Most anyone with ovaries can tell you that ovulation can cause a slew of symptoms, both physical and mental. But does ovulation cause depression? If you are tracking your ovulation in the hopes of getting pregnant, your mental health is just as important as your physical health. (And if you're not trying to conceive, your mental health is still just as important as your physical health.)
To find out more about how ovulation can impact your mental health and what you can do about it, Romper spoke with Dr. Sana M. Salih, MD, MS, Reproductive Endocrinology and Infertility Specialist at Detroit Medical Center’s Hutzel Women’s Hospital, and Shana Averbach, LMFT, PMH-C, a psychotherapist in San Francisco, California who specializes in women's mental health.
How Hormones Can Make You Depressed During Ovulation
"All women have the same general hormonal changes throughout their monthly cycles, but some women are more sensitive to those changes than others." Averbach tells Romper. "There is a dip in estrogen, which can lead to mood swings, irritability, anger, and weepiness. For some women this is subtle and pesky, and for some it’s like a debilitating, albeit short-lived, depression."
So, yes, ovulation can cause depression, but the severity and length of that depression will vary from person to person. "There is a lot of evidence and literature that supports the association between ovulation and mood disorders," Salih says. "They are categorized as premenstrual dysmorphic disorders (PMDD). PMDD is thought to be a brain chemistry malfunction that is triggered by ovulation." As a study published by the Medical Clinics Of North America found, “women with PMDD have a differential response to normal hormonal fluctuations. This susceptibility may involve the serotonin system, altered sensitivity of the GABAA receptor to the neurosteroid allopregnanalone, and altered brain circuitry involving emotional and cognitive functions.”
Salih says the reproductive cycle contains drastic rises and falls in the hormone levels throughout the cycle. These changes in the hormone levels can "trigger changes in the balance of the neurohormones dopamine and serotonin," she says. "This, in turn, can result in changes to your mental well-being and affect your mental health."
For people who experience PMDD, it can be debilitating. "If a woman is already depressed, these cyclical phases may exacerbate symptoms. But about 5% of women of childbearing age have PMDD, in which symptoms of depression — which begin after ovulation and end after menstruation — are severe," Averbach says. "These might include loss of pleasure and interest, impaired concentration, changes in eating and sleeping, extreme irritability, and sometimes even suicidal thoughts."
Who Is At Risk Of Developing Depression From Ovulation?
People with underlying mental health conditions might be particularly susceptible to depression after ovulation, too. "People with underlying anxiety and depression do report an exacerbation of symptoms around the time of ovulation," Salih says. "Ovulation has also been associated with worsening of symptoms in borderline personality disorder." A reported 40% of people diagnosed with PMDD also have clinical depression, according to the Center for Women's Mood Disorders at the University of North Carolina Medical Center, which means that it can be hard to diagnose and treat effectively.
Salih also has seen ovulation-related depression in her infertility practice. "Infertility patients are at increased risk of ovulation-induced mood changes. Women with infertility are given oral and injectable medications to stimulate the growth of the follicle and the release of the eggs," she says. "While an increase in the level of estrogen and progesterone hormones is essential to enhance fertility, these hormones may lead to mood changes and stress, which may negatively affect the couple's chance of pregnancy."
What Is The Treatment For Ovulation-Related Depression?
The good news, per Averbach and Salih, is that a wide variety of evidence-based treatment options are available. "If you are not trying to get pregnant, there are a variety of options that suppress ovulation like oral contraceptive pills, which are helpful for mood changes that are specific to ovulation," Salih says. "Your physician may also prescribe you tricyclic pills which will ensure that you have a period once every few months instead of every month, thereby also preventing or managing the mood changes that most women experience around the time of menstruation."
Psychotherapy is another option, according to Averbach. In therapy, you can "target the psychological aspect of the hormonal roller coaster — the thoughts and feelings that come with this phase of the month — and start to understand them in a new way," she says. "You can problem solve around the experience, looking at what choices you do have, even while struggling."
A 2013 review of research published in the journal Women's Health, found that anti-depressants, like selective serotonin reuptake inhibitors (SSRIs), can help prevent cyclical bouts of depression related to menstrual cycles. "Pharmacotherapy may be indicated in cases in which psychological treatment has not been effective, and the symptoms of anxiety and depression are moderate to severe," Salih explains.
You may also want to let your partner or a friend in on your struggles. "What I also see in my practice is the benefit of having a witness to the cycles. When we’re in any sort of depressive state, we usually just think that life is always this way, that this is just how we are. We become our symptoms," Averbach says. "Having a caring witness to say, 'You know, this happened for you exactly four weeks ago,' and when you were out of the fog, all these other facets of your life came to light."
Cyclical bouts of depression might actually be opportunities for reflection, Averbach continues. "When we notice things that aren't working for us while estrogen is on vacation — say, our demanding job, our hypercritical partner, or our energy-sucking friend — we do have the opportunity to make decisions about whether we need to make any changes to those areas of life. I just like to recommend finalizing your decision when feeling more grounded."
If you think your mood changes are becoming more severe, or that you're experiencing mood changes around ovulation, menstruation or infertility, it's important to remember that there is treatment available that can effectively assist you. "Please do not suffer in silence," Salih says. "Reach out to your OB-GYN, primary care physician, or reproductive endocrinologist today."
Study referenced:
Teresa Lanza di Scalea , Teri Pearlstein, Premenstrual Dysphoric Disorder, 2019
Experts:
Dr. Sana M. Salih, MD, MS, Reproductive Endocrinology and Infertility Specialist at Detroit Medical Center’s Hutzel Women’s Hospital
Shana Averbach, LMFT, PMH-C, a psychotherapist in San Francisco, California who specializes in women's mental health
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.
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