Hormone fluctuations and the menstrual cycle
The menstrual cycle is the natural process that happens when women reach reproductive age, usually around the age of 12, until menopause, which is usually between the ages of 45 and 55. The menstrual cycle is also known as your menses, menstrual period, menstruation or your period. While we often refer to periods – the part that we see – getting your period is only a small aspect of the whole process.
Menstruation is the loss of the uterine lining that occurs if an egg has not been fertilised, which would result in pregnancy and retention of the lining. The process is hormone-driven, with hormones produced by the hypothalamus, pituitary gland, and the ovaries. There are 4 key hormones involved: the follicle stimulating hormone (FSH), luteal hormone (LH), oestrogen and progesterone.
The menstrual cycle can be divided into two distinct parts: the follicular, or proliferative, phase, and the luteal, or secretory, phase.
- The follicular phase begins on the first day of your period, and ends with ovulation. This phase is characterised by a lower basal body temperature, and the development of ovarian follicles. Over this time, levels of oestrogen start to rise, which stimulates production of LH, culminating in ovulation.
- The luteal phase starts with ovulation and ends on the first day of your period. It’s characterised by a comparatively higher basal body temperature, alongside a thickening of the uterine lining and the egg travelling from the ovary to the uterus. Following on from ovulation, levels of LH and FSH fall rapidly. Oestrogen levels also dip but then rise again slightly, before falling towards the end of the cycle if no fertilisation occurs. Ovulation stimulates an increase in progesterone production, which peaks in the middle of the luteal phase, before falling if there is no pregnancy.
Menstruation and your BP: there is a link
While the fluctuation of hormones is a completely natural process, hormone level changes can affect other parameters such as blood glucose and blood pressure. This was definitively shown in 1991 by Dunne et al., who measured the blood pressure of 30 normotensive and 10 mildly hypertensive women at home every morning for 6 weeks. It was found that:
- Blood pressure was higher at the onset of menstruation than at most other phases of the cycle.
- Diastolic blood pressure (DBP) was higher during the follicular phase, immediately after menstruation – although it was only by a small amount: 1.23 mmHg, on average.
- During the second half of the cycle, or luteal phase, blood pressure was lower overall (again, DBP by around 1.19 mmHg on average; Systolic BP (SBP) by 0.65 mgHg, on average).
- Both hypertensive and normotensive individuals exhibited the same BP behaviours.
Menstrual symptoms can link to higher BP
In 2021, Chung et al. noted that heavy menstrual bleeding increased the incidence of hypertension by 53% and that the relationship may be directional i.e. BP can impact upon your menstrual cycle and vice versa. They showed that having hypertension increased the incidence of heavy menstrual bleeding by 23% and irregular periods by 42%.
Another study from Australia, completed in 2025, looked at 458 females between their early 20s and mid-40s. They noted three distinct populations: females with heavy menstrual bleeding, females with irregular periods, and females who suffered from severe period pain. Of these, there was no association between severe period pain and BP. However, heavy menstrual bleeding and chronic irregular periods were both associated with higher DBP. In fact, the authors even suggested that further studies in more diverse cohorts and age groups would be helpful in determining whether ‘routine monitoring of menstrual symptoms and blood pressure is beneficial for promoting cardiovascular health in midlife’. The reason for heavy menstrual bleeding in older women was attributed to the onset of menopause and fluctuations in the levels of oestrogen. It was also linked to an increased risk of developing polyps or endometrial hyperplasia (an abnormally thick uterine lining).
What about PMS (Premenstrual syndrome)?
PMS is a name for the symptoms that some women can experience in the lead-up to their period. The most common symptoms are:
- mood swings
- feeling depressed or irritable
- feeling upset, anxious or emotional
- tiredness or trouble sleeping
- bloating or cramping
- breast tenderness
- headaches
- spotty skin
- greasy hair
- changes in appetite or food cravings
A study from the US showed that there was an association between elevated DBP and young women with PMS. In this case, mean DBP was 72.3 mmHg for those with PMS, and 69.1 mmHg for those without. However, the authors did note that while they tried to account for it during analysis, the impact on BP may also be due to changes in behaviour due to PMS symptoms.
Is PMS a warning sign for development of hypertension when you are older?
A long-term study by the University of Massachusetts published in 2015 found that participants who had moderate to severe PMS symptoms before their period had a 40% higher risk of developing hypertension over the following 20 years compared with women who experienced few menstrual symptoms. Results were strongest for women who developed hypertension under the age of 40, who had a 3-fold risk increase compared with women without PMS.
Interestingly, study participants who had high dietary intakes of B vitamins, such as thiamine and riboflavin, had significantly lower risk of developing PMS (25–35%), and therefore lower risk of developing hypertension.
What about taking contraceptives?
Oral contraceptive pills, or medications, have seen a worldwide increase in users, with numbers rising from 97 to 151 million between 1994 and 2019. In fact, in 27 countries, 20% of the reproductive-aged, pregnancy-capable individuals report their use. While they were primarily developed to prevent pregnancy, they’re also effective as treatment for a variety of disorders including menstrual disorders, endometriosis, and polycystic ovarian syndrome.
