Is It PMS? Anxiety And Your Period
By: Corrina Horne
Updated January 28, 2021
Half the population experiences having a period, or has had a period at some point in their lives. Despite this, many people are unclear on exactly how everything works, ranging from the basic biological process to the hormonal and corresponding neurological shifts that occur during and following menstruation. While the term "PMS" is used broadly-and is often used negatively to discount a female's emotions or experiences-it actually refers to a specific set of occurrences during a menstrual cycle.
Far from being a negative, Premenstrual Syndrome is a direct result of biological processes that occur during your menstrual cycle. While it has been shrouded in embarrassment, frustration, or shame, experiencing PMS is not something to be embarrassed about. It is far more "normal," statistically than not experiencing symptoms at all during your menstrual cycle. PMS is often a normal, natural part of having a cycle, and is not necessarily an indication of ill health or imbalance.
What Occurs During Your Menstrual Cycle?
During your period, your body is breaking down all of the blood lining the wall of the uterus and any present tissue, and expelling this matter. During this time, hormones take a sharp nosedive. Low levels of estrogen and progesterone contribute to biological and mood changes in the body and brain, which can lead to feelings of irritability, anxiety, or depression. As your period continues and the lining of your uterus sheds, your uterus develops follicles, or fluid-filled pockets. These pockets will assist your body in hormone production as your cycle progresses.
Once your period has finished, your hormones experience a continual rise. This rise in hormone levels will work in tandem with biological factors to grow and produce an egg, which can be fertilized and could result in pregnancy once fertilized. If the egg is not fertilized, it is expelled alongside the blood once again lining the uterine wall during your next period.
During your cycle, your uterus grows and shrinks, as well. What may appear as bloating may actually be your uterus swelling due to hormonal shifts, and will dissipate as your cycle progresses. Unless it is accompanied by gas, gastrointestinal distress, diarrhea, or constipation, PMS-related bloating does not require medication. If, however, you do experience constipation, diarrhea, or another form of GI upset during your cycle, this could be a symptom of PMS or PMDD.
What is PMS?
PMS, or Premenstrual Syndrome, is a series of symptoms women often experience for 1-2 weeks preceding their period. These symptoms can be mild, such as mild bloating and sleepiness, or can be severe, such as intense bouts of depression, anxiety, and headaches. PMS is not uncommon; approximately 90% of women report some form of PMS prior to their period. PMS symptoms can persist well into your period, as well; symptoms usually do not subside entirely until 2-3 days following the conclusion of your cycle.
PMS symptoms are generally linked to the fall in hormone production leading up to your period, particularly after ovulation has occurred; hormones are at peak production during ovulation, and the corresponding dip can create symptoms of Premenstrual Syndrome. PMS is not necessarily cause for concern, and does not usually require medical or psychological intervention.
How is Anxiety Related?
Hormone production plays a significant role in mood and behavior overall. Hormone levels rising and falling will likely have a significant effect on your mood and your ability to regulate emotions, which can trigger symptoms of depression, anxiety, irritability, or sadness. During low hormone production stages of your cycle, things that might not typically cause distress can be extremely upsetting. Some women experience powerful bouts of anger, while others might feel exhausted or even lethargic during their cycle. The combination of ill physical feelings and difficulty regulating emotional states can create a cocktail of anxiety for women.
Anxiety might not appear to have a trigger or can be triggered by all manner of things from one's physical appearance to the state of your finances. The catalyst might not matter as much as the stage of your hormone production does. Anxiety can also develop while you wait for your period. If symptoms are severe, you may experience fear or dread leading up to your period, which can aggravate existing symptoms. Talk therapy could be of benefit with this particular type of anxiety, as a therapist can help you develop tools to deal with fear surrounding your PMS symptoms.
