8 Menstrual cycle symptoms: Causes, treatment & how to track

What are menstrual cycle symptoms?

Menstrual cycle symptoms are any physical, emotional, or behavioral characteristics caused by your menstrual cycle. These symptoms can be different for everyone and may vary depending on which cycle phase you are in. 

What causes menstrual cycle symptoms?

Hormones are the drivers of your menstrual cycle, most notably progesterone and estrogen [1]. Our levels of these hormones vary throughout the menstrual cycle, and most symptoms are likely to be side effects of these fluctuations. Let’s look at the two main phases of the menstrual cycle and how your hormones change in each. 

Follicular phase

Your menstrual cycle begins with the follicular phase, marked by the beginning of your period. The follicular phase typically lasts for between 10 and 16 days; however, this varies between individuals [1]. You begin the follicular phase with high levels of follicle-stimulating hormone (FSH). This hormone is responsible for the maturation of egg cells until a single dominant egg cell is ready for ovulation. The dominant egg cell then produces estrogen, suppressing FSH. Estrogen reaches its peak one or two days before ovulation, followed by a surge in luteinizing hormone (LH) and FSH. Ovulation, occurring at the very end of the follicular phase, is accompanied by a surge in androgen hormones like testosterone [1, 2]. High estrogen levels are associated with cycle symptoms such as increased energy and a higher pain tolerance [3, 4]. 

Luteal phase

The second phase, the luteal phase, is fairly consistent across individuals, averaging 14 days long. It begins after ovulation, when estrogen levels drop. A temporary gland called the corpus luteum is formed from the follicle after ovulation and produces progesterone. Progesterone levels remain high throughout the luteal phase. If the egg is not fertilized, progesterone levels fall, causing the uterine lining to shed and marking the beginning of your period (and your next menstrual cycle) [1]. Higher progesterone during this phase is associated with cycle symptoms such as acne, and rapid hormonal fluctuations at the end of your cycle are thought to contribute to PMS [5, 6]. 

8 common menstrual cycle symptoms

Because of how your hormones vary, the menstrual cycle symptoms you experience will likely change depending on whether you are in the follicular or luteal phase. Below are some of the most common menstrual cycle symptoms and tips for managing them. You might experience all, some, or none of these, and symptoms can vary from cycle to cycle.

Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is the collective name for the symptoms some people experience around the time of their period. PMS is very common, affecting over 90% of women, and once you learn more about your symptoms, they can be a key sign your period is coming [5]. Common PMS symptoms include stomach cramps, breast tenderness, backache, and headaches. PMS may also cause behavioral or psychological symptoms, like mood swings, brain fog, anxiety, and irritability. PMS can start at any time during the luteal phase, but typically subsides within a few days of the start of your period [5]. 

For many, PMS symptoms can usually be managed at home. Eating a healthy, balanced diet and getting regular exercise can help improve PMS symptoms, including stomach cramps, anxiety, and stress [7, 8]. If you have painful symptoms, such as backache or cramps, heat pads may help reduce pain, or you can consider over-the-counter pain medication [9]. 

If you experience severe pain or your PMS is interrupting your daily life and cannot be managed at home, it is important to speak to your doctor — severe symptoms can be related to medical conditions such as premenstrual dysphoric disorder (PMDD) or endometriosis. 

Bleeding 

Probably the most obvious menstrual period sign in your cycle is bleeding. At the start of your cycle, the follicular phase is your menstrual bleed. It is usually red at its heaviest, but some people also experience spotting or brown discharge before or after their period. In the late follicular phase, some people also experience ovulation bleeding. More research is needed on this phenomenon, but around 5% of women experience mid-cycle spotting, which coincides with the time when ovulation is likely to occur [10]. 

Once you are in your luteal phase, there is usually no bleeding until your period begins and the next cycle starts. However, if you are pregnant, you might experience implantation bleeding. Most evidence for implantation is anecdotal, but it is thought to occur when the fertilized egg implants in the uterine lining [11]. 

