Reproductive mental health refers to well-being or mental health challenges associated with the female reproductive system. For some women, physical discomfort and rapid hormone fluctuations that occur in connection with menstrual cycles, during and after pregnancy, and before and during menopause can contribute to irritability, depression, anxiety and other mood changes.

Health conditions involving a woman’s reproductive organs can also affect her mental health. Women who experience chronic pelvic or genital pain or cancers of reproductive organs are at higher risk of depression, anxiety and other emotional changes.

Reproductive losses can cause considerable distress. Women experiencing infertility, miscarriage, stillbirth, ectopic pregnancy or the loss of an infant often face mental health challenges as well.

Women who have experienced breast cancer have a wide range of emotional reactions. Some feel very worried about the future and especially whether the cancer will return. Some are dealing with long-term effects of cancer treatment, such as loss of a breast, scars, lymph swelling, nerve damage, brain fog and changes in sexual health. Even after full recovery from breast cancer, survivors may experience trouble sleeping, difficulty functioning, feeling sad or disliking their bodies. Women may also experience positive changes after breast cancer, such as living more in the moment, feeling closer to loved ones, having a deepened sense of spirituality, taking better care of themselves and finding meaning in helping others.

If you’ve had breast cancer and are struggling emotionally or would like to work toward positive changes in your life, consider speaking with your primary care provider or mental health clinician about support, counseling and other treatment options.

Breastfeeding can prompt a wide range of emotional reactions in women, from feeling relaxed, calm and connected to their baby to feeling stressed, depressed and burdened. Sometimes, women feel overwhelmed if they breastfeed but guilty if they don’t. Some women who have experienced sexual trauma find that normal sensations of breastfeeding bring back memories of the trauma, such that breastfeeding leads to intense anxiety.

Protecting the mother’s well-being — regardless of whatever personal decision she makes about breastfeeding — is vital in helping babies thrive. There are specific types of counseling and breastfeeding support that can help women who are deciding whether to breastfeed as well as women who want to breastfeed but find it challenging because of depression, anxiety, trauma or another reason.

Most of the time, birth control methods such as pills, injections, patches and implants don’t disrupt women’s moods. In fact, they may indirectly improve mental health by preventing unwanted pregnancies or by reducing bothersome menstrual symptoms. Yet some women experience a depressed mood, irritability or anxiety after starting hormonal contraceptives (birth control methods that contain hormones).

If you’re having these reactions, there are solutions. Consider speaking with your primary care provider or mental health clinician about assessment and treatment options.

During an ectopic pregnancy, a fertilized egg implants itself somewhere outside the uterus, such as in a fallopian tube. A woman with an ectopic pregnancy may experience typical pregnancy symptoms at first, such as a missed period, breast tenderness and nausea, along with a having positive pregnancy test. When it becomes clear that the pregnancy is ectopic, it is treated as a medical emergency. Because it’s so unexpected and urgent, the process of diagnosis and treatment can be stressful and sometimes traumatic.

Individuals differ widely in their long-term reactions to ectopic pregnancy loss. Some women experience prolonged grief, anxiety, depression, posttraumatic symptoms and suicidality. Others, especially if they have good support and counseling, can experience a deepened sense of meaning and spirituality.  This can include, for example, living more in the moment and finding meaning in helping others.

If you’ve had an ectopic pregnancy and are feeling distressed, consider speaking with your primary care provider or mental health clinician about counseling and other treatment options.

Endometrial cancer is cancer of the lining of the uterus. Women may hear this is a “good” cancer because it’s often curable. That doesn’t necessarily mean women with endometrial cancer feel happy! Women may worry about the cancer returning. They may have to live with long-term side effects of cancer treatment, such as scars, lymph swelling, nerve damage, brain fog and changes in sexual health. Some women become depressed or anxious after experiencing endometrial cancer. There may be positive changes also, such as living more in the moment, feeling closer to loved ones, having a deepened sense of spirituality, taking better care of themselves and finding meaning in helping others.

If you’ve had endometrial cancer and are struggling emotionally or would like to work toward positive changes in your life, consider speaking with your primary care provider or mental health clinician about support, counseling and other treatment options.

Infertility is a unique type of stress. It’s an invisible loss that interferes with the often cherished goal of having a baby. Women experiencing infertility may feel a sense of failure and may become more socially isolated. Infertility may challenge important beliefs, like a belief in the ability to choose one’s own destiny. For couples, infertility can be a shared stress that can bring them closer together, cause tension or both. Infertility treatments can also be stressful and involve difficult decisions, such as how often to try the treatments and whether to use donor eggs or sperm.

