Reproductive health and mental health

Throughout your monthly menstrual cycle, levels of certain hormones rise and fall. These hormone levels can affect how you think and feel mentally and physically.

Mental health conditions can cause period problems or make some period problems worse:

• Premenstrual syndrome (PMS). Most women have some symptoms of PMS in the week or 2 before their period. PMS can cause bloating, headaches, and moodiness. Women with depression or anxiety disorders may experience worse symptoms of PMS. Also, many women seeking treatment for PMS have depression or anxiety.¹ Symptoms of these mental health conditions are similar to symptoms of PMS and may get worse before or during your period. Talk to your doctor or nurse about ways to relieve PMS symptoms.
• Premenstrual dysphoric disorder (PMDD). PMDD is a condition similar to PMS but with more severe symptoms, including severe depression, irritability, and tension. Symptoms of PMDD can be so difficult to manage that your daily life is disrupted. PMDD is more common in women with anxiety or depression.² Talk to your doctor about ways to help if you experience worse symptoms of depression or anxiety around your period.
• Irregular periods. Studies show that women with anxiety disorder or substance use disorder are more likely to have shorter menstrual cycles (shorter than 24 days).³ Irregular cycles are also linked to eating disorders and depression.⁴ Women with bipolar disorder are also twice as likely to have irregular periods.⁵

Changing hormones during pregnancy can cause mental health conditions that have been treated in the past to come back (this is called a relapse). Women with mental health conditions are also at higher risk of problems during pregnancy.

• Depression. Depression is the most common mental health condition during pregnancy.⁶ How long symptoms last and how often they happen are different for each woman. Women who are depressed during pregnancy have a greater risk of depression after giving birth, called postpartum depression. If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back.
• Eating disorders. Women with eating disorders may experience relapses during pregnancy, which can cause miscarriage, premature birth (birth before 37 weeks of pregnancy), and low birth weight.
• Bipolar disorder. Women may experience relief from symptoms of bipolar disorder during pregnancy. But they are at very high risk of a relapse of symptoms in the weeks after pregnancy.⁷

Women with anxiety disorders and obsessive-compulsive disorder (OCD) are more likely to have a relapse during and after pregnancy.

Talk to your doctor or nurse about your mental health condition and your symptoms. Do not stop any prescribed medicines without first talking to your doctor or nurse. Not using medicine that you need may hurt you or your baby.

Maybe. Certain mental health conditions can make it harder to get pregnant:

• Eating disorders can affect your menstrual cycle. The extreme weight loss that happens with anorexia can cause you to miss your menstrual periods. If you have bulimia, your menstrual cycle may be irregular, or your period may stop for several months. Both of these period problems can affect whether you ovulate. Not ovulating regularly can make it harder to get pregnant. Also, the longer you have an eating disorder, the higher the risk that you will face some type of problem getting pregnant.
• Depression, anxiety, and stress can also affect the hormones that control ovulation. This could make it difficult for a woman to become pregnant.

If you are having problems getting pregnant, the stress, worry, or sadness can make your mental health condition worse. Talk to your doctor or nurse about your feelings. Treatment for your mental health condition helps both you and your chances of having a baby. During pregnancy, it can also lower your baby’s chances of developing depression or other mental health conditions later in life.

Maybe. Some medicines, such as antidepressants, may make it more difficult for you to get pregnant.⁸ Also, some medicines may not be safe to take during pregnancy or when trying to get pregnant. Talk to your doctor or nurse about other treatments for mental health conditions, such as depression, that don’t involve medicine. Learn more about taking medicine during pregnancy.

Women who are already taking an antidepressant and who are trying to get pregnant should talk to their doctor or nurse about the benefits and risks of stopping the medicine. Some women who have been diagnosed with severe depression may need to keep taking their prescribed medicine during pregnancy. If you are unsure whether to take your medicine, talk to your doctor or nurse.

