Hormones and Mental Health: PMDD, PCOS, Endometriosis, Perimenopause, and Shifts Across the Reproductive Lifespan

Written By Jess Coleman, Ph.D.

Table of Contents

1. How hormones can influence emotional well-being

Hormonal shifts and imbalances across the reproductive lifespan can influence mood, energy, sleep, anxiety, and emotion regulation. These shifts occur during menstrual cycles, fertility treatment, miscarriage and pregnancy loss, the transition from pregnancy to postpartum, and during perimenopause and menopause. While these experiences are often grouped together under the umbrella of hormonal changes, they do not all affect mental health in the same way.

Conditions such as Premenstrual Dysphoric Disorder (PMDD), Polycystic Ovary Syndrome (PCOS), and endometriosis each involve hormonal or endocrine factors, but they differ in how hormones interact with the nervous system, stress response, inflammation, pain, and emotion regulation. Some involve cyclical sensitivity to hormonal fluctuations, others involve chronic endocrine disruption, and others combine hormonal factors with ongoing physical stressors.

What they share is not a single mechanism, but a history of being poorly understood, minimized, or treated as purely physical or purely psychological.

Even when hormonal shifts are expected physiologically, they are often not easy to navigate. Many people feel dismissed or ashamed when they try to describe emotional and mental health symptoms connected to hormonal changes or imbalances. Growing research continues to highlight the meaningful ways hormones and the endocrine system interact with mental health, reinforcing that these experiences are real and worthy of thoughtful assessment and treatment.

2. Understanding PMDD, PMS mood shifts, and cyclical changes

Premenstrual Dysphoric Disorder (PMDD) and premenstrual mood symptoms can create predictable patterns of emotional and physical difficulty. Some people experience intense shifts the week before their period starts (called the luteal phase) that can impact their daily functioning, well-being, and relationships.

This can include premenstrual exacerbation (PMEs) of existing mental health conditions, such as depression or anxiety, where people experience a drastic increase in those symptoms. This also includes PMDD, where people experience a sudden onset of symptoms that they do not normally experience during the luteal phase every month. The symptoms decrease or go away completely within a few days of the person’s period starting.

This can feel like a rollercoaster to the person experiencing these hormonally-driven shifts, and to their loved ones.

PMDD and PMS symptoms can include:

  • Irritability or heightened sensitivity
  • Intense sadness or crying spells
  • Anxiety or tension
  • Difficulty concentrating
  • Physical symptoms such as bloating and pain

I work with clients in therapy to recognize menstrual related patterns, notice the impact of premenstrual symptoms on their functioning, learn to respond to them skillfully, and reduce shame around cyclical emotional shifts.

3. PCOS, endometriosis, and the emotional impact of chronic conditions

Medical conditions such as Polycystic Ovary Syndrome (PCOS) and endometriosis are now understood as complex endocrine and inflammatory conditions that affect far more than reproductive organs alone. Both involve disruptions in hormonal signaling and stress-response systems that interact with pain processing, mood regulation, energy, sleep, and cognitive functioning.

In PCOS, hormonal imbalance and insulin resistance can contribute to both physical and mental health symptoms. In endometriosis, chronic inflammation and pain place ongoing strain on the nervous system, increasing vulnerability to anxiety, low mood, and exhaustion over time.

Because these conditions affect the body’s endocrine and stress systems, their impact is often experienced across multiple domains. Physically, people may cope with pain, fatigue, cycle irregularities, heavy bleeding or cramping during periods, or side effects from medications and procedures.

Emotionally and psychologically, many describe changes in self-image, identity, sexual health, and their relationship to their body, as well as concerns related to fertility and family-building. These experiences are not separate from mental health, they are deeply intertwined with how the brain and body respond to chronic stress and uncertainty.

As a result, people living with PCOS or endometriosis often report anxiety about symptoms, pain, or fertility outcomes, frustration with long diagnostic delays, and feeling invalidated or dismissed by medical providers. Many struggle to find clinicians who specialize in endocrine conditions or who are familiar with current research and evolving treatment approaches.

Fear related to medications, procedures, or surgery is common, as is grief about the potential impact on fertility or life event timelines.

Living with a chronic reproductive condition can be stressful and emotionally exhausting. I work with clients to address both psychological and physical burdens, providing space to process uncertainty and stress, while developing ways to cope with the ongoing demands these conditions can create.

4. Perimenopause and menopause-related mood changes

Perimenopause is the transitional phase leading up to menopause and is driven by significant fluctuations in ovarian hormones, particularly estrogen and progesterone. People enter menopause after going through 12 consecutive months without a menstrual period.

Perimenopause, by contrast, can begin years earlier and is marked not by steady hormone decline, but by unpredictable hormonal variability. This distinction matters because it is often the fluctuations, rather than low hormone levels alone, that contribute to distressing physical and emotional symptoms.

