What are the signs and symptoms of the menstrual cycle?

Many people experience certain signs and symptoms during different phases of the menstrual cycle, especially a few days before and during menstruation. This is usually due to hormone fluctuations, which can affect everything from digestion to mood to acne to joint laxity to sleep. Although each person’s menstrual cycle is unique, there are some common symptoms to note and track to better manage them.

During menstruation, estrogen and progesterone are at their lowest, and, for some people, energy levels are equally low. Abdominal cramping, bloating, irritability, headaches, tender breasts, mood swings, and low back pain may also be experienced during this phase. If cramping is particularly intense and recurrent with each menses, it may be diagnosed as dysmenorrhea and should be assessed by a clinician for secondary causes, like endometriosis.^[1]

As the follicular phase progresses and estrogen rises, the symptoms of menstruation should subside. Mood and energy levels often improve,^[2] and, as ovulation nears, sexual desire may increase while hunger/appetite decreases.^[3][4] When ovulation occurs, some people feel abdominal pain (called mittelschmerz), likely related to the rise in luteinizing hormone that stimulates prostaglandin production and the consequential contraction of the ovary to release an egg.^[5]

With ovulation complete, the luteal phase begins, and progesterone levels rise. The precise effects of progesterone on mood are unclear and likely affect people differently.^[6] However, if a pregnancy does not occur, the subsequent drop in circulating progesterone and estrogen levels can cause negative symptoms. This is why the late luteal phase is often associated with food cravings, mood swings, gastrointestinal discomfort, breast tenderness, and poor sleep.^[7][8][9] If the symptoms are severe, it may be a sign of premenstrual syndrome (PMS).