Contraceptives have long been associated with an increased risk of hypertension, especially those that contain oestrogen, such as combined hormonal birth control pills. In fact, hypertension is one of the most common potential contraindications of contraceptive pill use. However, next-generation oestrogen-containing contraceptives do not seem to exhibit this effect, although large-scale research into this is still ongoing. That said, if you are using contraceptive medication, it’s still a good idea to keep an eye on your BP and, if it does start to rise, your healthcare professional may recommend an alternative method of contraception. Or, if you already have hypertension (or a family history of hypertension) they may advise you against taking it.
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The Take Home
There is a connection between the menstrual cycle and blood pressure, as well as connections between BP and menstrual symptoms such as heavy bleeding, irregular periods, and PMS. Furthermore, the use of oestrogen-based contraceptives can cause a rise in blood pressure over time in a few cases, and it’s important to keep an eye out if you are taking these. Wearing a Hilo Band is an easy way to do this.
After initial calibration, the Hilo Band will automatically measure your blood pressure, generating over 800 measurements per month, day and night, to give you personal insights into your BP patterns and how they match your cycle. The best part? All these measurements are taken discreetly and quickly, with no input required from the user. More importantly, the Hilo Band is a CE Marked Class IIa medical device that has undergone extensive and thorough clinical validation, approved for use as a medical device in Europe and the US. In fact, the technology is based on over 20 years of research and over 120,000 users, meaning the Hilo Team are experts in blood pressure measurements and analysis.
Disclaimer: Always talk to your primary care physician or gynaecologist first if you have any questions, experience symptoms, as well as before using any home remedies. This article does not replace specialist medical advice or blood pressure measurements. It contains general information and should not be used for self-diagnosis or self-treatment. We assume no liability for the correctness of the information and advice provided nor for any typos or omissions in the text of this article.
Sources:
Overview: Periods. National Health Service (NHS), UK. https://www.nhs.uk/conditions/periods/ (Accessed March 2026)
Starting your periods. National Health Service (NHS), UK. https://www.nhs.uk/conditions/periods/starting-periods/ (Accessed March 2026)
Overview: Menopause. National Health Service (NHS), UK. https://www.nhs.uk/conditions/menopause/ (Accessed March 2026)
F. P. Dunne, D. G. Barry, J. B. Ferriss, G. Grealy, D. Murphy (1991). Changes in blood pressure during the normal menstrual cycle, Clin. Sci., 81, 515. https://doi.org/10.1042/cs0810515
H.-F. Chung, I. Ferreira, G. D. Mishra (2021). The association between menstrual symptoms and hypertension among young women: A prospective longitudinal study. Maturitas, 143, 17. https://doi.org/10.1016/j.maturitas.2020.08.006
G. D. Mishra, C. Jin, H.-S. Chan, J. Doust (2025). Trajectories of menstrual symptoms and blood pressure in midlife: a prospective cohort study on Australian women. J. Hum. Hypertens., 39, 874. https://doi.org/10.1038/s41371-025-01070-0
B. J. Van Voorhis, N. Santoro, S. Harlow, S. L. Crawford, J. Randolph (2008). The Relationship of Bleeding Patterns to Daily Reproductive Hormones in Women Approaching Menopause. Obstetrics & Gynecology, 112, 101. https://doi.org/10.1097/AOG.0b013e31817d452b
Endometrial hyperplasia. National Health Service (NHS), UK. https://www.leedsth.nhs.uk/patients/resources/endometrial-hyperplasia-2/ (Accessed March 2026)
PMS (premenstrual syndrome). National Health Service (NHS), UK. https://www.nhs.uk/conditions/pre-menstrual-syndrome/ (Accessed March 2026)
E. R. Bertone-Johnson, S. C. Houghton, B. W. Whitcomb et al. (2016). Association of Premenstrual Syndrome with Blood Pressure in Young Adult Women. J. Women’s Health, 25, 1122. https://doi.org/10.1089/jwh.2015.5636
E. R. Bertone-Johnson, B. W. Whitcomb, J. W. Rich-Edwards, S. E. Hankinson, J. E. Manson (2015). Premenstrual Syndrome and Subsequent Risk of Hypertension in a Prospective Study. Am. J. Epidemiol., 182, 1000. https://doi.org/10.1093/aje/kwv159
N. A. Cameron, C. A. Blyler, N. A. Bello (2023). Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations. Hypertension, 80, 924. https://doi.org/10.1161/HYPERTENSIONAHA.122.20018
Contraception, pregnancy and pre-eclampsia. British Heart Foundation. https://www.bhf.org.uk/informationsupport/support/practical-support/contraception-and-pregnancy (Accessed March 2026)
FRSH Guideline: Combined Hormonal Contraception. Faculty of Sexual and Reproductive Healthcare (FSRH). https://www.bhf.org.uk/informationsupport/support/practical-support/contraception-and-pregnancy (Accessed March 2026)
Hilo Band. Hilo. https://hilo.com/uk/blood-pressure-monitor/ (Accessed March 2026)