Psychologists and medical doctors can also help you let go of any unhealthy narratives you might have surrounding PMS or PMDD, as some women have been told their behavior is their own fault, regardless of these conditions. As a medical perspective can attest, this is often not the case, and pervasive depression, irritability, anxiety, and fatigue are both physically and neurologically driven and are not a simple matter of choice.
What Is PMDD?
Premenstrual Dysphoric Disorder is a diagnosed condition some women may experience during their menstrual cycles. As stated above, hormone production experiences a spike and a drop each month during a woman's cycle, and for some women, these spikes and valleys can create overwhelming, intense symptoms. These symptoms, though they might fall under the umbrella of PMS, are usually far more intense than the standard feelings associated with PMS.
PMDD symptoms include extreme irritability, despair, anxiety, mood swings, difficulty focusing, binge eating or fasting, and the physical symptoms that often accompany PMS. Women suffering from PMDD might have thoughts of suicide or experience panic attacks. Although the symptoms typically reside 2-3 days following the conclusion of a period, the effects of PMDD can be lasting, as anxiety surrounding your menstrual cycle can persist.
Is All PMS PMDD?
No. Premenstrual Dysphoric Disorder is identified by its severity. PMS symptoms can be mild, but PDD symptoms are, by definition, severe. PMS can certainly turn into PMDD. While PMS affects 90% of women, PMDD is estimated to affect only 2-10% of women, and is both uncommon and largely misunderstood. Because PMDD might not immediately be recognized as a condition related to your menstrual cycle, it may be misdiagnosed as General Anxiety Disorder, or Major Depressive Disorder.
Is There a Cure for PMDD?
Although there are no definite cures for PMDD, aside from removing the menstrual cycle altogether, through surgery or upon reaching menopause, there are methods to treat PMDD, including pharmaceutical interventions, therapy, and dietary and lifestyle changes.
Antidepressants may be necessary to eliminate symptoms of PMDD-particularly in severe instances, when suicidal thoughts and major depressive episodes are present. Anti-anxiety medications may also be of use to women experiencing PMDD. Doctors may also want to prescribe birth control or alter existing birth control to work to more effectively regulate hormone production, so you do not experience dramatic highs and lows during your menstrual cycle.
Therapy can help you develop coping tools to deal with the depression, anxiety, and panic that occurs during two weeks of the month. These can include meditation, breathing exercises, or even simple talk therapy, all of which can help you reduce the symptoms of PMDD.
Finally, some studies have demonstrated a link between improved eating habits-specifically, reducing intake of sugar and processed foods-a more consistent exercise, and a decrease in symptoms of PMDD. These interventions do not require a dramatic overhaul of your lifestyle; instead, they require that you add more healthy, whole foods into your diet (think fruits, vegetables, lean meats, fish, and whole grains), and add at least 30 minutes of activity to your day. Some estimates have even determined that as little as 10 minutes of physical activity per day can have a positive effect on your health and overall wellness.
PMDD often affects women with existing anxiety or depression more than the general population. You may be at increased risk for developing PMDD if you have a diagnosed anxiety or depressive disorder, or have had one in the past. This is why it is important to take note of any changes you notice in your body or mental state during your cycle; a doctor will be best able to help you if your symptoms are clearly tracked.
When to Seek Help
While PMS does not typically require medical or psychological intervention, the severity of PMDD necessitates help. To receive a diagnosis, your doctor will conduct a physical examination, followed by an assessment of your experiences and the timeline of your symptoms. Keeping careful track of the time of month and frequency of your symptoms will help your doctor identify the likelihood of PMDD, versus a standard diagnosis of anxiety or depression.
Seek help if, at any point, thoughts of suicide arise, panic attacks become frequent and unbearable, or anxiety reaches a debilitating point. While some mood shifts and spikes are normal during your period, being unable to function physically or emotionally is neither healthy nor typical during a woman's menstrual cycle. Both a medical doctor and psychologist can be of help to find a PMDD diagnosis, as symptoms can be both neurological and physical.
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