Reproductive Mental Health: PMS, Perimenopause, and More

Amen Clinics
April 7, 2025

From PMS to infertility to menopause, a perinatal psychiatrist explains how women’s hormones affect mental health—and how to find relief.

Hormones can feel like an invisible hand guiding a woman’s emotional world—sometimes gently, sometimes like a storm. From puberty to menopause, the ebb and flow of hormones shape not only physical health but also mental well-being.

For many women, the most intense hormonal shifts—like those before a period, during pregnancy or postpartum, and throughout perimenopause—can trigger or intensify mental health issues. Yet too often, these connections are misunderstood, overlooked, or dismissed.

Understanding how reproductive hormones impact the brain is a critical step in empowering women to take charge of their mental health.

“Hormonal fluctuations have a huge impact on a woman’s mental health, not only during pregnancy, but throughout her life,” Neha Kansara, MD, a double board-certified psychiatrist with a specialty in perinatal psychiatry at Amen Clinics in Irving, Texas.

Here’s a closer look at women’s major reproductive events and mental health, plus tips from Dr. Kansara on how to support hormonal balance and general well-being throughout your lifetime.

An estimated 1 in 5 perinatal women are impacted by mental health disorders, including mood disorders, anxiety disorders, trauma-related disorders, obsessive-compulsive disorder, postpartum psychosis, and substance use disorders.

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WHAT IS REPRODUCTIVE MENTAL HEALTH?

Reproductive mental health simply refers to well-being or mental health challenges associated with the female reproductive system.

Indeed, a recent 2023 review of published studies found that hormonal changes affect the severity of symptoms in several mental health conditions, including depression, premenstrual dysphoric disorder (PMDD), PTSD, bipolar disorder, and schizophrenia.

Here are the reproductive stages and what science has discovered about how they impact mental health from puberty to menopause.

PUBERTY AND MENTAL HEALTH

Hormonal surges start early in life, especially for girls. Researchers report that an increase in sex hormones during puberty may contribute to what makes girls more susceptible to mood and anxiety problems, although other factors can play a role too.

When hormones surge at a younger age and cause early puberty, a girl is at an even greater risk of anxiety, depression, low self-esteem, eating disorders, substance use problems and body dysmorphia, research indicates.

MENTAL HEALTH AND PMS

At the onset of menstruation, a young woman begins to experience a complex interaction of hormones—luteinizing hormone, follicle-stimulating hormone, estrogen, and progesterone. The monthly fluctuation of these hormones can powerfully impact how a woman thinks and feels.

Studies show that between 80 to 90% of women report experience premenstrual syndrome (PMS) symptoms. PMS usually occurs the week or two before a woman has her period.

It can cause physical symptoms such as:

Bloating
Cramping
Headaches
Moodiness
Sadness
Anxiety
Depression

Some women experience premenstrual dysphoric disorder (PMDD) a more severe form of PMS that can disrupt daily life.

Women with mental health conditions are a greater risk of experiencing PMS and PMDD. Research shows that PMS can make symptoms of existing mental health conditions worse.

For instance, symptoms of major depressive disorder or an anxiety disorder are often exacerbated with PMS. The emotional effects of PMS can also increase the risk of suicide in hormone-sensitive females.

The American Psychological Association (APA) reports that research has shown approximately 60% of women with depression or bipolar disorder report mood changes related to their menstrual cycle. And women with schizophrenia report worsening psychotic symptoms, such as hallucinations, prior to menstruating.

On the other hand, certain mental health conditions—such as eating disorders, bipolar disorder, and sometimes depression—can cause irregular menstruation.

The cause of PMS is not clear. But since the symptoms occur with the fluctuations of the menstrual cycle, it is believed that hormonal imbalances like estrogen dominance and low levels of progesterone may be a contributing factor.

Low serotonin levels may also play a role in PMS symptoms.

MENTAL HEALTH DURING INFERTILITY

Infertility in women is a disorder of the female reproductive system, characterized by failure to achieve pregnancy after one year or more of regular, unprotected sexual intercourse.

The reality of infertility and the stress of fertility treatments can both be detrimental to a woman’s mental well-being.

A 2023 study titled “Women Infertility and Common Mental Disorders” involving 500 women (half infertile, half fertile) found that most of the infertile women had higher levels of stress, anxiety, and depression.

Part of the stress stems from women tending to feel responsible for infertility and carrying a heavier burden while undergoing fertility treatments, research has found.

