Menstrual cycle phases and symptoms: what changes each week

Your cycle has four phases: menstrual, follicular, ovulation, and luteal, each driven by a different mix of estrogen and progesterone. Symptoms shift along with those hormones, not randomly.

• Menstrual phase (bleeding, roughly days 1 to 5): cramps, fatigue, and lower back ache are common as the uterus sheds its lining. Both estrogen and progesterone are low.
• Follicular phase (after bleeding stops to ovulation): estrogen climbs, and most women notice clearer skin, more energy, and a steadier mood.
• Ovulation (around the cycle's midpoint): estrogen peaks. Some notice a one-sided twinge low in the belly, and a meta-analysis of over 7,500 women found sexual interest and risk recognition tend to run higher around this time (Neuroscience and Biobehavioral Reviews, 2019).
• Luteal phase (ovulation to your next period): progesterone rises, then both hormones fall sharply in the final days. This is when most physical and mood symptoms, bloating, breast tenderness, irritability, tend to show up.

For a fuller breakdown of what's happening hormonally in each stage, see the 4 phases of the menstrual cycle and menstrual cycle hormones, phase by phase.

The luteal phase, especially its last week, carries the heaviest symptom load for most women. A study of 301 midlife women approaching the menopause transition found anger and irritability were more severe in the days before a period than in the days right after one starts (Menopause, 2025).

Physical symptoms follow a similar pattern. A review of eumenorrheic athletes found the late follicular and ovulatory phases linked to more favorable neuromuscular and biomechanical profiles, while the premenstrual and menstrual phases carried a slightly higher injury-risk profile (Sports, 2026). The effect was small, and the reviewers stopped short of a definitive consensus, but they still suggested practitioners consider these phase-related differences when planning training. It fits the broader pattern. The body works a little differently in the week before a period.

That doesn't mean every symptom in that window is just hormones. A cycle pattern can sit alongside a real argument, a real deadline, or a real lack of sleep.

Not every luteal symptom is PMS, and not every PMS case is PMDD. The timing is similar. Symptoms cluster in the one to two weeks before a period and ease once it starts.

PMS is physical or emotional symptoms before a period that ease once bleeding begins. It's the broad, common pattern. PMDD is a specific diagnosis in the DSM-5-TR and ICD-11, requiring at least five symptoms, one of them mood-related, severe enough to disrupt daily life, confirmed by daily ratings over at least two cycles.

The luteal-only timing matters for treatment, too. A controlled trial found that giving the SSRI citalopram only during the luteal phase, with placebo the rest of the cycle, worked better than taking it continuously every day, and clearly better than placebo, for women with severe premenstrual irritability and low mood (Journal of Clinical Psychopharmacology, 1998). That intermittent approach is one option a doctor might discuss for PMDD today.

A pattern is easier to see on paper than in your memory. Track these daily, ideally for two full cycles:

• Mood: irritability, sadness, anxiety, or sudden tearfulness
• Sleep: trouble falling asleep, waking early, or sleeping more than usual
• Energy: fatigue or a noticeable dip in motivation
• Physical: cramps, bloating, breast tenderness, headaches, joint aches
• Skin and appetite: breakouts, cravings, or changes in hunger

Note the day of your cycle (day 1 is the first day of bleeding) next to each entry. After two cycles, look for whether symptoms cluster in the week or two before your period and clear within a few days of it starting. A cycle phase calculator or a hormone cycle chart can help you line up your notes with where you actually are.

Niyora is a PMS and PMDD support app that gives you an estimated PMS window based on your cycle, so you can see at a glance whether today sits inside it. If a fight or a wave of tears happens during that window, Niyora's Moon lets you write down what happened, look at it from another angle, and draft a reply you can hold onto for 20 minutes before you send anything.

Not everyone's mood or energy visibly shifts by phase. A study of 171 healthy women found only small, non-significant differences in sexual function, well-being, and mood across the follicular, ovulatory, and luteal phases (Psychoneuroendocrinology, 2025). If your experience doesn't match a dramatic monthly swing, that's also normal.

Symptoms are worth a closer look when they cost you something real, a week of work, a relationship strain that repeats every month, or days you can barely function. If this takes a week of every month, or you have thoughts of hurting yourself, see a GP or gynecologist and bring two months of daily notes. That record helps a doctor tell PMS, PMDD, and premenstrual exacerbation of another condition apart, since each one calls for a different approach, from CBT to certain hormonal contraceptives to an SSRI taken only in the luteal phase.

For more on how the hormonal swings of this phase connect to mood, read how your menstrual cycle affects your mood or go deeper on the luteal phase: what's happening in your body and mood.