Post-menstrual syndrome, like PMS after menstruation, prompts the need for more research on hormonal influences, emphasising symptom tracking, individualised treatments, and validating women's concerns in gynaecological literature.

Female hormones fluctuate throughout the menstrual cycle, and these changes can impact mood. While doctors and researchers recognise premenstrual syndrome, or PMS, as a hormonal condition that can affect emotions in the late luteal phase of the cycle, more research is needed on conditions that can arise during other phases. 

Among conditions vying for attention is post-menstrual syndrome, a PMS lookalike that can occur after one’s period and at the beginning of the follicular phase. Post-menstrual syndrome is not recognised as an official diagnosis, but the fluidity of hormones throughout the menstrual cycle—combined with patients’ experiences of emotional distress following their period—may warrant more research on the condition.

“We know that hormones fluctuate throughout our cycle, and this fluctuation allows for ovulation and menstruation.”

- Says Sameena Rahman, a board-certified gynaecologist and founder of the Center for Gynecology and Cosmetics in Chicago

“Like most things in women’s sexual health, [post menstrual syndrome] has not been extensively studied or understood.”

- Says Dr. Rahman

Mood changes in the follicular phase

Estrogen and progesterone levels can influence mood throughout the cycle. Reduced estrogen has been linked to physical discomfort and lower mood. Reductions in estrogen can also facilitate or exacerbate psychosis. Estrogen and progesterone levels plummet at the end of the luteal phase, during which PMS can occur. Estrogen and progesterone levels are also very low at the onset of the follicular phase, during which post-menstrual syndrome may occur. As the follicular phase progresses, levels rise.[1]

One self-reported study on cortisol levels, psychiatric symptoms, and the menstrual cycle found that participants—those deemed healthy women—experienced higher symptoms of depression, albeit lower levels of cortisol, in the early and late follicular stages compared to the mid-luteal phase.[2] 

Post-period symptoms may also be delayed responses to hormonal changes or a “response to hormone withdrawal.”[1]

Barry Peskin, MD, an OB/GYN based in Coral Springs, FL, and Medical Advisor at Happy V, says that while “the term ‘post-menstrual syndrome’ isn't widely recognised in established gynaecological literature,” people can experience a range of symptoms in the days following their menstrual cycle, including “lingering effects,” from their period.

“Women experiencing post-menstrual symptoms might report symptoms similar to those of premenstrual syndrome, such as mood swings, fatigue, and even some lingering physical discomfort,” Dr. Peskin adds. 

When meeting with a patient to discuss such symptoms, it is important to also consider the entire “clinical picture and conduct a thorough evaluation before attributing these symptoms solely to the menstrual cycle,” Dr. Peskin says.

How to help patients work through symptoms following their period

Diagnosis aside, Dr. Rahman says there are ways to help patients address symptoms and seek relief. She often recommends that patients track their physical and mental symptoms daily and note their severity in order to best detect how and if these symptoms are related to their cycle. Depending on the individual’s needs, consider talking to patients about diet or exercise changes, cognitive behavioural therapy, or hormonal therapies (like birth control), she adds.

“Anecdotally, when I see a patient who does not get relief from PMS or PMDD symptoms after her cycle, then I believe them,” Dr. Rahman says. “We try to work around some of the hardships or find triggers or other things that may help their quality of life.”

To best serve her patients, she says that she and other doctors need assistance from those above them, too.

“The field of obstetrics and gynaecology continually evolves, and more comprehensive research and discussion are needed,” Dr. Peskin says. Future research should look into what causes symptoms, what intensifies symptom severity, and how to provide rigorous, individualised patient care, he adds.

Disclaimer: This story is contributed by Claire Wolters and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.