In addition, infertility hormonal treatments can cause a host of symptoms, including sleep disturbances, disruptions in sex drive, hot flashes, depressed mood, or anxiety. Infertility stress management is critical for women undergoing treatment, according to Dr. Kansara.

PREGNANCY AND POSTPARTUM MENTAL HEALTH

The window between trying to conceive (TTC) through pregnancy to postpartum is one of the most hormonally active times in a woman’s life. Consequently, it’s also a period of higher risk of mental health issues. Indeed, a 2023 review study concluded that pregnancy-related mental disorders are frequent.

In fact, there’s a field of expertise called perinatal psychiatry, geared to maternal mental health support. “Women are at higher risk of experiencing perinatal mood and anxiety conditions during this period, which can be a 2- to 5-year window,” explains Dr. Kansara.

The perinatal period is one of the most challenging times for a woman’s mental health. An estimated 1 in 5 perinatal women are impacted by mental health disorders, including:

Mood disorders
Anxiety disorders
Trauma-related disorders
Obsessive-compulsive disorder (OCD)
Postpartum psychosis
Substance use disorders

Depression and anxiety are the most widely recognized mental health conditions experienced during pregnancy. Additionally, women with histories of mental health problems who stop taking psychotropic drugs—antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilizers—during pregnancy, are at particularly high risk of recurrence.

It’s vital for women who are trying to conceive and pregnant women with existing mental health disorders to consult a perinatal mental health professional about a plan regarding psychiatric medication.

Mental health issues can also be associated with pregnancy-related issues such as physiological disorders, miscarriages, abortions, broken homes, relationship problems between the couple, unhealthy work-life balance, undue stress, and other issues. Alarmingly, suicide from untreated mental illness is the leading indirect cause of maternal mortality.

The dramatic hormonal changes after giving birth can make coping with postpartum emotions challenging for most women, according to Dr. Kansara.

Postpartum depression (also called perinatal depression) is a serious but treatable medical illness that may develop before the baby is born or just after giving birth.

It involves feelings of extremes sadness, despair, indifference, and/or anxiety. It also affects energy, sleep, and appetite. This condition carries risks for both mother and child.

Without treatment, postpartum depression can last for months or even years. The good news is that there’s a lot of postpartum depression help available. It’s wise for women to talk to their OB/GYN early as possible about postpartum mental health tips and postpartum anxiety solutions.

Press Play to Learn More About Postpartum Mental Health Issues

In this video, Dr. Neha Kansara shares what brain scans revealed about a patient who was struggling with postpartum anxiety, depression, and panic attacks.

Click below to watch.

PERIMENOPAUSE, MENOPAUSE, AND MENTAL HEALTH

The menopausal transition occurs over months or years during which reproductive hormone levels—estrogen and progesterone—naturally fluctuate and then drop. Eventually, the ovaries cease releasing eggs.

Menopause can also occur if a woman’s ovaries are surgically removed or damaged by certain illnesses or treatments.

Perimenopause refers to the period of time when a woman notices the first signs and symptoms of menopause, usually months or years before a woman’s last menstrual period. Once a woman goes 12 consecutive months without menstruation, she’s in menopause. From that moment on, she’s considered postmenopausal.

The hormonal shifts during the menopausal transition impact the brain. In particular, it influences the following brain regions:

Prefrontal cortex
Hippocampus
Hypothalamus
Amygdala

These areas of the brain are involved with sleep regulation, learning, memory, and temperature regulation.

“A lot of executive and cognitive dysfunction start occurring during perimenopause,” says Dr. Kansara. This is likely why women experience menopause symptoms such as increased worry, attention problems, poor sleep, mental fog, memory lapses, and hot flashes.

Research has found that estrogen fluctuations can also affect serotonin and GABA levels in the brain, making women more vulnerable to anxiety and depression, as well as sleep disorders and bipolar disorder.

A woman’s feelings about fertility, aging, and where she fits into society, as well as other social/environmental issues, also factor into mental health during the menopausal transition.

REPRODUCTIVE MENTAL HEALTH CARE TIPS

Adopting a healthy lifestyle is one of the best things you can do to support mental wellness during times of increased hormonal fluctuation, as well as protect against hormonal imbalances.