There are lots of period product options to help you manage your period, such as pads, tampons, period pants, or a menstrual cup. Other bleeding, such as ovulation spotting, should be very light, and you shouldn’t need more than a light pad. Always speak to your healthcare practitioner if you experience any unusual spotting between periods, are experiencing irregular periods, or have very heavy bleeding.

Fatigue 

Did you know that tiredness is one of the most common symptoms reported by our users in the NC° app? Fatigue hits us all differently, but it is common to feel particularly tired in the luteal phase of your cycle [5]. One small study of menstruating women found that mental fatigue was worse in the mid-luteal phase compared to the early follicular phase, though more research is needed in this area [12]. As to why we may feel fatigued in the luteal phase, this is likely due to low estrogen levels. Estrogen is known to play a critical role in sleep quality, including sleep rhythm, temperature control, and serotonin levels. This is one reason fatigue is common in perimenopause [13]. There is also a link between higher progesterone levels — as we experience in the luteal phase — and fatigue, though more research is needed [14].

While you may not be able to reduce fatigue during the luteal phase, there are sometimes small changes to make it more manageable. You could try switching out high-energy activities for gentler ones, like swimming or yoga. If you have flexibility in your schedule, it may help to reschedule any big meetings or decisions until you know your energy will be back to normal. For Natural Cycles users, you can view personalized sleep insights in the NC° app. Using real-time data from your NC° Band or Oura Ring along with your daily rating of how you feel you slept, you can analyze sleep factors like duration, efficiency, and timing in comparison to your menstrual cycle phases, to see how your sleep changes throughout your cycle. 

When fatigue doesn’t seem to be linked to anything in particular, and it is persistent, it may be a sign of an underlying health condition, so always speak to your doctor if you are bothered by or worried about fatigue [15]. 

Energy

Once your period starts, you might notice your fatigue gradually giving way to a boost in energy! Limited research has examined the relationship between energy, motivation, exercise performance, and the menstrual cycle, and found that participants reported their highest energy and motivation in the late follicular phase, with a perceived decline in performance and energy after ovulation. Some participants reported increased energy as early as day 2 of their cycle, once fatigue and PMS symptoms had subsided [3].

If you know you have more energy at certain times in your cycle, try harnessing it to your advantage! For example, you could use this time to increase your gym efforts, work on a creative project, or focus on any big decisions you need to make.

Discharge

Vaginal discharge is a normal part of the menstrual cycle, but it can look and feel different depending on what stage of your cycle you are in. Just before and directly after your period, you may find you don’t have a lot of discharge. If you do, it is likely to be white and sticky. Around the middle of your cycle, you might notice clear, stretchy discharge resembling egg white. This is cervical mucus, a fluid produced by the cervix that nourishes sperm and helps it travel through the reproductive system, and that can often be a sign that ovulation is near [16]. 

Most of the time, there is no need to treat or manage discharge, though a light pad or period underwear can help with comfort. If you notice vaginal discharge that is green or gray, contains clumps, has a foul smell, or is accompanied by itching or irritation, speak to your doctor as this may be a sign of an infection [17]. 

Sex drive changes

If you’ve ever wondered why your libido fluctuates, the answer might be in your menstrual cycle. During the follicular phase, estrogen and testosterone levels are higher, both of which are associated with a higher libido [18, 19]. So if you notice you are “in the mood” around the middle of your cycle, this may be why! This is also the time when you are most fertile, known as the fertile window, so if you are trying to avoid pregnancy, make sure you abstain or use additional contraception such as condoms. After ovulation, testosterone and estrogen fall, progesterone increases, and the luteal phase begins. It is common to notice lower libido in this phase, though some women may experience increased sex drive nearer to their period, too [19, 20]. 

