PMS Anger: Symptoms, Mood Swings & Mental Health Explained

Anger and irritability can be common PMS symptoms, typically occurring due to hormonal fluctuations that influence neurotransmitters involved in mood regulation. For some individuals, emotional sensitivity during PMS may include anger or irritability. While these feelings can be intense, they often reflect nervous-system changes and heightened vulnerability rather than character flaws. Here, you’ll find a guide to PMS anger, including why it occurs, causes and risk factors, and practical strategies for managing symptoms and maintaining emotional balance, including working with a therapist.

PMS anger vs PMDD anger

In general, symptoms occur due to the hormonal changes that happen in the final phase of the menstrual cycle, known as the luteal phase. During this time, estrogen levels usually fall, and progesterone levels rise. This often impacts neurotransmitters that affect mood regulation. This can cause or worsen mental and emotional challenges. 

What PMDD is and how it differs from PMS

In some individuals, these effects may be especially pronounced, leading to a more severe form of PMS known as premenstrual dysphoric disorder (PMDD). PMDD affects up to 10% of people who have periods.

How is PMDD different from PMS? While they do share some overlapping symptoms, PMDD is a serious disorder that can have a significant impact on a person’s life. It is usually characterized by more intense psychological PMS symptoms. While PMS symptoms, like low energy, food cravings, and weight gain, can be disruptive, they are typically manageable. Symptoms of PMDD, on the other hand, are typically severe enough to interfere with daily life.

DSM criteria and mood symptom requirements

PMDD is identified as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Symptoms of PMDD include: 

• Marked depressed mood
• Marked anxiety
• Marked affective lability (mood swings)
• Marked irritability or anger, or increased interpersonal conflicts.
• Decreased interest in usual activities
• Difficulty in concentration
• Lethargy, or marked lack of energy
• Marked changes in appetite
• Sleep disturbances
• A sense of being overwhelmed
• Breast tenderness or swelling, joint or muscle pain, and other physical symptoms

According to the DSM, for a diagnosis, an individual must exhibit five of these symptoms (including at least one mood-related symptom) “in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.” These symptoms must also affect your ability to function in your daily life and not be related to another condition.

How is PMDD diagnosed?

If you feel you are experiencing symptoms of PMDD, talk to a healthcare professional. 

There are a few diagnostic tests for PMDD. To diagnose PMDD, a clinician may obtain a health history, family history, and perform a physical and pelvic exam, and they may refer you to a mental health professional. Keeping track of your symptoms as they relate to your menstrual cycle can also help, and you may need to provide information that covers several months. Generally, to be diagnosed with PMDD, you must experience five or more of the above-listed symptoms during most menstrual cycles.

PMS anger and irritability: Causes and risk factors

PMS anger and irritability are primarily driven by hormonal fluctuations in people of childbearing age who have periods, but they can be influenced by factors like stress, physical health, and overall socioemotional function.

Hormonal fluctuations

The hormonal fluctuations during the luteal phase, particularly the drop in estrogen and the rise and fall of progesterone, can disrupt neurotransmitters, like the brain chemical serotonin, which typically regulates mood. When hormone levels drop, this imbalance can lead to irritability, as lower serotonin levels usually make it harder to manage stress and emotional responses.

Stress

The hormonal changes that occur during PMS can lower resilience to stress. Everyday irritations or stressful events, which might otherwise be manageable, may contribute to anger, irritability, and emotional outbursts. One study found that online stress management training could decrease the psychological symptoms of PMS. 

Pre-existing mental health conditions

Mental health conditions can exacerbate the psychological symptoms of PMS. For example, one systematic review and meta-analysis found high comorbidity rates between PMDD/PMS and mood disorders, including major depressive disorder, bipolar disorders, persistent depressive disorder, and cyclothymic disorder.

How to control PMS anger: 8 evidence-based tips

PMS-related anger can seem overwhelming, but by implementing healthy coping skills and prioritizing physical and mental self-care practices, you may be able to maintain emotional balance throughout your cycle. Consider the following evidence-based strategies for managing PMS anger and irritability.