Many people feel upset, depressed or anxious when dealing with infertility and its treatment. While these reactions are normal, they can be distressing and make it difficult to function. If you’re experiencing these reactions, consider speaking with your primary care provider or mental health clinician about counseling and other treatment options.

As women transition into menopause, they may experience changes in their menstrual cycles, hot flashes, night sweats, vaginal dryness, urinary changes and other physical symptoms. This transition into menopause is called perimenopause. Perimenopause begins when menstrual cycles first change and ends a year after the last menstrual cycle, when a woman enters menopause. During perimenopause, a woman’s risk of feeling depressed is double what it is before or after. Women also may experience increased anxiety. This is due in part to fluctuating hormones and midlife stress. Many women experience major life changes in middle age, such as retirement, children leaving home, divorce, widowhood, caring for elderly parents and coping with chronic medical concerns in themselves and loved ones.

Do you think you might have depression or anxiety affected by menopause or perimenopause? Complete the screening checklist to learn more.

Checklist for depression or anxiety related to menopause or perimenopause

(Adapted from the North American Menopause Society)

Is there a recent change in how often you have periods?

Is there a recent change in how many days you bleed?

Has your period recently become very heavy?

Do you have any of these symptoms?

• Hot flashes
• Night sweats
• Increased difficulty sleeping
• Increased fatigue
• Irritability
• Anxiety
• Depressed mood
• Crying spells
• Increased urination
• Leaking urine
• Dry or itchy vagina
• Pain during sexual intercourse

If you answered yes to at least three questions, consider speaking with your primary care provider or mental health clinician about assessment and treatment options.

A miscarriage is the loss of a pregnancy before 20 weeks. Grieving a loss after expecting to bring a life into the world can be especially difficult. Often, nothing else in a woman’s experience has prepared her for this. Other people may not know how to be supportive, so it may be difficult to talk about this loss.

There is a wide range of emotional reactions to miscarriage. Many women feel as though the baby is still inside, dream about pregnancy or about the baby, and think about the baby a great deal. Some women become depressed or anxious. Some blame themselves for the miscarriage. Women with partners may find that miscarriage makes them feel closer to their partners or creates tension in the relationship.

While depression or anxiety is normal after a miscarriage, it can be distressing and make it difficult to function at times. If you’ve had a miscarriage and are experiencing these reactions, consider speaking with your primary care provider or mental health clinician about counseling and other treatment options.

Ovarian cancer is an especially challenging type of cancer. Many women who have experienced it report intense concerns about whether it will return after treatment and whether they will die young. Some women worry much of the time and scan their bodies for possible signs of the cancer returning. Some describe a sense that everything is in limbo and a reduced feeling of control. It can be difficult to know what to say to others, especially children, about the cancer. When women feel pressured to “think positive,” they may feel alienated from others.

Women may also experience positive changes after ovarian cancer. Some women report living more in the moment, feeling closer to loved ones, having a deepened sense of spirituality, taking better care of themselves and finding meaning in helping others.

If you’ve had ovarian cancer and are struggling emotionally or would like to work toward positive changes in your life, consider speaking with your primary care provider or mental health clinician about support, counseling, and other treatment options.

Pelvic exams are helpful for many reasons, such as reducing a woman’s risk of cancer, treating genital and pelvic infections, maintaining a healthy pregnancy, diagnosing pelvic pain and figuring out why a woman is having urinary problems. If you feel anxious about pelvic exams, you’re not alone. Many women are nervous about pelvic exams, fearing something bad will be found, expecting pain, feeling a loss of control over their bodies or worrying that they’ll have to talk about their sexual practices. Women may also feel embarrassed about undressing or exposing their genitals. Women who have experienced sexual trauma may be reminded of the trauma during pelvic exams.

Some women are so anxious that they avoid needed pelvic exams. Others go to the exams but feel intensely distressed, experiencing panic attacks, flashbacks, or other signs of anxiety.

If a pelvic exam has been recommended for you and you’re anxious about it, consider telling your primary care provider, gynecologist or mental health clinician about your concerns. They can help you prepare, and the gynecologist can modify the exam to reduce anxiety.

Chronic pain of any kind can increase depression and anxiety. More than 18% of women Veterans who receive VA health care are diagnosed with chronic pelvic pain. The percentage is even higher among women who have experienced military sexual trauma.

Many women reduce activities they would otherwise enjoy or find meaningful because of the pain. In particular, pelvic pain can interfere with intimate relationships.

Medical and gynecological exams sometimes reveal the causes of chronic pelvic pain, but sometimes no specific cause is found, which can increase women’s feelings of frustration, anxiety, depression and hopelessness. Psychological counseling can teach people to manage and reduce the emotional toll of chronic pain so they can improve their quality of life.

