Is It PMS? Anxiety And Your Period

Approximately half the population experiences the menstrual cycle. Despite this fact, many people remain unclear on the hormonal and neurological shifts that occur during and following menstruation. Premenstrual syndrome (PMS) is a group of symptoms that can happen during the premenstrual period. More severe symptoms sometimes qualify for a premenstrual dysphoric disorder (PMDD) diagnosis.

Severe anxiety, mood swings, and similar symptoms can be a part of both PMS and PMDD. These can often be treated with medications and lifestyle adjustments such as dietary changes and regular aerobic exercise. Working with a therapist or another licensed mental health professional can help you determine how best to manage anxiety related to the menstrual cycle.

What occurs during your menstrual cycle?

The menstrual cycle is a process in which a biologically female body breaks down and expels tissues lining the uterine wall. This causes hormone levels to drop dramatically. Low estrogen and progesterone levels tend to contribute to biological and mood changes in the body and brain, which can lead to irritation, depression, and anxiety. Serotonin levels also tend to drop during this time.

As your menstrual cycle continues, the uterus develops follicles or fluid-filled pockets. These pockets typically assist your body in hormone production as your cycle progresses.

After the shedding of the uterine lining, the luteal phase begins. During this 10- to 16-day period, hormone levels rise. This rise in hormone levels typically works in tandem with biological factors to thicken the uterine walls and produce an egg, which, if fertilized, can result in pregnancy. If the egg is not fertilized, it will be expelled along with the uterine lining during your next period. Heightened levels of hormones can cause an individual to experience symptoms that resemble anxiety disorders, such as increased irritability and mood swings. Taking steps to reduce anxiety during this time can be helpful.

During your cycle, your uterus usually grows and shrinks as well. What may appear as bloating may actually be your uterus swelling due to hormonal shifts and will likely dissipate as your menstrual cycle progresses. Unless it is accompanied by gas, gastrointestinal distress, diarrhea, or constipation, bloating as a result of PMS generally does not require medication. 

Experiencing heightened levels of anxiety before your period begins is a common phenomenon for many individuals, often attributed to hormonal fluctuations during the premenstrual phase. However, if you do experience constipation, diarrhea, or another form of gastrointestinal tract upset during your cycle, you may be at an increased risk of PMS or PMDD.

What is premenstrual syndrome?

Premenstrual syndrome (PMS) is usually defined as a group of mental and physical symptoms that people might experience for one to two weeks preceding their periods. These symptoms can be mild, such as mild bloating, breast tenderness, and sleepiness, or can be severe, such as intense bouts of depression, anxiety, and headaches. 

PMS is relatively common; approximately 90% of people with a menstrual cycle report symptoms as a result of PMS prior to their periods. PMS symptoms can persist well into your period, as well — symptoms usually do not subside entirely until two or three days following the conclusion of your cycle.

PMS symptoms are linked to the fall in hormone production leading up to your period, particularly after ovulation has occurred. Hormones are normally at peak production during ovulation, and the subsequent dip can create symptoms of PMS.

PMS is not necessarily a cause for concern and does not usually require medical or psychological intervention.

Can premenstrual syndrome cause anxiety?

Hormone production often plays a significant role in mood and behavior overall. Hormonal fluctuations will likely have a significant effect on your mood and your ability to control emotions, which can trigger hallmark symptoms of depression, anxiety, irritability, or sadness. 

However, hormonal changes may not be the only cause of premenstrual anxiety. According to one study, hormones, environmental stressors, and genetics can all interact to cause anxiety spikes before and during a period.

Premenstrual anxiety may be triggered by several factors, or it might not appear to have any specific trigger. The catalyst might not matter as much as the hormone production stage does. 

Anxiety can also develop while you wait for your menstrual cycle. If symptoms are severe, you may experience fear or dread prior to getting your period, which can aggravate existing symptoms. Talk therapy can be a great option for this particular type of anxiety. A therapist can help you develop tools to cope with fear surrounding your PMS symptoms.

