general, is something we actually know very little about, we do at least have some medications which can be taken daily and have been proven to help with certain disorders. Women have daily patterns, too. But we also have an infradian rhythm that corresponds with our menstrual cycle. So while daily application of some medications may be appropriate, it does not necessarily address the issues that show up only in certain phases. We definitely need more research, but I have had some NFP clients who are able to convince their doctor to adjust medications for ADHD, anxiety, or depression based on their cycle phases-- and they have seen positive results with that.

Now, let's get one thing very straight: menstrual cycles do not cause all women to ​become crazy.​ Menstrual cycles may cause some predictable changes in moods, but it's not normal by any metric for women to exhibit psychotic symptoms before their periods.

But for women who are already struggling with health, menstrual cycles can make diagnosis and treatment of some issues more difficult by adding a layer of complexity to something that is already very complex.

This is why I think it's really important for us to educate girls and women about the possible emotional and mental shifts that can happen throughout the menstrual cycle! We should all be told about what's normal, so that if we experience some minor shifts (e.g., feeling more sensitive, less energetic, less creative during the luteal phase) then we can:

• name that experience
• understand why I might be feeling this way
• accept it as a temporary, transitional state
• develop strategies for diet, exercise, sleep and other self-care to address these changes in a positive way

Girls and women who are equipped to do this can also be empowered to speak up whenever ANY symptom of their cycle becomes disruptive to daily life. In my cycle education programs, I talk to girls about mild or moderate ​PMS​, some of which may be perfectly normal and managed with some herbal tea and a nice bubble bath, versus severe PMS or even ​PMDD​ which do require more attention and possibly medical intervention.

Even the simple acknowledgment that women legitimately struggle with mental health differently from men is a huge step in the right direction.

It's frustrating to feel that women have to fight for acknowledgment that our symptoms are real. But they are. And if you are experiencing ANY issues with mental health-- regardless of whether they are connected to our reproductive hormones!-- then you deserve help.

The lingering question, though, is-- what do we do with this info?

If we accept that women deal with mental health issues differently than men do, what difference does it make? Here are a few quick thoughts I've had:

1. Women can learn to differentiate between persistent mental health issues, and ones that are only present at certain times in their cycles. Do my cycles exacerbate a problem that is already there? Or are cycle-related shifts actually causing something that is otherwise not present? This has the potential to be hugely helpful in diagnosis and treatment, if our doctors are open to working with us on that!
2. Rather than being dismissive and just thinking that a woman is acting "hormonal," family and friends can be attentive to ​warning signs of mental illness​ and take care during sensitive times to offer additional support.
3. Women can use their menstrual cycle charts to help them adjust habits or medications to account for expected hormonal shifts. I always remind girls that when it comes to symptom alleviation, being proactive is much more effective than being reactive. Meaning if we can anticipate challenges and make changes in advance, we don't have to struggle to play "catch up" once symptoms do set in.
4. All health crises, including mental health, are occasions for spiritual trial. We would do well to always fortify ourselves spiritually for health struggles, and to consider how our sufferings may be ways we encounter Christ and allow others to serve us as Christ. JPII wrote, "All those who suffer have been called once and for all to become sharers "in Christ's sufferings", just as all have been called to "complete" with their own suffering "what is lacking in Christ's afflictions". At one and the same time Christ has taught man to do good by his suffering and to do good to those who suffer. In this double aspect he has completely revealed the meaning of suffering." (​Salvifici doloris​)

As Catholics, I think it can be difficult to process the way our Church has treated various aspects of mental illness over the years. I definitely don't have the time to get into that in this email, but I do think that learning how our biology contributes to mental health through this very OBVIOUS connection with menstrual cycles is an invitation to some really interesting conversations.

Can demons affect our mental state? Yes. Should we warn against committing sins of despair? Yes. Can we also say that mental illness is actually illness, and is no more or less deserving of the healing touch of our Divine Physician than other ailments? Yes, yes, and yes.

I'm grateful that throughout the tumult of the 20th century, the Church preserved and faithfully pursued research in areas pertaining to women's fertility and cycle health, now that the medical community finally seems to be acknowledging this information might be important. 🙄 What remains our task is to ensure that women and men are not reduced to mere biology, and that we always keep in mind the dignity of the whole person-- body, mind, and soul-- who is in a very special way, an opportunity for encounter with Christ.

READING LIST

FURTHER READING on the science of cycles and mental health: note that not all of these are Catholic sources, so they may not necessarily agree with certain moral positions related to cycles and birth control. But I offer them here for their instructive nature.

• FACTS- ​Allopregnanolone and the Menstrual Cycle​
• Dr. Lara Briden- ​Progesterone Treatment Options for PMDD​
• Dr. Aviva Romm- ​PMS is not all about Reproductive Hormones​
• Dr. Jolene Brighten- ​PMDD: Symptoms, Diagnosis, and Treatment​
• FACTS- ​Hormonal Balance and the Female Brain

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