Here are three top tips for hormonal balance from Dr. Kansara:

Diet

Keep your diet as clean as possible. Choose whole foods (lean meats, fruits, vegetables, healthy fats, lean poultry/meats, fatty fish, whole grains, and fermented foods). Avoid processed foods, artificial sweeteners, refined carbohydrates, and sugary treats, which are inflammatory and can cause hormonal issues.

Diet also includes proper hydration. Divide your body weight by two and drink that number of ounces. Hydration is critically important for hormonal balance and healthy brain function.

Sleep

Women need more sleep than men, so make sure you get enough quality sleep. Your hormones need rest. Dr. Kansara recommends that women over the age of 35 take a quick 20-to-40-minute power nap to reboot the system, just like we reboot a computer if it has updates.

Building Lean Muscle

Most women in their early teens and 20s need to focus on lean muscle building and maintaining that practice. When you hit your 40s and 50s and the body starts to lose muscle, you’ll be more likely to retain it.

Do a combination of activities four to five days a week. Include cardio with some mild to moderate strength training, along with yoga and meditation.

GET CARE FOR REPRODUCTIVE MENTAL HEALTH ISSUES

Whatever stage of hormonal fluctuations you experience—whether it’s monthly with PMS or PMDD, infertility, perinatal, perimenopause, or menopause—be sure to protect your mental health.

According to Dr. Kansara, there’s no reason to suffer needlessly. She recommends reaching out to a mental health professional, perinatal psychiatrist, or OB/GYN. There are many types of therapy, lifestyle changes, nutritional supplements, and medications (when necessary) that can help you feel better.

We're Here To Help

Postpartum depression, PMS, menopause brain fog, and other reproductive mental health conditions can’t wait. At Amen Clinics, we provide personalized, science-backed treatment plans designed to target the root causes of your symptoms. Our 360-approach includes brain SPECT imaging, clinical evaluations, innovative therapeutic techniques, medications (when necessary), and holistic lifestyle recommendations to promote the health of your brain, body, and mind. Speak to a specialist today at 888-288-9834 or visit our contact page here.

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Founded in 1989 by double-board certified psychiatrist and neuroscientist Daniel G. Amen, MD, Amen Clinics Inc. (ACI) is known as the best brain and mental health company in the world. Our clinical staff includes over 50 healthcare specialists, including adult and child psychiatrists, integrative (functional) medicine physicians, naturopaths, addiction specialists, forensic psychiatrists, geriatric psychiatrists, nutritionists, licensed therapists, and more. Our clinicians have all been hand-selected and personally trained by Dr. Amen, whose mission is to end mental illness by creating a revolution in brain health. Over the last 35-plus years, ACI has built the world’s largest database of functional brain scans—over 250,000 SPECT scans on patients from 155 countries—related to how people think, feel, and behave.

REFERENCES

Wieczorek K, et al. Reproductive Hormones and Female Mental Wellbeing

Women September 2023. 3(3):432-444

Pfeifer J and Allen N. Puberty initiates cascading relationships between neurodevelopmental, social, and internalizing processes across adolescence. Biol Psychiatry. 2020 Sep 9;89(2):99–108.

Rudolph K, et al. Long-term consequences of pubertal timing for youth depression: Identifying personal and contextual pathways of risk. Dev Psychopathol. 2014 Nov;26(4 Pt 2):1423-44.

Gudipally P, et al. Premenstrual Syndrome. Stat Pearls. Last Update: July 17, 2023.

American Psychological Association (APA) website

The Menstrual Cycle and Mental Health, December 20, 2023

https://www.psychiatry.org/news-room/apa-blogs/the-menstrual-cycle-and-mental-health-concerns

Accessed March 30, 2025

Kamboj N, et al. Women infertility and common mental disorders: A cross-sectional study from North India. PLoS One. 2023 Jan 5;18(1)

Sharma A, et al. Psychological Problems Related to Infertility. Cureus. 2022 Oct 15;14(10)

Abdelhafez M, et al. Psychiatric illness and pregnancy: A literature review. Heliyon. 2023 Oct 20;9(11)

APA Website

Providing Recommendations on Maternal Mental Health Care

https://www.apaservices.org/advocacy/news/maternal-mental-health

Accessed March 30, 2025

Humphreys, J. et al. Perinatal psychiatry: a new specialty or everyone’s business? Maternal Mental Health Collection. Cambridge University Press: 02 January 2018

Hu, LY, et al. Risk of Psychiatric Disorders Following Symptomatic Menopausal Transition. Medicine (Baltimore). 2016 Feb 12;95(6)