Female hormones fluctuate throughout the menstrual cycle, and these changes can impact mood. While doctors and researchers recognize premenstrual syndrome, or PMS, as a hormonal condition that can affect emotions in the late luteal phase of the cycle, more research is needed on conditions that can arise during other phases. 

Among conditions vying for attention is post-menstrual syndrome, a PMS lookalike that can occur after one’s period and at the beginning of the follicular phase. Post-menstrual syndrome is not recognized as an official diagnosis, but the fluidity of hormones throughout the menstrual cycle—combined with patients’ experiences of emotional distress following their period—may warrant more research on the condition.

“We know that hormones fluctuate throughout our cycle, and this fluctuation allows for ovulation and menstruation,” says Sameena Rahman, a board-certified gynecologist and Founder of Center for Gynecology and Cosmetics in Chicago. “Like most things in women’s sexual health, [post menstrual syndrome] has not been extensively studied or understood,” Dr. Rahman says.

 

Mood changes in the follicular phase

 

Estrogen and progesterone levels can influence mood throughout the cycle. Reduced estrogen has been linked to physical discomfort and lower mood. Reductions in estrogen can also facilitate or exacerbate psychosis. Estrogen and progesterone levels plummet at the end of the luteal phase, during which PMS can occur. Estrogen and progesterone levels are also very low at the onset of the follicular phase, during which post-menstrual syndrome may occur. As the follicular phase progresses, levels rise.

Handy AB, Greenfield SF, Yonkers KA, Payne LA. Psychiatric symptoms across the menstrual cycle in adult women: A comprehensive review. Harvard Review of Psychiatry. 2022;30(2):100-117.

 

One self-reported study on cortisol levels, psychiatric symptoms, and the menstrual cycle found that participants—those deemed healthy women—experienced higher symptoms of depression, albeit lower levels of cortisol, in the early and late follicular stages compared to the mid-luteal phase.

Walder DJ, Statucka M, Daly MP, Axen K, Haber M. Biological sex and menstrual cycle phase modulation of cortisol levels and psychiatric symptoms in a non-clinical sample of young adults. Psychiatry Research. 2012;197(3):314-321.

 

 

Post-period symptoms may also be delayed responses to hormonal changes or a “response to hormone withdrawal.”

Handy AB, Greenfield SF, Yonkers KA, Payne LA. Psychiatric symptoms across the menstrual cycle in adult women: A comprehensive review. Harvard Review of Psychiatry. 2022;30(2):100-117.

 

Barry Peskin, MD, an OB/GYN based in Coral Springs, FL, and Medical Advisor at Happy V, says that while “the term ‘post-menstrual syndrome’ isn't widely recognized in established gynecological literature,” people can experience a range of symptoms in the days following their menstrual cycle, including “lingering effects,” from their period.

“Women experiencing post-menstrual symptoms might report symptoms similar to [those] of premenstrual syndrome, such as mood swings, fatigue, and even some lingering physical discomfort,” Dr. Peskin adds. 

When meeting with a patient to discuss such symptoms, it is important to also consider the entire “clinical picture and conduct a thorough evaluation before attributing these symptoms solely to the menstrual cycle,” Dr. Peskin says.

 

How to help patients work through symptoms following their period

 

Diagnosis aside, Dr. Rahman says there are ways to help patients address symptoms and seek relief. She often recommends that patients track their physical and mental symptoms daily and note their severity in order to best detect how and if these symptoms are related to their cycle. Depending on the individual’s needs, consider talking to patients about diet or exercise changes, cognitive behavioral therapy, or hormonal therapies (like birth control), she adds.

“Anecdotally, when I see a patient who does not get relief [from] PMS or PMDD symptoms after her cycle, then I believe them,” Dr. Rahman says. “We try to work around some of the hardships or find triggers or other things that may help their quality of life.”

To best serve her patients, she says that she and other doctors need assistance from those above them, too.

“The field of obstetrics and gynecology continually evolves, and more comprehensive research and discussion is needed,” Dr. Peskin says. Future research should look into what causes symptoms, what intensifies symptom severity, and how to provide rigorous, individualized patient care, he adds.