28 days later: A prospective daily study on psychological well-being across the menstrual cycle and the effects of hormones and oral contraceptives

BackgroundWe aimed to study how hormonal status (oral contraceptive users vs naturally cycling) affects different dimensions and variability of psychological well-being, and how they relate to sex hormone levels (estradiol, progesterone and testosterone). Methods22 participants with a natural cycle (NC) and 18 OC users reported daily affective and physical symptoms and collected daily salivary samples across 28 days. They were compared using average psychological well-being levels, day-to-day variability, and network models. In NC participants the time-varying associations between hormones and psychological well-being aspects were assessed using both person-centered level and change scores. ResultsLowered variability was found for OC users agitation, risk-taking, attractiveness, and energy levels. This was paralleled by lower overall ratings of happiness, attractiveness, risk-taking, and energy levels, but OC users also reported more relaxation, sexual desire, and better sleep quality compared to the NC group. The impact of sex hormones on psychological well-being varied significantly across menstrual cycle phases, with the largest effects for progesterone levels.ConclusionsOur results confirm that hormonal status is associated with a range of psychological well-being domains beyond mood and sexual desire, among which energy levels, feelings of attractiveness, risk taking, and agitation. Our results of lower variability in OC users compared to NC participants fit with ‘emotional blunting’ as a possible mechanism behind OC’s side effects. The differential influence of the menstrual cycle and sex hormones on markers of psychological well-being emphasizes the need to adequately account for the menstrual cycle when studying hormone-related mental health.