PMS And Premenstrual Depression

PMS, also called premenstrual syndrome, is a group of symptoms that occurs one to two weeks before a woman gets her period. Almost 90% of women experience some form of PMS, but the kind and severity of the symptoms can vary widely from person to person. PMS can have both physical and emotional components and is thought to be a result of the natural fluctuations in hormone levels that occur between ovulation and menstruation.

Perhaps you have wondered for some time if you or someone you know is experiencing depression that may be connected to PMS. After all, fluctuations in hormone levels can be connected to changes in mood. Ahead, we’ll discuss the symptoms of PMS in addition to treatment methods that can potentially alleviate depressive symptoms connected to it.

What are the symptoms of PMS?

While symptoms of PMS can vary widely between individuals, there are a few common symptoms. Some people may experience most of these symptoms, while some might experience only a few. The severity of the symptoms can also vary. Symptoms of PMS may change throughout a person's lifetime, especially after adolescence, after childbirth, and when approaching menopause.

Physical symptoms may include swollen, tender breasts, cramps, bloating, appetite changes, headache, backache, fatigue, and lowered libido. These symptoms can range from mild to debilitating, depending on the individual. Emotional symptoms may include irritability, mood swings, and feelings of sadness or depression. While PMS is often stereotypically associated with irrational emotional outbursts, it can manifest in a variety of different ways.

What is premenstrual depression?

Premenstrual depression, also called premenstrual dysphoric disorder (PMDD), is similar to PMS but much more severe.

PMDD includes many of the symptoms associated with PMS, as well as symptoms of depression, including irritability, mood swings, feelings of sadness, withdrawal from friends and family, fatigue, and anxiety. The emotional symptoms associated with PMDD are generally much more severe and can significantly negatively affect a person's life during the two-week span in which they occur. In especially severe cases, people can even experience suicidal ideation* and other serious mental health issues.

*If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7.

While PMDD differs from PMS mostly in the intensity of the symptoms, PMDD differs from depression in that it only occurs at a particular time in a woman's monthly reproductive cycle. Symptoms of PMDD usually go away during or after menstruation and do not return for several weeks. For those who already have depression and other mental health issues, PMDD can exacerbate and intensify existing mental illness.

How to treat PMS

Anyone who's ever had a period may be familiar with strategies for treating PMS, from herbal medicine to medications prescribed by a doctor. PMS treatment can include a variety of methods, depending on the severity of the symptoms.

Exercise

While exercise might be the last thing on your mind when you're feeling under the weather, it can do a great job of fighting many of the typical symptoms of PMS. Exercise can help soothe physical symptoms like cramps and muscle aches. Physical activity can also have a positive impact on mental health and can even help stave off feelings of anxiety and depression. Exercise is a good idea at any time of the month, but it may be an especially good idea when you start to feel symptoms of PMS.

Eat well

When you're about to get your period, it can be tempting to satisfy your cravings for junk and comfort food. But while it's okay to indulge a little, foods high in fat and sugar can make your PMS symptoms worse. Eating healthy, whole foods can help to combat PMS, especially just before your symptoms start to kick in. Foods high in calcium, magnesium, vitamin B6, and polyunsaturated fatty acids like omega-3 and omega-6 have also been shown to help reduce PMS symptoms. Try incorporating foods like dairy, fruit, nuts, fish, and leafy greens into your diet to reap these positive benefits.

Apply heat to sore areas

For relief from physical symptoms, try applying heat and pressure to places where you're experiencing cramps or aches and pains. A hot water bottle is an easy, affordable option that does a great job of soothing PMS symptoms. You can also use a microwaveable hot pad or heated blanket. As an added measure, a hot cup of tea can warm you from the inside out and help promote calm and relaxation.

Get enough rest

Rest is important at any time of the month but is especially so when you're about to get your period. Lack of sleep can exacerbate any mental and emotional symptoms of PMS you might be experiencing, so it's a good idea to get a full night's sleep. If you're feeling especially under the weather, an afternoon nap can also help you rest and recuperate.