What is premenstrual dysphoric disorder?

According to the U.S. Department of Health and Human Services, premenstrual dysphoric disorder (PMDD) is a diagnosable condition where hormone production experiences a spike and a drop each month during a person’s cycle, and for some people, these spikes and valleys can create intense symptoms.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, PMDD may be diagnosed when the following conditions are met.

First, one of the four following emotional symptoms must be present:

• Noticeable mood swings or emotional sensitivity.
• Severe irritability or anger or increased relationship troubles.
• Markedly depressed mood or feelings of hopelessness or worthlessness.
• Increased anxiety or tension.

In addition to these symptoms, an individual with PMDD might also experience at least one of the following symptoms, but between the two lists, a total of five symptoms must be clinically observed for a PMDD diagnosis:

• Loss of interest in activities.
• Difficulty focusing.
• Tiredness and low energy.
• Food cravings, appetite changes, and weight gain or loss.
• Hypersomnia or insomnia.
• Overwhelm.
• Physical symptoms, such as breast tenderness, bloating, or muscle pain.

It can be important to note that some individuals with PMDD experience even more severe symptoms, such as thoughts of suicide or panic attacks. 

To count toward a PMDD diagnosis, the physical and psychological symptoms listed above must not be caused by other health conditions and must be severe enough to have a negative impact on your daily life. 

Is there a cure for premenstrual dysphoric disorder?

Although there may not be any definite cures for premenstrual dysphoric disorder, there may be effective methods to treat symptoms, including pharmaceutical and therapeutic interventions. If you are having difficulty with severe depression, anxiety, or other psychiatric symptoms related to your menstrual cycle, you can seek the guidance of a medical doctor or psychiatrist. 

In some cases, antidepressants or anti-anxiety medications may be employed to alleviate symptoms of premenstrual dysphoric disorder, particularly in severe instances when suicidal thoughts and major depressive episodes are present. Doctors may prescribe hormonal birth control to help balance hormone production and curb extreme highs and lows during the menstrual cycle.

A few studies confirm a link between a healthy diet, consistent aerobic exercise, and a decrease in symptoms of PMDD. Some estimates have even determined that as little as 10 minutes of physical activity per day can boost serotonin levels and have a positive effect on stress management levels and overall health and wellness. Keeping a regular sleep schedule can also be crucial for mood control. Additionally, focusing on relaxation techniques during your menstrual cycle, such as incorporating mindfulness and meditation into your daily life, can reduce the likelihood of anxiety and depression symptoms.

It has been suggested that regular use of evening primrose oil can help normalize the menstrual cycle due to its high concentration of an omega-6 fatty acid called gamma-linolenic acid (GLA). GLA may also help alleviate symptoms of PMDD and other symptoms related to a hormone imbalance.

Talk to a medical health professional about your medical history. You may be at an increased risk for developing PMDD if you have a diagnosed anxiety or mood disorder or have had one in the past. Taking note of any changes you notice in your body or mental state during your cycle can be a helpful way to be aware of early signs of an anxiety or mood disorder. Keeping a record of your symptoms can help your healthcare provider create an effective treatment plan.

When to seek help

Seek help if thoughts of suicide arise, panic attacks become frequent, or anxiety levels reach a debilitating point. While some mood shifts and spikes can be common during your menstrual cycle, being unable to function physically or emotionally is neither healthy nor typical during the menstrual cycle. 

Keeping careful track of the time of month and frequency of your symptoms can help your doctor identify the likelihood of PMDD versus a diagnosis of other anxiety or depressive conditions.

Additionally, online therapy can allow you to speak with a licensed therapist from the comfort of your own home. Using platforms like BetterHelp, you can also send your therapist a message at any time via in-app messaging, which may be helpful if you’re navigating symptoms of PMDD. One study explored how online cognitive-behavioral therapy (CBT) affected symptoms of depression and anxiety. Researchers found that participants typically experienced significant reductions in symptoms over time, leading them to conclude that online therapy could produce “sustained and clinically meaningful improvements.”