If you’ve been around here for a while, you may remember “Jackie” from some of my previous articles.
Now remember, Jackie isn’t actually real. She’s my made-up character that I borrow whenever I need someone to help tell a story. She’s a way for me to share concepts while protecting the privacy of the very real people who inspired them.
And if you don’t remember Jackie, here’s a quick refresher. Jackie’s Story
A while back when we met Jackie, she was beginning to wonder whether she might have MCAS, or Mast Cell Activation Syndrome. At the time, she was experiencing symptoms that seemed to move around the body and change from day to day. Some foods bothered her and then didn’t. Her digestion seemed unpredictable. Her anxiety would spike without an obvious reason. Sometimes she felt fine, and other times it seemed like her body was reacting to everything.
Since then, Jackie has connected with medical professionals who specialize in MCAS and related chronic health conditions. Not only was MCAS confirmed, but she also learned that she has POTS, or Postural Orthostatic Tachycardia Syndrome. POTS can affect heart rate, blood pressure, energy levels, dizziness, temperature regulation, and exercise tolerance. Meanwhile, MCAS can contribute to histamine-related symptoms that affect digestion, skin, headaches, sleep, anxiety, and a wide variety of other body systems.
For Jackie, finally having names for some of what she was experiencing was life changing. I often think about how understanding changes the equation. Unknown often feels unsafe. When we begin to understand what’s happening, the body frequently feels a little safer. Not because the symptoms magically disappear, but because we are no longer navigating them completely in the dark.
Now that Jackie was feeling a bit safer with understanding her body more, we started looking deeper.
Like many people living with chronic health conditions, Jackie had become an excellent detective. She tracked her food. She tracked her sleep. She tracked her hydration. She tracked her energy. She paid attention to stress, digestion, headaches, environmental triggers, medications, supplements, and all the other variables that people with chronic illnesses often learn to monitor because they have to.
What she hadn’t been taught to track was any of those things alongside her hormone cycle.
No one had ever suggested looking at food reactions and cycle data together. No one had ever suggested looking at digestion and cycle data together. No one had ever suggested looking at energy, sleep, headaches, anxiety, nervous system symptoms, or chronic illness flares through the lens of where she was hormonally throughout the month.
And honestly, that’s not unusual.
Whether someone is living with chronic health issues or not, I find that many AFAB individuals have never been taught to track their symptoms alongside their hormone cycle. We are often encouraged to notice what is happening, but not necessarily when it is happening within the larger rhythm of the month.
At the same time, many healthcare providers are asking excellent questions.
Is it worse in the morning or evening? Does stress make it worse? What happens after exercise? How are you sleeping? Are symptoms related to certain foods?Does illness trigger a flare?
These are important questions because symptoms rarely happen in isolation. Understanding patterns is often one of the most helpful ways we begin making sense of what the body may be trying to communicate.
But for many AFAB individuals, there is another pattern unfolding quietly in the background every month.
And for Jackie, once she started paying attention to it, she couldn’t stop seeing it.
When Jackie began laying her symptom tracking on top of her cycle tracking, something interesting started happening.
Patterns emerged. Not every month. Not perfectly. But consistently enough that they were difficult to ignore.
Around ovulation, she often noticed that her body felt more reactive. Digestion became more challenging. Certain foods seemed harder to tolerate. Sometimes headaches appeared. Sometimes anxiety felt louder. Sometimes it was simply a feeling that her body had become more sensitive to everything around her. Sleep was also a bit rough around this time.
Then another shift would often arrive later in the month.
As she moved into the luteal phase, her digestion frequently became even more difficult to manage. Her symptoms that she now knows are from her POTS seemed more noticeable. The same activities that felt manageable a week earlier required more energy. Her overall capacity felt lower. Sometimes the most challenging days arrived in the week leading up to her cycle.
What struck me wasn’t that Jackie had symptoms at different times of the month. Many people have symptoms that vary. That’s what I made the hormone tracker for.
What struck her the most was that she had a rhythm, and it wasn’t actually random at all.
And once she saw that rhythm, it changed the questions she was asking about her body.
Honestly, it changed some of the questions I was asking too.
I think this is an important place to pause and offer a caveat.
Jackie’s pattern is Jackie’s pattern.
One of the things I’ve learned from working with AFAB individuals living with cycling bodies, POTS, MCAS, autoimmune conditions, migraines, chronic pain, and nervous system dysregulation is that there is rarely one universal experience. Some people notice symptom flares around ovulation. Others notice them during the luteal phase. Some feel their worst before menstruation, while others notice the biggest shifts during menstruation itself. Some don’t notice a hormonal pattern at all.
The goal isn’t to fit yourself into Jackie’s story.
The goal is to discover your own.
That may be one of the most important lessons I’ve learned since writing Mood & Moon. We spend so much time looking for the “right” pattern that we sometimes forget our job is simply to notice the pattern our own body is already showing us.
Another of the unexpected things that has happened since publishing Mood & Moon is that I’m already mentally collecting notes for a second edition. If you’re an author, you might understand that even as it’s going to the printer you wish you could make some other changes to your book. Until then….I’ve got my blogs!
One area that I’ve realized that didn’t make it into the original book was….chronic illness.
What?
I know.
I specialize in chronic health issues.
The truth is, it wasn’t that chronic illness wasn’t important. It was that every time I thought I had reached the bottom of the research, I discovered another rabbit hole.
As I’ve continued researching, preparing presentations, participating in podcasts, and learning from individuals living with conditions such as POTS, MCAS, Ehlers-Danlos Syndrome, migraines, autoimmune conditions, and chronic pain disorders, I’ve found myself becoming increasingly curious about hormones as a missing variable in many of these conversations.