Sex drive is very personal, and what is “low” or “high” for you will be different from others. Be kind to yourself, lean into how your body is feeling, and keep communication open with your partner. Remember that many things, not just the menstrual cycle, can affect your sex drive, and if you have any concerns about your sex drive, speak to your doctor. 

Pain tolerance

How we perceive and handle pain can fluctuate during our menstrual cycle. Studies have found we are less sensitive to pain during high-estrogen times in our cycle, such as the follicular phase. On the other hand, we may feel more sensitive to pain during the luteal phase and our period, when estrogen is lower [4].

For Natural Cycles users, the NC° app will send you a reminder to do a breast self-exam. This is usually sent in the follicular phase after your period ends, as it can be more comfortable while your pain threshold is higher, and it is recommended to perform the self-exam at the same time each cycle. 

Skin changes

Acne and skin changes are often associated with puberty, but the hormones of our menstrual cycle can affect our skin, too. Increased estrogen levels (such as in the follicular phase) are associated with higher skin water content and a stronger skin barrier, which may make your skin feel more hydrated and glowy. On the other hand, increased progesterone levels (such as in the luteal phase) are associated with acne, psoriasis, eczema, and dermatitis [6]. The peak in androgen hormones around ovulation can also stimulate the production of sebum, contributing to mid-cycle acne or blocked pores [21].

Acne and other skin conditions can often be managed with over-the-counter remedies, such as tea tree skincare products. Speak to your doctor if your skin is causing distress or discomfort, as they may be able to prescribe more tailored treatments. 

How to track menstrual cycle symptoms with NC°

Everyone experiences different menstrual cycle symptoms. But knowing what is “normal” for you and your cycle can feel empowering and help you learn more about your body. In the NC° app, you can log what symptoms you notice throughout your cycle, and the app will pick up on any patterns between your menstrual cycle and the symptoms you log. 

To do this, open the NC° app and click the “+” button. You will see a full list of categories and tags. Click on any tags you want to log, then hit save. You can log physical symptoms such as cervical mucus, skin changes, sex drive, bleeding, and PMS symptoms like cramps. You can also log lifestyle tags such as sleep quality, exercise, caffeine, stress, and psychological symptoms about how you are feeling. 

At the end of each cycle, you’ll receive a Cycle Summary that shows you an overview of what symptoms you have logged and when, as well as cycle characteristics such as period length, cycle length, and likely date of ovulation. You can then use this information to help you learn what symptoms may be related to your cycle, prepare for symptoms in advance, and spot any abnormalities.

When to see a doctor

PMS and other menstrual cycle symptoms are usually manageable at home. However, sometimes severe symptoms or irregularities can indicate a medical condition that should be investigated. Speak to your doctor if:

• Your cycles are shorter than 21 days or longer than 35 days
• The length of your cycle varies by more than 7-9 days 
• You don’t have a period for three months or longer
• Your periods last longer than seven days
• Your period bleed is much heavier or lighter than usual
• Your period is very heavy (soaking tampons or pads every 1 to 2 hours), or you pass large blood clots
• You experience pain or bleeding during sex
• You have bleeding or spotting between periods
• You have severe pain during your period 
• You have discharge that is an unusual color or smells bad
• You have extreme PMS symptoms that affect your mental health
• You experience significant mood-related changes throughout your cycle that are distressing or hard to manage

[22]

Learn more about your menstrual cycle

The NC° app is a valuable tool for learning more about your menstrual cycle. As well as spotting patterns between symptoms and your menstrual cycle, you can use Natural Cycles to track your fertility. The NC° app is the first FDA-cleared app to be used as a hormone-free contraception, available with NC° Birth Control. For those trying to get pregnant, NC° Plan Pregnancy helps you know when you are likely to be at your most fertile, and NC° Perimenopause can help guide you through the transitional phase as you approach menopause. Whichever phase of life you are in, if you spot anything out of the ordinary about your cycle or symptoms, you can also download a six-month Cycle Report to share with your doctor and feel knowledgeable about your menstrual health.