Physical and mental fatigue across the menstrual cycle in women with and without generalised anxiety disorder

Horm Behav. 2020 Feb:118:104667. doi: 10.1016/j.yhbeh.2019.104667. Epub 2020 Jan 8.


Subjective, disabling fatigue is a common complaint and a key feature of numerous medical conditions, and is a transdiagnostic feature of psychiatric disorders. Despite physical and mental fatigue being associated with functional impairment and reduced quality of life, little is understood about its underlying mechanisms or modulating factors. Women commonly experience exacerbation of other (non-fatigue related) psychiatric symptoms during the luteal phase of the menstrual cycle, and report greater fatigue prevalence compared to men. It is therefore plausible that subjective fatigue may similarly fluctuate across the menstrual cycle. Here we compared physical and mental fatigue in the early-follicular (lower ovarian hormones) and mid-luteal (higher ovarian hormones) phases of a single menstrual cycle, while controlling for sleep disruption, in women with (n = 18) and without (non-anxious; n = 20) generalised anxiety disorder (GAD). As expected, women with GAD reported greater physical and mental fatigue than healthy women. Further, although there were no changes in physical fatigue from the early-follicular to mid-luteal phases in both groups, mental fatigue in non-anxious women increased to levels equivalent to those experienced by their GAD counterparts in the mid-luteal phase. Although salivary levels of estradiol and progesterone increased from the early-follicular to mid-luteal phase, hormones did not significantly predict fatigue in either phase. These findings are consistent with the exacerbations of state anxiety and mood disturbance recognised to occur in the luteal phase of the menstrual cycle. We speculate that increased mental fatigue in the luteal phase may represent a vulnerable period for the development and maintenance of psychiatric disorders, potentially via compromised emotional regulation.

Keywords: Generalised anxiety disorder; Menstrual cycle; Mental fatigue; Ovarian hormones; Physical fatigue.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anxiety Disorders / blood
  • Anxiety Disorders / complications
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / physiopathology
  • Case-Control Studies
  • Emotional Regulation / physiology
  • Estradiol / blood
  • Fatigue / blood
  • Fatigue / complications
  • Fatigue / epidemiology*
  • Female
  • Humans
  • Menstrual Cycle / blood
  • Menstrual Cycle / psychology*
  • Mental Fatigue / blood
  • Mental Fatigue / complications
  • Mental Fatigue / epidemiology*
  • Progesterone / blood
  • Quality of Life
  • Young Adult


  • Progesterone
  • Estradiol