In fact, I recently had the opportunity to talk about some of these topics on the Standing Up to POTS podcast. One of the things I appreciated about that conversation was the opportunity to discuss how hormones may influence the lived experience of chronic illness, even when they are not the root cause of the condition itself.
The more I learn, the less I think hormones are “the answer” and the more I think they may be one of several variables influencing how these conditions show up in the body. That distinction matters because the goal isn’t to reduce every symptom to hormones. The goal is to better understand how hormones may interact with all the other systems already participating in the conversation.
I often think about it like weather. If you’re planning a picnic, the temperature matters. So does the wind. The chance of rain matters. The amount of sunlight matters. Heck, even where you live matters. I’ll tell you right now that 85 degrees in Colorado feels very different than 85 degrees in Missouri. Here in Kansas City, humidity can make the exact same temperature feel completely different.
None of those variables alone determines whether you’ll have a good day outside, but ignoring one of them can leave you surprised by the outcome. The same is true in our bodies. Sleep matters. Stress matters. Nutrition matters. Hydration matters. Chronic illness matters. Hormones matter too. They may not be the entire forecast, but for many people they may be one of the weather patterns we’ve forgotten to check.
One of the reasons Jackie’s experience caught my attention is because researchers have been exploring many of the same questions.
A 2025 review examining the relationship between estrogen and mast cells discussed how estrogen appears capable of influencing mast cell activation and histamine release through receptors located directly on mast cells (Wang et al., 2025). Researchers have also continued exploring how these hormone-immune interactions may contribute to symptom fluctuations in conditions such as allergies, asthma, endometriosis, migraines, and mast cell disorders.
For some individuals, ovulation appears to be one of those windows worth paying attention to.
Ovulation represents one of the highest estrogen points of the month, and for some people with histamine sensitivity or MCAS, that may correspond with increased body reactivity. This can show up as digestive changes, headaches, flushing, itching, sleep disruption, anxiety, or simply a feeling that the body is less tolerant of things that normally feel manageable. Earlier research examining female sex hormones and mast cell function has also suggested that estrogen and progesterone may influence mast cell behavior in ways that help explain why some people experience cyclical symptom changes (Zierau et al.).
Not everyone experiences this.
But enough people report similar patterns that researchers have started paying attention.
Interestingly, many people living with MCAS noticed these patterns long before researchers began studying them. In some ways, the science may simply be catching up to what many individuals have already been observing in their own bodies.
The same curiosity exists within the POTS community.
Researchers have been documenting menstrual cycle-related symptom fluctuations in POTS for years. More recent reviews continue to explore how reproductive hormones influence blood volume regulation, vascular tone, and autonomic nervous system functioning. A 2026 review examining hormones and POTS highlighted that many individuals report symptom changes throughout reproductive transitions and across the menstrual cycle itself (Blitshteyn, 2026).
Because POTS involves many of these same systems, researchers have become increasingly interested in understanding how hormone fluctuations may influence symptom severity throughout the month.
For some individuals with POTS, the luteal phase appears to be one of the more challenging times of the month. As progesterone rises following ovulation, some people report increased fatigue, dizziness, exercise intolerance, elevated heart rate, brain fog, or greater difficulty regulating energy and physical activity. Long-term POTS research has also documented significant menstrual concerns and hormone-related symptom fluctuations among many individuals living with the condition (Boris et al., 2025).
Again, this doesn’t mean hormones cause POTS.
It means hormones may influence how POTS shows up in the body.
And that is a very different conversation.
Interestingly, this is where Jackie reminds us why tracking matters. Some studies suggest symptoms may worsen around menstruation or during the late luteal phase. Jackie noticed shifts around ovulation and again during the luteal phase. Neither observation is necessarily wrong. It simply highlights the reality that individuals experience these conditions differently, which is exactly why tracking your own patterns is often more useful than trying to follow someone else’s.
When I think about Jackie now, what stands out to me isn’t that we found the answer.
We didn’t.
She still has MCAS.
She still has POTS.
She still has days where her body surprises her.
What changed was that her symptoms stopped feeling completely random.
Once she began layering her cycle data on top of everything else she was already tracking, she started seeing rhythms she had never been taught to look for. She wasn’t just noticing what she ate, how she slept, or whether she was hydrated. She was also noticing where she was in her cycle and how those hormonal shifts seemed to interact with everything else happening in her body.
That didn’t solve the puzzle overnight.
But it gave her another piece of it.
And honestly, that’s how I feel about this entire topic.
The more I learn about hormones, chronic illness, histamine, the autonomic nervous system, and mental health, the less interested I become in finding a single explanation for why someone feels the way they do. Human beings are simply too complex for that. What interests me is understanding how these systems interact and how changes in one system may create ripple effects throughout the rest of the body.
Maybe that’s why I already find myself thinking about a second edition of Mood & Moon.
For now, my hope is simply that this gives you another question to ask.
Not just, “How am I feeling today?”
But also, “Where am I in my cycle?”
Because sometimes the body isn’t being random at all. Sometimes it’s following a pattern we were never taught to see.
And remember, you can get your free tracker to start tracking your symptoms here…
Wang, J., et al. (2025). Unravelling the Intricate Link: Mast Cells and Estrogen.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12509920/
Blitshteyn, S. (2026). Postural Orthostatic Tachycardia Syndrome, Menopause and Hormones.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12941859/
Boris, J.R., et al. (2025). The Long-Term Postural Orthostatic Tachycardia Syndrome Study.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12283190/
Zierau, O., et al. Role of Female Sex Hormones in Mast Cell Function.
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