Premenstrual syndrome (PMS) affects a high percentage of women of childbearing age, with many women feeling mood changes in the days before menstruation. And while menstrual symptoms like irritability, anger, and mood swings are a monthly bother for most women, severe PMS can be emotionally debilitating for some. Fortunately, treating PMS with medication and lifestyle changes can help women control mood changes and other emotional difficulties.
A Roller Coaster of Emotions
PMS can cause wild, uncontrollable mood swings in some women, who may go from crying spells to angry outbursts and anxiety attacks, then back to a stable emotional state — all in one day.
“You’ll know these emotional ups and downs are due to PMS if they start consistently a week to two weeks before your period and stop a day or two after menstruation starts,” says New York City gynecologist and fellow of the American College of Obstetricians and Gynecologists, Carol Livoti, MD. PMS symptoms, including mood swings, occur during the last (luteal) phase of the menstrual cycle, which starts after ovulation — typically day 14 to 28 of a woman’s monthly cycle. Once menstruation starts, mood swings usually disappear.
The most common emotional PMS symptoms are:
- Feeling nervous and anxious
- Alternating sadness and rage
Getting to the Root of PMS Mood Swings
Although researchers don’t know exactly why PMS strikes, these emotional disturbances are thought to be connected to the rise and fall of hormones, specifically estrogen, throughout the menstrual cycle. Estrogen levels begin to rise slowly just after a women’s period ends, and it peak two weeks later. “Then estrogen levels drop like a rock and begin rising slowly before dropping again just before menstruation starts,” explains Livoti. These hormonal peaks and valleys are thought to cause mood swings and other menstrual symptoms.
“Stressful situations, such as a divorce or job loss, don’t cause PMS, but they can make it worse,” adds Livoti. Some research suggests that female hormones interact with brain chemicals in a way that can affect mood in those with PMS. “Reduced levels of estrogen during the luteal phase of the cycle could possibly cause a drop in serotonin, although more research needs to be done to confirm this link,” says Livoti. Lower serotonin levels are associated with depression, irritability, and carbohydrate cravings, all of which can be PMS symptoms.
Severe PMS: Beyond Run-Of-The-Mill Mood Swings
Between 3 and 8 percent of menstruating women have an even more severe condition called premenstrual dysphoric disorder (PMDD). These women become seriously depressed a week or two before their periods. “With PMDD, major depression and extreme irritation are the foremost symptoms,” says Livoti. “PMS is milder and usually involves physical menstrual symptoms, as well as emotional ones.”
Women with a family history of depression or who have previously experienced postpartum depression are at increased risk for PMDD, which is included on the American Psychiatric Association’s list of mental illnesses (the Diagnostic and Statistical Manual of Mental Disorders). To be diagnosed with PMDD, a woman must have at least five of the following symptoms around the time of her period:
- Deep sadness or despair, with possible suicidal thoughts
- Lasting irritability and anger, which may include frequent outbursts at loved ones
- Feelings of tension or anxiety
- Panic attacks
- Mood swings
- Disinterest in daily activities and relationships
- Trouble thinking or focusing
- Feeling out of control or overwhelmed
- Low energy
- Food cravings or binge eating
These symptoms will disappear shortly after menstruation starts. “If they last all month, that’s not PMDD,” says Livoti. Instead, another mental or physical illness may be the cause.
Treating PMS Symptoms, From Mild to Severe
For many women, lifestyle changes can be a successful part of PMS treatment. For women with severe PMS, medication may be needed. The following PMS treatment options can help stabilize mood swings and improve a woman’s emotional health in the weeks before menstruation:
- Exercise. Physical activity can lift moods and improve depression. It’s believed that endorphins — feel-good brain chemicals that are released during exercise — may help counteract some of the hormone changes that may trigger severe PMS. “Exercising can also boost energy and help with cramps and bloating, which may help you feel better,” says Livoti. Aerobic exercise such as walking, running, bicycling, or swimming is recommended.
- Small, frequent meals. Eating small meals throughout the day rather than two or three big meals may also help ease PMS symptoms. A large meal, particularly one high in carbohydrates, can cause blood sugar swings, which could worsen PMS. “Low blood sugar may contribute to crying spells and irritability that are often seen in women with severe PMS,” says Livoti. Try to eat six small meals a day to keep your blood sugar levels steady.
- Calcium supplements. In a 2009 double-blind clinical trial of college women with PMS, those who supplemented their diet with 500 milligrams of calcium twice daily had significantly less depression and fatigue than those who didn’t. In fact, “a number of studies have shown that getting plenty of calcium can help ease mood changes related to severe PMS, although we don’t know exactly why,” says Livoti.
- Avoid caffeine, alcohol, and sweets. Staying away from coffee and other caffeinated drinks for two weeks before your period may make a difference in your mood because caffeine can increase anxiety, nervousness, and insomnia. Cutting down on alcohol may also be helpful because alcohol acts as a depressant. And steering clear of candy, soda, and other sugary foods, especially in the week before your period, may help ease severe PMS symptoms by preventing mood swings associated with blood sugar fluctuations.
- Stress management. Stress can make severePMS symptoms worse, so finding ways to give stress the slip can help treatPMS. Try relaxation techniques such as meditation, deep breathing, and yoga. Individual or group therapy has also been found to be an effectivePMS treatment for women with severe mood swings and debilitating emotional changes.Antidepressants called selective serotonin reuptake inhibitors (SSRIs) that change serotonin levels in the brain have been shown to be helpful for women with severe PMS and PMDD. In fact, the U.S. Food and Drug Administration has approved three of these medicines — Zoloft (sertraline), Prozac or Sarafem (fluoxetine), and Paxil CR (paroxetine) — for the treatment of PMDD.Talk to your doctor about which of these approaches might work best for any moderate or severe emotional PMS symptoms you’re experiencing.