Women Experience Sleep Disruptions, Heightened Anger in Days Leading Up to Period

Jessica Meers, PhD

Credit: Center for Innovations in Quality, Effectiveness, and Safety

A new study found women experience heightened feelings of anger and sleep pattern disruptions the days leading up to a period.¹

“Our research provides valuable insights into the complex interplay between menstrual cycles, emotions, and sleep and the impact of hormonal fluctuations on women's well-being,” said investigator Joanne M. Bower, from the University of East Anglia’s School of Psychology, in a press release.² “By understanding how these factors interact, we can better address the unique needs of women in terms of sleep health and emotional well-being.”

Led by Jessica Meers, PhD, from the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, the study aimed to assess how subjective and objective sleep influences women’s emotions.¹

Recruited from online advertisements targeting the local community and a research participant pool of undergraduate psychology students, the study included 51 healthy women aged 18 – 35 years (mean age: 24 years). Participants had regular periods lasting 24 – 35 days and did not take hormonal contraception within the past 3 months. Less than half of the participants were Caucasian (43%), 29.4% were Asian, 13/7% were mixed race, 9.8% were African American, 2% were American Indian/Alaska Native, and 2% were not reported.

The team collected self-reported daily reports on sleep and emotion measures using the ecological momentary assessment methodology from May 2020 to January 2021. Participants completed short emotion assessments via a smartphone app which notified them 3 times a day—morning, evening, and a random time—to rate 3 positive emotions (happy, calm, enthusiastic) and 3 negative emotions (angry, afraid, sad) on a 9-point scale. The assessment took only about 90 seconds to complete.

Participants kept a diary and wore actiwatches to track sleep across 2 menstrual months. The Morningness/Eveningness Questionnaire was also completed to inform investigators of the participants’ circadian preference—if they preferred mornings or nights.

The team compared diary and actigraphic measurements with daily ratings of sleep and emotions across 4 phases of the menstrual cycle: perimenstrual, mid-follicular, periovulatory, and mid-luteal. They considered the perimenstrual phase to be late luteal. The team assessed relationships between the menstrual phase, sleep, and emotion with multistep hierarchical linear modeling.

Investigators calculated phase timing by subtracting 14 days from the projected start of the next menstrual cycle to guess when ovulation might be. For duration, they found participants had a mean cycle length of 28.61 days, a mean actigraphy of 51.29 nights, and a mean EMA data of 59.31 days.

The team found women during the perimenstrual phase—the part of the menstrual cycle right before the period—women have disrupted sleep patterns, spending more time awake at night and having lower sleep efficiency. The perimenstrual phase is a collective term of the late luteal and early follicular phase, encompassing the final 3 days of 1 cycle and the first 3 days of the next cycle.

Women reported heightened feelings of anger in the days leading up to their period, more heightened than other phases of their menstrual cycle. The findings suggest the perimenstrual phase can predict anger (P < .001) but no other emotions. The team also found greater rates of sleep disruption during the perimenstrual phase compared with other phases.

The perimenstrual phase also predicted greater rates of total wake time at night. The diary total wake time at night was 8 – 16 minutes longer during the perimenstrual phase compared to other phases (P < .001), and actigraphic total wake time was longer by 4 – 7 minutes (P < .001).

The relationship between sleep and the menstrual phase was able to predict emotions of happiness (P = .006), calmness (P = .02), and enthusiasm (P = .01). The findings suggest the days before a period are linked to reducing positive emotions by 0.05 – 0.10 points.

Although the study did not find strong effects of COVID-19 stress on variables, investigators pointed out the pandemic most likely impacted participant’s emotions and sleep patterns. Other limitations the investigators highlighted included self-reported data, not using more intensive methodological approaches, modeling the menstrual cycle as a nonlinear function of time, and most of the sample being younger women.

Overall, the findings suggest the importance of hormonal fluctuations when addressing sleep disorders and emotional distress in women.

“The implications of this research reach further than just the controlled setting, providing potential pathways for interventions and treatments aimed at enhancing sleep quality and emotional resilience in women,” Bower said.²

^References

1. ^{Meers JM, Bower J, Nowakowski S, Alfano C. Interaction of sleep and emotion across the menstrual cycle. J Sleep Res. Published online March 21, 2024. doi:10.1111/jsr.14185}
2. ^{Research Reveals Link Between Menstrual Cycles, Emotions, And Sleep Patterns in Women. EurekAlert! March 21, 2024. https://www.eurekalert.org/news-releases/1038479. Accessed March 27, 2024.}