Menstruation is a “fifth vital sign,” offering real-time insight into overall health and body function.

PMS is usually mild; severe symptoms are uncommon and treatable with medical and lifestyle support.

Hormonal shifts can boost mood, cognition, and social awareness, though experiences vary by person.

When I was growing up, some of my friends called their menstruation “the curse,” and others whispered, “My friend is visiting.” The second group was closer to the truth because menstruation not only provides fertility information, it also offers biological feedback about overall health and, for some people, social functioning, learning, and resiliency.

1. Menstruation can tell us about our general health.

In fact, the American College of Obstetricians and Gynecologists (ACOG) recommends that doctors ask about the menstrual cycle to assess physical functioning. Many call it a “fifth vital sign” because it functions as a real-time, continuous health monitor. In addition to providing fertility information, menstrual cycle patterns can offer useful insight into overall health, and abnormal or changing cycles can sometimes signal endocrine, gynecologic, metabolic, nutritional, or stress-related problems (1, 1a). A regular cycle, however, does not by itself prove that all of these systems are functioning optimally, so don’t miss your checkups.

2. Premenstrual mood changes can be a downer for some, but not for most.

Although some women experience increased irritability and decreased resilience as they approach menstruation each month, only about 3 to 8 percent of women experience changes severe enough to be diagnosed with premenstrual dysphoric disorder (PMDD) (2). In fact, most of my patients describe PMS as an inconvenience, not a disaster, and say that, in retrospect, most of the anger or criticism they expressed while experiencing PMS felt valid, but their threshold for addressing problems was lowered. Sometimes, they say, that was a good thing, sometimes not.

Although these mood alterations are temporary, they may need attention. If PMS mood changes are severe enough to interfere with daily life or family functioning, tell your physician. Evidence-based treatment options can include cognitive behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), and some hormonal treatments; exercise and other lifestyle measures may also help some people (3, 3a).

3. The estrogen increase that follows menstruation acts as an upper—literally.

Did you know that as estrogen rises and peaks mid-cycle, some people report improvements in verbal memory, problem-solving flexibility, and multitasking ability? Since estrogen increases serotonin, our feel-good hormone, and dopamine, our “reward-center” neurotransmitter, optimism, energy, and motivation levels may also increase. In fact, one study reported that we may be more responsive to pleasant emotional stimuli and memories during this phase than during any other (4). If you find that you are experiencing this natural “high,” use it to practice self-care, do something charitable (which boosts serotonin even more), or plan an enjoyable activity for your PMS days later.

4. Even our emotional intelligence seems to be boosted by our hormones.

Wait, there’s more: Some studies suggest social perception and emotional sensitivity increase as estrogen rises, which may boost our ability to focus on others’ facial expressions and, in turn, increase social awareness. In other words, this is when we may be more likely to see others’ points of view, argue less, and empathize more (5).

Look for times each month when your thinking, creativity, and motor skills seem enhanced. If there’s a pattern over time, as some of my patients report, there may be a hormonal component, because estrogen boosts endorphin levels and helps regulate serotonin and norepinephrine, which stabilize mood. That said, these patterns aren’t consistent for everyone, so don’t worry if you don’t notice clear changes across your cycle.

5. If you exercise regularly or play sports, you may have read that your menstrual cycle affects your performance.

Self-reports from some professional and serious athletes suggest their reaction time, strategic thinking, and stamina may be best during ovulation, but controlled research and study reviews are not conclusive (6). According to my colleague Janet Choi, reproductive endocrinologist and chief medical officer at Progyny, there is not enough evidence to support the claim that cycle-syncing workouts optimize results. In fact, individual differences seem greater than similarities in many studies. Tracking your own personal experience during your cycle, however, can give you valuable insight about your own mind and body that you can use to increase your sense of control over your menstrual rhythms.

Bottom line? Our menstrual cycles are both unique to us in some ways and universal in others, and there is increasing research into both. Get to know your cycle so you can manage its inconveniences and take advantage of the information it provides for self-knowledge and self-care.

(1) ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstet Gynecol, December 2015; 126(6): e143–e146. doi: 10.1097/AOG.0000000000001215. PMID: 26595586

(1a) The menstrual cycle as a vital sign: a comprehensive review. F&S Reviews, Volume 6, Issue 1, June 2025, 100081. Ana K. Rosen, Vollmar Ph.D., Shruthi Mahalingaiah M.D., Anne Marie Jukic Ph.D.

(2) The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. Journal of Affective Disorders, Volume 349, 15 March 2024, Pages 534–540. Thomas J. Reilly, Siya Patel, Ijeoma C. Unachukwu, Clare-Louise Knox, Claire A. Wilson, Michael C. Craig, Katja M. Schmalenberger, Tory A. Eisenlohr-Moul, Alexis E. Cullen.

(3) Management of Premenstrual Disorders. Clinical Practice Guideline, ACOG Clinical, Number 7, December 2023.

(3a) Premenstrual syndrome: new insights into etiology and review of treatment methods. Psychiatry, 22 April 2024, Volume 15 (2024). https://doi.org/10.3389/fpsyt.2024.1363875. Stefan Modzelewski, Aleksandra Oracz, Xawery Żukow, Kamila Iłendo, Zofia Śledzikowka, Napoleon Waszkiewicz.

(4) Evidence of estrogen modulation on memory processes for emotional content in healthy young women. Psychoneuroendocrinology, Volume 65, March 2016, Pages 94–101. Assunta Pompili, Benedetto Arnone, Mario D’Amico, Paolo Federico, Antonella Gasbarri.

(5) Neurobiological Underpinnings of the Estrogen-Mood Relationship. Current Psychiatry Reviews, August 1, 2012; 8(3): 247–256. doi: 10.2174/157340012800792957. Whitney Wharton, Carey E. Gleason, Sandra R. M. S. Olson, Cynthia M. Carlsson, Sanjay Asthana.

(6) Inconsistencies in the perceived impact of the menstrual cycle on sport performance and in the prevalence of menstrual cycle symptoms: A scoping review of the literature. Journal of Science and Medicine in Sport, Volume 27, Issue 6, June 2024, Pages 373–384. Oester, C., Norris, D., Scott, D., Pedlar, C., Bruinvels, G., & Lovell, R.

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