Use over-the-counter pain relief

Over-the-counter pain relief can help ease physical symptoms like headache, backache, and cramps. If your physical symptoms are severe, prescription pain medications are also available to help mitigate the effects of PMS.

Take birth control pills

Some hormonal birth control methods can help prevent or lessen both physical and emotional PMS symptoms. The symptoms of PMS and the effects of various methods of birth control can vary widely from person to person, and some birth control methods can even intensify symptoms, so it's best to consult with a doctor and find the method that works best for you.

Ask a psychiatrist about antidepressants

For emotional symptoms of PMS, doctors can prescribe antidepressants to be used while symptoms persist. SSRIs, or selective serotonin reuptake inhibitors, are one of the more common antidepressants used to treat PMS. As with birth control, different people respond differently to different medications, so some trial and error may be necessary to find a strategy that works best for you.

The good news about PMS symptoms is that they usually go away on their own within a few days after the start of menstruation. While treatment strategies are often unique to each, there are many ways to manage the emotional and physical symptoms of PMS.

How to treat PMDD

While most people who get periods experience some form of PMS, far fewer experience the intense emotional symptoms that constitute PMDD. While it's unclear why only certain people experience PMDD, it may be linked to different levels of hormones and neurotransmitters in the brain. PMDD symptoms are usually debilitating enough to cause significant impairment to daily functioning during the period in which they occur. Treatment options for PMDD include those for PMS but may also feature additional measures.

Medical diagnosis

If you think you might be experiencing PMDD, it's important to get a medical diagnosis to gain the widest possible range of treatment options. Doctors can evaluate whether you might have PMDD based on the number, severity, and duration of your symptoms. If you're not sure whether you have PMDD or depression, a doctor can also help determine whether your menstrual cycle is exacerbating underlying mental health issues.

Birth control

Just like for PMS, hormonal birth control can be an effective way of managing the symptoms of PMDD. Research is still ongoing concerning the effects of various hormones on PMDD, and it's still not clear the extent to which different methods of birth control might be effective in treating symptoms. Depending on the individual, hormonal birth control methods that feature progesterone, estrogen, and GnRH agonists can all affect hormone levels in ways that might mitigate the symptoms of PMDD. Hormonal birth control methods often include various combinations of these hormones, with different brands having varying amounts.

Antidepressants

Antidepressants called SSRIs have been shown to have a positive effect on symptoms of PMDD. While the causes of PMDD are still unclear, researchers theorize that it may be connected to serotonin levels in the brain, making SSRIs uniquely effective at combatting the emotional symptoms of PMDD. People can often take antidepressants intermittently depending on the severity of their symptoms and the length of their cycle.

Just as with PMS, PMDD is usually only temporary, lasting one to two weeks at the end of the menstrual cycle. PMDD symptoms can be more severe and even life-threatening in some cases, so they should be taken seriously and treated medically when necessary.

The benefits of online therapy

If you are experiencing concerning symptoms related to PMS, PMDD, or depression, then therapy may be a helpful place to explore solutions. Online therapy is a particularly appealing option for many people who have busy schedules and may benefit from the flexibility in appointment scheduling that platforms like BetterHelp afford. Additionally, users can schedule appointments from a preferred location, if there is a strong internet connection. Whether you’re experiencing cramps, mood swings, or other symptoms, there’s no need to leave the comfort of your own bed, should that be the ideal place to attend a therapeutic session.

It's true that studies have affirmed online therapy’s effectiveness in treating people who experience symptoms of PMDD. In one 2019 study, 174 women with PMDD were randomized to a treatment group or waitlist control group. Those in the treatment group participated in an eight-week therapist-guided treatment course if internet-based cognitive behavioral therapy (iCBT). Evidence was taken before and after treatment, and at six months post-intervention. Researchers concluded that iCBT was highly effective in reducing the burden of PMDD and useful in adding coping styles and stress management.