Perimenopause represents one of the most intense hormonal transitions across the female lifespan. The magnitude of hormonal change during this period is often compared to puberty and the postpartum period. Like those transitions, perimenopause can bring rapid biological changes that outpace emotional or psychological adjustment, particularly when the transition is unexpected or poorly understood.

Perimenopause can begin in the mid-to-late 40s, but onset varies widely. Some people begin experiencing changes in their 30s or early 40s, which can make symptoms difficult to recognize or attribute to a hormonal transition.

The duration of perimenopause also varies significantly. While the average length is often cited as several years, some people experience this transition for a decade or more, with symptoms waxing and waning before menstruation fully stops. This long and variable course is one reason perimenopause has historically been misunderstood, misdiagnosed, and minimized. When these symptoms are dismissed, people may struggle to make sense of their experiences or feel unsure about seeking support.

Hormonal fluctuations during perimenopause affect systems beyond reproduction. Estrogen plays a central role in mood regulation, sleep, energy, cognition, and stress response. As hormone levels rise and fall unpredictably during perimenopause, people may experience:

  • Anxiety
  • Irritability or emotional reactivity
  • Low mood
  • Grief about identity changes
  • Concentration difficulties, memory lapses, or brain fog
  • Sleep disruption, insomnia, or fatigue
  • Fear or uncertainty about physical changes such as loss of bone density, hair loss or thinning, and weight gain around the abdomen
  • Menstrual changes (irregular, lighter or heavier bleeding, spotting between cycles)
  • Hot flashes and night sweats
  • Vaginal dryness, irritation, or pain during sexual activities involving vaginal penetration

These reactions reflect the body and brain adapting to a prolonged hormonal transition, not personal weakness or poor coping skills. In therapy, clients work to adapt to changes that come with the perimenopause process over time.

Treatment often includes symptom management, coordination with medical providers to explore integrated treatment options, and support in reducing the impact of symptoms on daily functioning, relationships, and work.

5. Why distress related to hormonal shifts or imbalances is often misunderstood

Hormonal concerns are frequently minimized, which can make people feel judged, unseen, and pressured to pretend they aren’t experiencing real and challenging disruptions to their daily functioning and well-being.

Many clients share that they feel unheard by providers or unsupported by people in their lives. This lack of validation can intensify emotional distress and make symptoms harder to manage.

6. How therapy can help navigate hormonal and menstrual concerns

Finding a therapist who specializes in reproductive mental health can be an effective step toward making progress in managing these symptoms. In therapy, I work with clients collaboratively to help them understand hormonal experiences and their emotional impact, and work to enhance overall well-being.

This can include:

  • Identifying emotional and physical symptoms that may be closely tied to these biological experiences, rather than perceiving them as separate mental health concerns
  • Tracking and creating awareness of cyclical patterns of symptom increases in order to create effective coping patterns
  • Reducing shame or self-blame related to symptoms
  • Learning coping tools for mood and anxiety symptoms, cognitive symptoms, and physical symptoms
  • Navigating medical anxiety and treatment decision-making
  • Building tools for effective communication with medical providers
  • Building tools to communicate effectively and set boundaries with loved ones during more emotionally vulnerable phases
  • Navigating identity shifts related to reproductive changes or concerns
  • Cope with grief related to fertility concerns or aging
  • Cope with stigma or cultural expectations
  • Explore what matters most and working to enhance well-being

I use CBTs including Acceptance and Commitment Therapy and Behavioral Activation to help clients navigate hormonal and endocrine related symptoms with more flexibility, compassion, and skill. I integrate trauma-informed approaches, knowing that people may have experienced lack of support and understanding from their community or medical providers.

7. Telehealth therapy for hormonal and endocrine-related stressors

Therapy for PMDD, PCOS, endometriosis, and perimenopause is available via telehealth for clients located in North Carolina, California, and many PSYPACT states. Online sessions allow you to access specialized support without additional logistical stress.

8. Frequently Asked Questions

Is it normal for hormones to affect my mood this strongly?

Yes. Hormonal shifts or imbalances can significantly influence emotional well-being.

Can therapy help with PMDD or PMS mood swings?

Yes. Therapy can help you understand how to anticipate changes based on where you are in your monthly cycle, and build tools for cyclical emotional changes and symptom management.

Does PCOS or endometriosis affect mental health?

Many people with PCOS or endometriosis experience anxiety, depression, and impacts to self-esteem related to chronic symptoms or medical experiences. They can also experience significant physical symptoms that impact quality of life and well-being. These conditions are underdiagnosed and undertreated.

Is therapy helpful during perimenopause?

Yes. Therapy can promote better mood, adjustment to identity transitions, physical symptom management, and communication during a long period of hormonal change.

9. Further Reading

Jess Coleman, Ph.D.
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