Some women notice that they have symptoms that occur only before their period, typically lasting for several days. Common symptoms include feeling irritable, tired, bloated, sore and overwhelmingly stressed. Women also may experience increased appetite and cravings for certain types of food.

When there are only a few symptoms and they are mild, this is known as premenstrual syndrome (PMS). When there are at least five symptoms and they are more intense, it could be a condition called premenstrual dysphoric disorder (PMDD). Treatments for PMS and PMDD include lifestyle changes, medications, hormone therapy and behavioral therapy.

Do you think your menstrual cycle might be affecting your mood? Complete the screening checklist for PMS and PMDD.

Screening checklist for premenstrual syndrome and premenstrual dysphoric disorder

Do you experience any of these symptoms during the two weeks before your period?

• Feeling more angry or irritable than usual
• Feeling more anxious or tense
• Feeling down or less interested in things
• Having more difficulty concentrating
• Feeling more tired
• Eating more than usual or craving certain foods
• Sleeping more or less
• Feeling overwhelmed more easily
• Physical changes like bloating, breast tenderness, headaches and joint pain

If you answered yes to several of these, or if your symptoms are interfering with your life, consider speaking with your primary care provider or mental health clinician about assessment and treatment options.

If you are considering or planning a pregnancy, it’s a great time to take stock of your mental health. When planning a pregnancy, it’s important to remember that improving your well-being and lowering your stress increases the likelihood of a healthy pregnancy and healthy baby. The sooner you can prevent or address any mental health challenges, the better outcome you’re likely to have. It’s never too soon or too late to take care of your mental health. In therapy, you may discover tools that will help you through other events and life stages, including the often-difficult postpartum phase (the first year after giving birth) and early parenthood.

If you are pregnant or planning a pregnancy, talk with your VA provider about your mental health history and any symptoms you may be experiencing. Do not stop taking any prescribed medicines without first consulting your provider, as doing so could be harmful to you or your baby.

Are you planning a pregnancy and interested in improving your mental health? Complete the checklist for preconception mental health planning.

Checklist for preconception mental health planning

• Are you sometimes anxious in a way you think is disproportionate to circumstances?
• Have you felt sad, down or depressed?
• Do you wish you could handle anger differently?
• Have you experienced very stressful or traumatic situations in the past that still affect you?
• Do you sometimes use alcohol, cigarettes, cannabis or other substances in an attempt to relax or cope?
• If you have a partner, do you want to improve the way you and your partner communicate or share household responsibilities?
• Do you feel confident that you can manage most stress without feeling overwhelmed?
• If you’ve been diagnosed with a mental health condition, have you spoken with a mental health clinician about how the symptoms could affect a pregnancy or how pregnancy could affect your condition?
• If you’re taking medication for mental health, have you spoken with a doctor, nurse or pharmacist about the pros and cons of continuing the medication while pregnant?

If you answered yes to any of the questions 1–6 or no to any of the questions 7–9, consider speaking with your primary care provider or mental health clinician about treatment options for preconception mental health.

Becoming pregnant is a life-changing event. Women’s emotional reactions to pregnancy can vary widely according to life circumstances, such as social support, safety, housing, financial resources and stress. The physical changes of pregnancy can cause discomfort and sleep loss that affect emotional well-being.

The first year after giving birth, the postpartum period, is a time when women may be more vulnerable than usual to mental health challenges, especially if they don’t have enough support. In addition to experiencing dramatic hormonal changes, women who have recently given birth are often sleep deprived, in pain and adjusting to motherhood. It can be challenging for new mothers to find time to relax, exercise, prepare healthy meals and care for themselves. It’s not surprising that many mental health symptoms arise or worsen after childbirth .

Fortunately, postpartum depression and other postpartum mental health conditions are treatable, and they can often be prevented if women seek mental health services before or during pregnancy. If you would like to learn more about protecting postpartum mental health, or if you’re experiencing postpartum distress, consider speaking with your primary care provider or mental health clinician about prevention, assessment and treatment options.

A stillbirth is the loss of a pregnancy after 20 weeks. At this point in a pregnancy, many women have felt their babies move inside them and feel strongly bonded to their babies. If you’re grieving someone you love but haven’t met, it can be difficult to console yourself with positive memories. Sometimes the process of delivering a stillborn baby can be traumatic.

After a stillbirth, seeing other babies or pregnant women can become painful reminders of the loss. This can lead to social isolation. The sense of isolation can be intensified if people who want to be supportive seem not to understand what stillbirth is like.

Many women experience depression or posttraumatic symptoms after a stillbirth. If you’ve had a stillbirth and are feeling distressed, consider speaking with your primary care provider or mental health clinician about counseling and other treatment options.