There has been a lot of research dedicated to understanding women’s experiences with depression because of hormone changes, but women’s experiences of emotional arousal, including anxiety, irritability, and anger have received less attention. A group of researchers recently decided to change that by studying more than 200 women to determine the effect of menstrual cycle phase and reproductive age on a woman’s likelihood of being emotionally aroused. Most of these women were partnered, employed, and white.

Through their research, they discovered that participants experienced greater severity of anger, irritability, and feeling out of control during premenses rather than postmenses and more severe irritability, impatience, and feeling out of control symptoms during the early menopause transition (when a woman’s ovaries begin to produce less estrogen and cause noticeable changes in the body) rather than the late reproductive phase (the period immediately before the menopause transition characterized by subtle changes in menstrual flow and cycle length).

In addition, the research demonstrated that many women begin to experience symptoms often associated with the menopause transition even as early as the late reproductive stage, although these women typically experience increasing severity of these arousal symptoms as they continue through the transition. Because the research mostly involved women who were continuing to have menstrual cycles, it was not possible to conclude whether arousal symptoms continue to vary during later stages of reproductive aging when their cycles become markedly irregular.

Results of the study are published in the article “Effects of menstrual cycle phases and reproductive aging stages on arousal symptoms: observations from the Seattle Midlife Women’s Health Study.”

“The findings of this study highlight what women have been telling us for years—that they experience anger and irritability and feel out of control just before their menstrual cycles and that this is more pronounced in the menopause transition. The results also speak to the need to better support women both physically and emotionally as they go through this universal life transition,” says Dr. Stephanie Faubion, medical director for The Menopause Society.

For more information about menopause and healthy aging, visit www.menopause.org.

The Menopause Society (formerly The North American Menopause Society) is dedicated to empowering healthcare professionals and providing them with the tools and resources to improve the health of women during the menopause transition and beyond. As the leading authority on menopause since 1989, the nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for healthcare professionals, researchers, the media, and the public and leads the conversation about improving women’s health and healthcare experiences. To learn more, visit menopause.org.

“Perimenopause is when the menstrual cycle has started to change, and it is persistent,” explained Lauren Baker, DO, an obstetrics and gynecology physician at The Ohio State University Wexner Medical Center and certified practitioner with the Menopause Society. “The formal definition is periods fluctuate by at least seven days for at least 10 months.”

A new survey by Ohio State Wexner Medical Center of 1,068 women in the United States shows 61% believe they will hit menopause in their 40s. When, in fact, some will start to experience symptoms as early as their 30s, and most women won’t see menopause start until their early 50s.

Ohio State experts say it’s important not to ignore symptoms just because of your age. Baker said that perimenopause is not a universal experience, which is why it’s so important to bring any changes, concerns or symptoms to your doctor’s attention to find the best treatment for your body.

The Ohio State survey showed half of the women (52%) believe diet and exercise can help treat menopause symptoms, and experts agree.

“Having a diet that’s rich in calcium and vitamin D is really important for bone health,” said Baker. “Fiber and protein are also helpful from a weight management perspective. And then making sure you’re getting whole foods, lots of fruits and veggies also is really important.”

The survey also revealed one in three women are concerned about the long-term health effects of menopause. Other concerns related to reproductive aging among those surveyed include physical symptoms (25%) and mental health (18%). Younger women were more likely to say mental health is their top concern related to menopause than older women (25% among 18-29-year-olds versus 10% among those ages 65+).

“Problems in the workplace, adverse effects on one’s quality of life and adverse health events all have been associated with menopause, too,” said Baker. “There are effective treatments and ways to feel better to not only survive but thrive.”

Survey methodology:
This study was conducted by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was
conducted across two back-to-back Omni waves from February 7-10, 2025, and February 21-
24, 2025, among a combined total sample of 1,068 female respondents. The survey was
conducted via web (n=1,031) and telephone (n=37) and administered in English. The margin of
error for total female respondents is +/-3.4 percentage points at the 95% confidence level. The
data was weighted to represent the target population of U.S. female adults ages 18 or older.

The study, published today in the journal Obstetrics & Gynecology, found that individuals receiving a COVID-19 vaccine during the first half of their menstrual cycle are more likely to experience cycle length changes than those receiving a vaccine in the second half.

Building on prior work from the same research team that first identified an association between COVID-19 vaccines and menstrual cycle length, this study furthers understanding of how timing of vaccination is associated with this change.

“Understanding these changes on a population level allows us to more effectively counsel patients about what to expect with a COVID-19 vaccine,” said Alison Edelman, M.D., M.P.H., the study’s lead author and professor of obstetrics and gynecology and division director of Complex Family Planning in the OHSU School of Medicine. “We hope this work helps validate the public’s experiences and ease fears and anxiety around vaccination.”

With data from nearly 20,000 users of the FDA-cleared birth control application Natural Cycles, researchers sought to determine whether timing of COVID-19 vaccination is associated with changes in menstrual cycle length. Individuals in the cohort analysis granted researchers permission to use their de-identified data.

Researchers compared three groups: individuals vaccinated in the follicular phase, the first phase of the menstrual cycle when the body collects follicles, or small sacs that have the potential to release an egg for fertilization during ovulation; individuals vaccinated in the luteal phase, the second part of the menstrual cycle starting after ovulation; and an unvaccinated control group.

Analysis shows that individuals who were vaccinated in the follicular phase experienced, on average, a one-day increase in cycle length when compared with their pre-vaccination cycle average. Changes typically resolved in the cycle after vaccination.

While there is now a large body of evidence demonstrating that the COVID-19 vaccine is associated with temporary menstrual cycle disturbances, the exact biological mechanism for these changes is still unknown.

“We are constantly learning about how our bodies work together, but we do know the immune and reproductive systems interact closely with one another,” Edelman explained. “Based on this relationship, it is certainly plausible that individuals may see temporary changes in their menstrual cycle due to the immune response that vaccines are designed to produce.”

Experiencing an unexpected change in menstrual cycles can be alarming. Researchers emphasize that these findings shouldn’t be a cause for concern, but should provide reassurance that, if changes in cycle length occur with vaccination, they are likely to be small and temporary. Individuals who notice prolonged changes in menstruation are encouraged to seek guidance from their clinician.

Since the study’s data were gathered from individuals with regular menstrual cycles pre-vaccine, the team emphasizes that additional research is needed to establish whether observed differences vary in some people who experience irregularities in their cycle. Additionally, researchers hope to better understand how other aspects of the menstrual cycle are affected by vaccination, such as menstrual-related symptoms and menstrual flow.

“Historically, menstruation has not been prioritized in scientific and medical research, which leaves individuals who menstruate with a lot of unanswered questions, especially when they are experiencing something that’s not ‘normal’ for their body,” Edelman said. “Menstruation is a key indicator of fertility and overall health, so understanding these changes is very important to us as reproductive health researchers and to our patients.”

Research reported in this publication was funded by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and Office of Research on Women’s Health under award number HD089957. The work is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.