Why Anxiety Worsens Before Period (PMDD)

Many people notice that their anxiety gets worse right before their period. This is often due to premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). These conditions are linked to changes in hormone levels that happen during the menstrual cycle. Understanding why this happens and how to manage it can help ease the symptoms.

Key Takeaways

• Hormonal changes can make anxiety worse before a period.
• PMS and PMDD have different symptoms and levels of severity.
• Neurotransmitters like serotonin and dopamine play a role in mood changes.
• Existing mental health issues can get worse before a period.
• There are treatments and self-care strategies that can help manage premenstrual anxiety.

Hormonal Fluctuations and Their Impact on Anxiety

Role of Estrogen and Progesterone

The primary drivers behind both PMS and PMDD are the hormonal fluctuations that occur throughout the menstrual cycle. Estrogen and progesterone—two key hormones—rise and fall dramatically in the days leading up to menstruation. These fluctuations can affect neurotransmitters in the brain, such as serotonin, which plays a critical role in regulating mood. When serotonin levels are impacted by these hormonal changes, it can lead to feelings of anxiety and mood instability. Estrogen levels, both high and low, may also increase anxiety levels.

Neurotransmitter Changes

We still don’t know exactly why fluctuating levels of estrogen and progesterone can cause so many PMS symptoms during the premenstrual phase of the menstrual cycle. But one theory that relates to the emotional symptoms of PMS is that both these hormones can alter the production of certain brain chemicals – or neurotransmitters – linked with mood regulation, including:

• Serotonin: Often called the ‘feel-good’ hormone, serotonin is important for your mood as well as other things such as your sleep-wake cycle and cognitive function. According to the Anxiety & Depression Association of America there’s also some evidence to suggest the female brain doesn’t process serotonin as quickly as the male brain.
• Dopamine: Often described as controlling feelings of pleasure and reward, dopamine is also involved in motivation and learning.
• Glutamate: This is also important for cognitive functions such as memory and learning.
• GABA: Gamma aminobutyric acid has a calming effect, so it’s important for managing feelings of anxiety and stress.

Changing levels of the hormone cortisol may also have something to do with premenstrual anxiety. That’s because cortisol is known to trigger anxiety and rises rapidly in the few days before your period starts, which is when your premenstrual anxiety may be at its worst.

Timing of Hormonal Shifts

During the first half of your cycle, levels of certain hormones – follicle-stimulating hormone and estrogen – start to rise. Then roughly halfway through your cycle (this is around day 14 of a typical 28-day cycle) your estrogen levels are high and you start producing another hormone called luteinizing hormone to trigger the release of an egg (in other words, ovulation).

After you’ve ovulated your body starts pumping out progesterone as well as higher amounts of estrogen. But if the egg isn’t fertilized – that is, if you don’t become pregnant – your estrogen and progesterone levels drop dramatically during the last phase of your cycle, called the luteal phase. While your body is experiencing the rising and falling of these hormones you’re also most likely to be affected by PMS symptoms, including anxiety. Thankfully your hormone levels settle down again and you feel much more like yourself again when your next cycle starts, which is when you get your period.

Distinguishing Between PMS and PMDD

Symptoms of PMS

Premenstrual Syndrome (PMS) is a common condition that affects many people who menstruate. Symptoms typically appear a week or so before the period begins and can range from mild to severe. These symptoms include:

• Emotional and behavioral changes such as mood swings, irritability, anxiety, and tearfulness.
• Physical symptoms like breast tenderness, bloating, fatigue, and changes in sleep and eating habits.

Symptoms of PMDD

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS. It affects a smaller percentage of people but can be debilitating. PMDD symptoms are intense and can significantly impact daily life. They include:

• Severe emotional symptoms such as intense sadness, despair, anxiety attacks, persistent irritability, and feeling overwhelmed or out of control.
• Physical symptoms like significant fatigue, sleep disturbances, and physical pain.

Diagnostic Criteria

The key difference between PMS and PMDD lies in the severity and impact of the symptoms. While PMS can be managed with lifestyle changes, PMDD often requires more intensive treatment, including medication and counseling. Recognizing the signs of PMDD is crucial for seeking appropriate care.

For those experiencing severe symptoms, consulting a healthcare provider is essential. They can offer a diagnosis and a tailored treatment plan. Additionally, using New York Times's Top pick period underwear can provide comfort during this challenging time. 

The Role of Neurotransmitters in Premenstrual Anxiety

Serotonin and Mood Regulation

Serotonin, often called the 'feel-good' hormone, plays a crucial role in regulating mood. During the premenstrual phase, fluctuating levels of estrogen and progesterone can alter serotonin production. This change can lead to feelings of anxiety and mood swings. According to the Anxiety & Depression Association of America, the female brain may not process serotonin as quickly as the male brain, which could explain why women are more likely to experience anxiety before their period.

Dopamine's Influence

Dopamine is another neurotransmitter that affects mood, specifically feelings of pleasure and reward. It is also involved in motivation and learning. Changes in dopamine levels during the menstrual cycle can contribute to premenstrual anxiety. When dopamine levels are disrupted, it can lead to feelings of unease and stress.

Impact on Mental Health

The impact of these neurotransmitter changes is not just limited to mood swings. They can also exacerbate existing mental health conditions. For women with ongoing mental wellbeing problems, the premenstrual phase can be particularly challenging. Understanding that these feelings are part of a broader physiological process can provide a sense of relief and validation. It's a reminder that these symptoms are part of a natural cycle and not just a matter of feeling a bit more stressed or worried.

