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.

The Menstrual Cycle: the Luteal Phase

Ovulation follows the follicular phase's estrogen spike: a fully matured egg is released from the ovarian follicle and becomes available for fertilization. Testosterone also peaks during this phase, which can affect sex drive. Ovulation typically lasts 2-3 days; if the egg is not fertilized, the uterus begins preparing to shed its lining, marking the transition into the luteal phase.

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The reproductive hormone cycle for those assigned female at birth consists of phases which can yield daily-life changes for both one’s physicality and mental state. The phases include: the menses (bleeding period), follicular phase, ovulation, and luteal phase.

When studying mood disorders, understanding this cycle is crucial. As the hormone levels spike, peak, and drop throughout the entirety of the menstrual cycle, an individual can experience a variety of symptoms, including (but not limited to) low mood, trouble focusing, and depleted energy. Studies on mood disorders tend to neglect the impact of the menstrual cycle on these symptoms, which may also be characteristics of mood disorders, making it difficult to get a full grasp on a treatment’s efficacy or a study’s generalizability — particularly for those who menstruate.

The Menstrual Cycle

The follicular phase begins along with the menses and tends to last about two weeks. As the menses ends, the production of estrogen from the ovarian follicles increases, and allows for a generally more positive affect (as it is a serotonin producer), along with a bit of an energy boost. With an estrogen spike, the follicles develop and an egg matures, the endometrium thickens, and the follicular phase ends as the ovulatory phase begins.

Follicular Phase of the Menstrual Cycle

The menses, otherwise known as the bleeding period, marks the restarting of one's menstrual cycle. At this point, the body's levels of progesterone and estrogen are returning to base level, after just undergoing a major drop off in the luteal phase. 

The menses can last anywhere from 2 to 12 days, with discharge consisting of blood, mucus, and endometrium (uterine lining) cells. This phase of the cycle occurs if the newly implanted egg has not been fertilized during the cycle.

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