As estrogen and progesterone fall sharply in the final days of the luteal phase, before menses begins, this decline is associated with premenstrual mood changes (increased anxiety and depressive symptoms) and physical symptoms (cramps, headaches, acne).

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After the mature, unfertilized egg is released from the ovarian follicle, the uterus prepares to shed its endometrium. There is a strong drop-off in estrogen and progesterone; because estrogen is a serotonin producer, this decline is linked to significant changes in one's daily life, including both mood (increased anxiety and depression) and physical symptoms (cramps, headaches, acne). The drop-off of these hormones signals the beginning of the menses, also known as the beginning of the shed of the uterine lining.

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