Talk therapy is one way to help women with depression. This type of therapy has no risks for women who are trying to get pregnant. During talk therapy, you work with a mental health professional to explore why you are depressed and train yourself to replace negative thoughts with positive ones. Certain mental health care professionals specialize in depression related to infertility.

Regular physical activity is another safe and healthy option for most women who are trying to get pregnant. Exercise can help with symptoms such as depression, difficulty concentrating, and fatigue.⁹

It depends on the medicine. Some medicines can be taken safely during pregnancy or while you are breastfeeding, but others are not safe. Your doctor or nurse can help you decide. It is best to discuss these medicines with your doctor or nurse before you ever become pregnant.

Learn more about medicines and breastfeeding in our Breastfeeding section. You can also enter your medicine into the LactMed^® database to find out whether your medicine passes through your breastmilk and, if so, any possible side effects for your nursing baby.

As you approach menopause, certain levels of hormones in your body begin to change. This initial transition to menopause when you still get a period is called perimenopause. During perimenopause, some women begin to feel symptoms such as intense heat and sweating (“hot flashes”), trouble sleeping, and changing moods.

As you get closer to menopause, you may notice other symptoms, such as pain during sex, urinary problems, and irregular periods. These changes can be stressful on you and your relationships and cause you to feel more extreme emotions.

Women with mental health conditions may experience more symptoms of menopause or go through perimenopause differently than women who do not have mental health conditions.

• Women with depression are more likely to go through perimenopause earlier than other women. Studies show that women with depression have lower levels of estrogen.¹⁰
• Bipolar disorder symptoms may get worse during perimenopause.¹¹
• Insomnia affects up to half of women going through menopause.¹² Insomnia may be more common in women with anxiety or depression.
• Menopause can cause a relapse of obsessive-compulsive disorder (OCD) or a change in symptoms.¹³

Steps you can take to support good mental health include the following:

• Get enough sleep. Good sleep helps you stay in good mental health. If pregnancy or your menopause symptoms, such as hot flashes, are keeping you awake at night, talk to a doctor or nurse about treatments that can help. Learn more about how sleep affects mental health.
• Get enough physical activity. Exercise may help prevent or treat some mental health conditions. Researchers know that physical activity or exercise can help many people with mental health conditions, including depression, anxiety, schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), eating disorders, and substance abuse.¹⁴ Exercise alone does not usually treat or cure mental health conditions, but combined with other treatments like therapy or medicine, it can make your symptoms less severe.
• Choose healthy foods most of the time. Getting the right nutrients, including enough fiber, and staying hydrated can help you feel better physically and can boost your mood.
• Take your medicines. If you take medicines for a mental health condition, don’t stop without first talking to your doctor or nurse. Once you go through menopause, medicines may work differently for you. They may not be as effective or may have different or worse side effects. Talk to your doctor or nurse about whether you need to switch medicines.
• Keep a support network. Whether you talk to friends, family, or a therapist, stay in good communication with people who know you well. Ask for help if you need it.
• Stay involved as you get older. Retirement can be a positive opportunity for change, but it can also be stressful. You may miss going to work each day. Having a chronic disease like diabetes or heart disease may change how much you see friends and family. Find opportunities for volunteering, social activities such as golf or community gardening, or even part-time work to stay connected to others and your community.

Learn more about steps you can take for good mental health.

For more information about reproductive health and mental health, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Depression During Menopause — Toolkit from the University of Michigan.
• Menopause: Emotional Aspects (Including Depression) — Fact sheet from the Cleveland Clinic.
• Mood Swings — Information from the Hormone Health Network.
• Postpartum Depression — Brochure from the American Psychological Association.
• Postpartum Depression and the Baby Blues: Signs, Symptoms, Coping Tips, and Treatment — Information from HelpGuide.org.
• Premenstrual syndrome — Publication from the U.S. National Library of Medicine.
• Premenstrual Syndrome and Premenstrual Dysphoric Disorder — Publication from the American Academy of Family Physicians.

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