1. Track your periods and moods

A good first step may be to track your moods and habits throughout your cycle. You might also consider keeping a daily journal to record other factors that may influence your state of mind, such as life stressors, interpersonal conflicts, or health issues. This can enhance self-awareness and give you a detailed understanding of how your emotional state correlates with your menstrual cycle.

2. Use anger management techniques

Learning effective coping strategies can be essential in managing the emotional symptoms of PMS. Consider exploring different anger management techniques to add to your self-care toolkit, such as deep breathing exercises, mindfulness meditation, and cognitive reframing. These strategies can help you calm down and regain mental clarity when anger and mood swings occur.

3. Get plenty of exercise

Research suggests that exercise can help alleviate PMS symptoms. Regular exercise typically releases mood-boosting endorphins, helps you get enough sleep, and reduces stress levels, which can help with emotional regulation. You might try to make time for daily exercise, particularly during your luteal phase. You can also use exercise to help you process anger, such as by going for a walk when you feel frustrated. 

4. Maintain nutritious eating habits

Research has found a link between eating habits and PMS symptoms, with evidence suggesting that processed, high-carbohydrate, and high-fat foods may increase the risk of PMS symptoms. In contrast, unprocessed, nutrient-dense foods may maintain stable blood sugar levels, promoting mood regulation and healthy sleep patterns.

5. Implement mindfulness practices

Mindfulness is a mental skill that can help you maintain emotional control and remain grounded in the present moment. One study found that women who scored higher on measures of mindfulness usually experienced significantly lower levels of PMS severity. Mindfulness practices like meditation, yoga, and deep breathing can help you develop this skill and effectively manage your emotions. 

6. Vitamins and supplements

Studies have found that calcium, vitamin D, and vitamin B6 can help alleviate symptoms of PMS and PMDD. Consider prioritizing foods rich in these nutrients, such as the following:

• Leafy greens, dairy products, and fortified plant-based milks (calcium) 
• Fatty fish and egg yolks (vitamin D)
• Bananas, chickpeas, and poultry (vitamin B6)

7. Consider therapy

Cognitive behavioral therapy (CBT) may improve emotional symptoms of PMS and PMDD. This type of therapy usually focuses on identifying cognitive distortions and learning more helpful ways of thinking. You’ll also learn healthy coping skills, work toward beneficial self-care habits, and identify any underlying mental health conditions that could be worsening your PMS symptoms. 

8. Talk to your doctor

It may be worth discussing your PMS symptoms with your doctor. They may prescribe medications like oral contraceptives, which can regulate hormone levels, help control physical symptoms, and improve PMS symptoms. If your provider diagnoses you with PMDD, they may refer you to a psychiatrist, who can prescribe other forms of medication. Your psychiatrist may also recommend that you attend therapy.

Premenstrual exacerbation (PME): How PMS can worsen depression and anxiety

Premenstrual exacerbation (PME) is a term generally referring to the worsening of existing mental health conditions, such as depression and anxiety, during the luteal phase of the menstrual cycle. While PMS commonly affects mood and emotional regulation, individuals with PME may experience heightened symptoms of their underlying conditions, making it more challenging to cope. 

If you have an underlying mental illness and experience severe PMS symptoms, it may be advisable to discuss your concerns with a doctor, as well as your mental health provider. Your doctor may prescribe medication, such as antidepressants or hormonal birth control, to help stabilize your mood or hormone levels, as well as offer guidance on managing your symptoms with lifestyle changes.

Online mental health support for PMS, PME, and PMDD

For those struggling with severe PMS, including premenstrual dysphoric disorder and premenstrual exacerbation, online mental health support can be an invaluable resource. Through virtual therapy platforms like BetterHelp, you can attend weekly therapy appointments with a licensed mental health professional trained in evidence-based CBT and anger management techniques.

Online therapy can be just as effective as in-person treatment, and it may be preferable for those in need of a convenient and cost-effective way to access mental healthcare. With tools and features like digital CBT worksheets, guided journaling, and group sessions, you can get the most out of your mental health investment.