Are you saying I’m cranky?
Tackling Mood and PCOS

For many women with PCOS, irregular or absent periods are more than just a medical symptom. They can bring uncertainty, frustration, and even a sense of disconnection from your body. Some women I’ve worked with have described feeling “broken” or anxious about not knowing when their period will arrive, while others feel dismissed when their concerns are minimised by healthcare providers.

These emotional experiences are valid. Understanding the impact of irregular cycles is an important step in caring for both your physical and mental health.

Why irregular cycles affect emotions

Menstrual cycles are guided by a rhythm of hormonal changes that influence not only reproduction but also mood, energy, and mental wellbeing. In PCOS, irregular or absent ovulation means these hormones often do not follow their usual patterns. Instead of a predictable rise and fall of oestrogen and progesterone, women may experience fluctuating oestrogen with little or no progesterone to balance it.

This disruption can lead to:

• Anxiety and stress: hormonal fluctuations, particularly low progesterone, may reduce the calming influence of GABA in the brain, contributing to heightened anxiety.
• Low mood and irritability: unopposed oestrogen and variable androgens can influence neurotransmitters such as serotonin and dopamine, making mood changes more likely.
• Uncertainty about fertility: the absence of ovulation or irregular bleeding can raise questions about reproductive health, adding another emotional burden.

Rather than being “all in your head,” these experiences are rooted in the biology of PCOS, which helps explain why mood changes are so common.

Research has shown that women with PCOS are significantly more likely to experience mood difficulties. One large UK survey reported that around 50% of women with PCOS met criteria for anxiety and nearly 14% experienced depression using standard screening tools. Other international studies have found that more than half of women with PCOS report depressive symptoms, with around a quarter experiencing anxiety symptoms. These rates are substantially higher than in women without PCOS, highlighting the very real emotional burden of the condition.

How hormonal changes influence mood

Alongside the unpredictability of cycles, hormonal imbalances themselves can affect emotional wellbeing.

• Unopposed oestrogen: In regular cycles, ovulation triggers the release of progesterone, which balances oestrogen. In anovulatory cycles (common in PCOS), progesterone may be low or absent, leaving oestrogen relatively “unopposed.” High oestrogen without progesterone’s calming balance has been linked to mood swings, irritability, and heightened emotional sensitivity.
• Low progesterone and GABA: Progesterone plays a key role in producing allopregnanolone, a neurosteroid that enhances the calming neurotransmitter GABA in the brain. Without sufficient progesterone (as in anovulatory cycles), this pathway is weakened, which can contribute to anxiety, low resilience to stress, and difficulty with sleep.
• Androgens and mood: Higher levels of testosterone and other androgens, often present in PCOS, have been associated with changes in mood regulation and may contribute to irritability in some women.
• Insulin resistance and blood sugar swings: Fluctuating glucose and insulin levels can also affect energy and mood stability, adding another layer of emotional disruption.

These hormonal dynamics help explain why women with PCOS may experience more frequent or intense mood changes, beyond the emotional impact of irregular cycles alone.

PMS and PCOS

Premenstrual syndrome (PMS) describes the physical and emotional symptoms that occur in the days before a period. These may include mood swings, irritability, bloating, and breast tenderness. In PCOS, PMS can sometimes feel more severe.

Because cycles are often longer and ovulation less frequent, progesterone levels can remain low while oestrogen fluctuates. This imbalance contributes to symptoms such as heightened irritability, anxiety, and sleep disturbance. The unpredictability of cycles can also mean PMS arrives unexpectedly, adding to distress.

While PMS is very common, if symptoms are severe or interfere with daily life, it is important to discuss them with a healthcare professional.

When PMS becomes PMDD

For some women, premenstrual symptoms go beyond PMS and develop into premenstrual dysphoric disorder (PMDD), a recognised mood disorder. PMDD causes severe emotional symptoms such as intense mood swings, depression, irritability, or anxiety in the luteal phase of the cycle (the two weeks before menstruation).

Although research into PMDD in PCOS is still developing, the hormonal irregularities of PCOS may increase vulnerability in some women. If you suspect PMDD, it is important to speak to your GP. Diagnosis usually involves symptom charting across several cycles, and treatment options can include medical, psychological, and lifestyle approaches.

You do not need to suffer in silence. Support is available, and seeking help is an important step towards improving quality of life.

The impact of feeling dismissed

A common theme for many women with PCOS is feeling unheard when they raise concerns. Being told “it’s just irregular periods” or “come back when you’re trying for a baby” can feel incredibly invalidating. Over time, this can add to feelings of isolation and frustration.

Recognising that these concerns are legitimate – and that your emotional wellbeing matters as much as your physical symptoms – is an important part of managing PCOS.

Supportive ways to cope with cycle unpredictability

While irregular cycles cannot always be fully controlled, there are ways to feel more grounded and supported:

• Cycle journaling: Even when cycles are long or unpredictable, noting symptoms such as mood, skin changes, or energy can help you find your own patterns.
• Self-care planning: Keeping essentials on hand (period products, heat packs, calming teas) can reduce stress about being caught off guard.
• Emotional support: Talking to others with PCOS, or to a practitioner who understands, can reduce feelings of isolation.
• Mind-body approaches: Techniques such as mindfulness, yoga, or breathing exercises can help calm the nervous system, especially when GABA is lower due to lack of progesterone.

These strategies cannot change the underlying hormonal patterns alone, but they can restore a sense of control and self-compassion.

When to seek professional input

If irregular cycles, PMS, or possible PMDD are causing distress or interfering with daily life, it may help to seek support. A GP can investigate medical options, while a nutrition practitioner can help you explore evidence-based ways to support hormone balance.

It is important to remember that you deserve support not just for your physical health, but also for the emotional impact of living with PCOS. If you’d like to chat further, why not book a free call?