There are mornings when I look in the mirror and it seems like my whole face has mutated overnight.

My jaw is softer, as though made of wet clay. My nose has migrated, so I try to push it back into shape. Makeup only seems to make it worse. Some rational part of me whispers that nothing has changed. But to me, it’s undeniable: I look weird. And not just weird — I look ugly.

As a female in the 21st century, a base-level degree of body dissatisfaction seems like part of the package. I have managed mine through a careful combination of tent dresses, anxiety medication, and aging. But none of those defense mechanisms help on days like this. How can I negotiate my face when I don’t even recognize it?

Only in the past few years have I noticed a correlation between these bizarro mornings and my menstrual cycle. Right on schedule, a few days before my period, all of the armor I’ve built up around my appearance vanishes in the funhouse mirror of my hormones. I can’t be the only one dealing with this, can I?

As it turns out, no. Once I began talking about my experience, others chimed in. Caitlin, 34, describes an eerily similar experience. “About once a month, I look in the mirror and my features seem exaggerated,” she says. “I'd think, Wow, that person's eyes are really far apart. Any change I fixated on was something that seemed to get bigger, and therefore more unlovable.”

Like me, she believed this was just part and parcel of low self-esteem. “This happened in my 20s, when I wasn't happy with my appearance on a daily basis, anyway," she explains. "So, I'm not sure I thought much of it. It was just another episode of self-loathing. It wouldn't be until a few days later, when my period had started, that I would gain any perspective.”

This phenomenon is so common among women I know that I even gave it a label: PMS-related dysmorphia. Naming it made it easier for me to recognize, but it didn’t help me understand it any better. Can reproductive hormones actually change the way we see our faces? Is there a connection between what’s happening in the uterus and what’s happening in the mirror? Do I have my period — or am I just ugly?

Let’s get this out of the way first: Women’s mental health, especially concerning hormones, is criminally understudied. As reproductive psychiatrist Catherine Birndorf recently told The Cut, in an article about the link between estrogen and mental health, “If men can’t get an erection, it’s a natural disaster... But very little is studied in women because of our reproductive capacity and because of patriarchy. We need to try to understand women better.”

Not one of the medical experts I reached out to for this article knew of research that explicitly discussed PMS-related dysmorphia as its own condition. That’s not to say they didn’t believe in its existence. If someone has body dysmorphic disorder, it is entirely probable that it could be exacerbated by the menstrual cycle, according to Dr. Edwin Raffi, MD, MPH, a psychiatrist at Massachusetts General Hospital’s Center for Women’s Mental Health. “We’d call this PME, or premenstrual exacerbation of an underlying disorder.”

PMS and Premenstrual Dysphoric Disorder (PMDD) cause a range of symptoms relegated to the menstrual phase of a reproductive cycle. Unlike those, PME can actually amplify existing conditions. “If someone is struggling with low moods or obsessive thinking,” says Dr. Raffi, “then in that one week before your cycle, those symptoms are sort of bolded.”


Sim, 24, finds her exigent body struggles intensifying around her period. “I have an autoimmune disorder and it has changed my body a lot,” she says. “When I'm on my period, it's like things are changing that never did before. I can spend nearly an hour looking in the mirror, picking at my skin and tugging on areas of my face. It's like in Charlie and the Chocolate Factory, when Violet Beauregarde inflates. Why are my freckles darker? What is that wrinkle by my eye? Where is my hairline going?” This obsessive dysmorphia, Sim says, lasts until her period is over. “Gradually, it's less noticeable. And then I think about it for days, sometimes until my next period rolls around. Why did my face do that? Did my face do that?”

Tory Eisenlohr-Moul, a clinical psychologist and researcher at the University of Illinois at Chicago studying the effects of the menstrual cycle on behavior and emotions, points to studies that show that body dissatisfaction peaks in the perimenstrual phase, and others showing that women perceive their bodies as larger when they have their periods. “We’ve found that people who are on the continuum of hormone sensitivity have this window of risk around their periods, where feelings of body dissatisfaction can be amplified,” she tells me. “This can apply to anything that is bothering you, any feelings of shame or insecurity — all of those feelings will really just be amped up.”

What we don’t know, however, is exactly what is happening inside our bodies that causes this phenomenon.

“There is so much we have to learn about how emotion shapes sensory perception,” says Eisenlohr-Moul. “We know that it does, but we don’t have a ton of detail about where it happens in the brain. One way to think about it is that PMS can distort your sensory cues, so you might fixate on things you already struggle with.”

“The exact reason why people are getting worse premenstrually, no one can tell you,” says Dr. Raffi. “They think it has to do with hormones, but it could be an interplay between hormones and neurotransmitters. We know this because in some people when we stop the oscillation of hormones, as in with hormonal birth control, PMS symptoms might decrease. For others, however, the symptoms get worse.”

Without knowing exactly why my face goes mutant once a month, then, it’s impossible to know how to put an end to it. That said, there are things I (and you) can try.

“First, address the severity of your symptoms,” says Eisenlohr-Moul. “Severe menstrual disruption, true obsession with negative thoughts about your body — these are real disorders that deserve medical attention.”

If, however, you’re like me — just your monthly mirror-bound monster — Dr. Raffi recommends a biopsychosocial approach. This means looking at biological factors, including diet, exercise, and body chemistry; psychological factors, such as therapy or medication; and social and environmental factors, like partners or seasonal changes, to assess how you can best habituate yourself to hormonal shifts. The medical experts I talked to agree on is the importance of tracking your symptoms.

“Be aware of when the thoughts that come up are more likely to be exaggerated or distorted, more likely to be feeding those caustic cultural messages,” says Eisenlohr-Moul. “It’s helpful to understand that your hormones are outside of your control, and that when you have these thoughts, it’s your hormones talking — not your true perception.”

Dr. Raffi concurs: “In menstrual cycle-related mood disorders, the way to approach it is to keep a diary. That can be empowering because it is both diagnostic and, to a certain degree, its own form of treatment. You can realize ... this is my body going through changes. It is a lot easier to tell yourself not to look in the mirror, because you know it’s going to go away.”

Tracking hasn’t stopped me from spending an extra 20 minutes poking at my face on bad mornings, but I can, at the very least, understand that what I’m seeing isn’t reality: It’s just my brain and my hormones doing their peculiar dance. Above all, simply knowing this exists means a lot. “Women start getting these symptoms when they first get their period, and they think they just have to get used to it,” says Dr. Raffi. “They think that they just have to suffer. But that’s a quarter of your life spent suffering. No one has to live like that.”

