Dear Doctor

I tend to be so moody, agitated and at times depressed, but I have noticed that this happens in the middle of my menstruation cycle. Could the mood swings have something to do with ovulation? What can one do to cope with this?

Dear Lillian,

You have not specified your age and whether you are having regular menstrual cycles? Normally around menopause and in the perimenopausal phase, women feel alteration of mood and that often includes depression and anxiety. But it can happen during ovulation and immediately after ovulation as well.

Menstruation and ovulation occur due to the balance of the 2 hormones, estrogen and progesterone. These in turn influence the neuroregulatory systems associated with mood and behavior. In an average cycle ovulation occurs around 14-21st day (day 1 of the menstrual bleeding is counted as day 1) of the cycle. The cycle varies between 21-30 days plus, minus one week and vaginal bleeding may occur from 3 to 5 days and even 7 days. This cycle is highly variable from one woman to another.

Around ovulation time, there is surge of estrogen and basal body temperature also rises. The cervical mucous becomes thick and sticky. Apart from these physical changes, lot of mental changes also occur in many women in what is known as, "other time of the month” or pre menstrual syndrome, as menstruation follows ovulation, if conception does not occur. Increased anxiety, depression, irritability, desire to be isolated, unexplained desire to cry, all such mood changes can happen in this period. The amount of mood swings is variable among women. Other factors like age, overall physical and mental health also influence the mood swings occurring during ovulation. Many women experience an increased libido in this period.

Those prone to migraine headache, tend to have bouts of migraine around ovulation. If they maintain a diary of their migraine attacks and menstrual cycles, attacks would seem to coincide with time of ovulation. Asthma, arthritis, e.t.c. problems also follow a similar pattern. A rise in estrogen and progesterone may exaggerate gum’s sensitivity to plaque and bacteria and may increase the risk for gum infections, or gingivitis. This is also the time to have acne/pimples. Women prone to heart problems may have episodes of angina at this time, due to changes in the hormone balance. All these problems add to the depression and or anxiety, around ovulation.

Education about the hormonal changes and counseling would be beneficial in managing mood swings around ovulation. A woman should learn to accept her menstrual cycles, as they are. She should be mentally prepared for the mood swings, breast tenderness, e.t.c. problems occurring before menstruation. This attitude by itself would help one to cope with this problem. Staying busy mentally in something creative, helps the mind to be diverted away from the mental and physical changes occurring during this time. If the problem is persistent or severe enough to be disabling, anti depressant drugs, particularly the serotinergic anti depressants are helpful. They should be taken under the guidance of an expert.