Premenstrual Exacerbation of Existing Mental Health Conditions

Premenstrual exacerbation of an existing psychiatric disorder refers to the worsening of symptoms inherent to the condition during the premenstrual phase. This phenomenon can significantly impact individuals who already struggle with mental health issues, making it crucial to understand and manage these changes effectively.

Treatment Options for Premenstrual Anxiety

Premenstrual anxiety can be challenging, but there are several treatment options available to help manage symptoms effectively. These treatments range from medications to lifestyle changes and therapeutic interventions.

Pharmacological Treatments

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat mood and anxiety disorders related to the menstrual cycle. SSRIs can help reduce mood symptoms associated with your period, but they may take 4-8 weeks to become effective. Combined oral contraceptives, particularly those containing Drospirenone, are also FDA-approved for treating PMDD. In rare cases, surgery, such as an oophorectomy, may be recommended for severe PMDD.

Lifestyle Modifications

Incorporating regular exercise into your routine can significantly alleviate premenstrual symptoms. Aim for at least 30 minutes of moderate exercise, such as brisk walking or cycling, most days. Practicing mindfulness and relaxation techniques, like yoga and meditation, can also help reduce stress and anxiety. Maintaining a balanced diet rich in whole foods, fruits, and vegetables is crucial. Limiting the intake of sugary foods and caffeine can help stabilize mood fluctuations. Additionally, using period underwear can provide comfort and reduce stress during menstruation.

Therapeutic Interventions

Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for anxiety. CBT helps individuals change negative thought patterns and behaviors, leading to improved mental health. Other therapeutic options include counseling and support groups, which can provide emotional support and coping strategies.

By combining these treatment options, individuals can find a comprehensive approach to managing premenstrual anxiety.

Preventive Measures and Self-Care Strategies

Tracking Symptoms

Keeping a detailed record of symptoms can be incredibly helpful. By using an app or a diary, individuals can track their symptoms throughout their menstrual cycle. This practice allows for better identification of patterns and triggers, which can be crucial for managing premenstrual anxiety. Tracking symptoms can also provide valuable information for healthcare providers, aiding in more accurate diagnoses and treatment plans.

Improving Sleep Hygiene

Good sleep hygiene is essential for managing anxiety. Establishing a regular sleep schedule, where one goes to bed and wakes up at the same time every day, can significantly improve sleep quality. Avoiding screens and heavy meals before bedtime can also help. Creating a relaxing bedtime routine, such as reading or taking a warm bath, can signal the body that it's time to wind down.

Stress Management Techniques

Effective stress management techniques can greatly reduce premenstrual anxiety. Practices such as yoga, meditation, and deep breathing exercises can promote relaxation and mental well-being. Regular physical activity, like brisk walking or swimming, can also help in reducing stress levels. Additionally, limiting the intake of caffeine, alcohol, and sugary foods can prevent exacerbation of anxiety symptoms.

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When to Seek Professional Help

Indicators of Severe Anxiety

If you experience mood shifts that interfere with your relationships, a depressed mood, or suicidal thoughts, it is crucial to seek professional help. Anxiety or depression that disrupts your daily life is a significant indicator that you may need additional support. If you find it challenging to manage your symptoms on your own, consulting a healthcare professional is advisable.

Diagnostic Process

A healthcare provider can help diagnose whether you are experiencing PMS, PMDD, or another condition. The diagnostic process typically involves a detailed medical history, symptom tracking, and possibly some lab tests. Accurate diagnosis is essential for effective treatment.

Available Medical Treatments

There are various treatment options available for managing premenstrual anxiety. These include medication, therapy, and lifestyle changes. In some cases, a combination of treatments may be the most effective. For instance, SSRIs can take 4-8 weeks to show results and are often paired with combined oral contraceptives. Non-pharmacological options like yoga and acupressure can also help alleviate symptoms. If you are experiencing severe symptoms, it is essential to seek professional help to explore these treatment options.

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Conclusion

In summary, anxiety before a period is a common experience for many and can be attributed to conditions like PMS and PMDD. These symptoms are largely due to hormonal changes that occur during the menstrual cycle. Understanding the underlying causes can help in managing and treating these symptoms effectively. If anxiety before your period significantly impacts your daily life, it is advisable to seek medical advice for proper diagnosis and treatment options. By addressing these symptoms, individuals can improve their overall well-being and quality of life.

Frequently Asked Questions

What causes anxiety before a period?

Anxiety before a period can be caused by hormonal changes related to premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). These hormonal shifts can affect brain chemicals that regulate mood, leading to increased anxiety.

What is the difference between PMS and PMDD?

PMS includes a variety of physical and emotional symptoms that occur before a period, while PMDD is a severe form of PMS with more intense emotional symptoms like severe anxiety, depression, and mood swings.

How can I manage anxiety before my period?

Managing anxiety before your period can involve lifestyle changes like regular exercise, a healthy diet, and good sleep hygiene. Some people may also benefit from medications or therapy.

When should I see a doctor about premenstrual anxiety?

You should see a doctor if your anxiety before your period is severe, affects your daily life, or if home treatments aren't helping. A doctor can provide a proper diagnosis and recommend effective treatments.

Are there medications that can help with premenstrual anxiety?

Yes, medications such as selective serotonin reuptake inhibitors (SSRIs) can help manage severe premenstrual anxiety. Your doctor can help you determine the best treatment plan for your needs.

Can tracking my symptoms help manage premenstrual anxiety?

Yes, tracking your symptoms can help you identify patterns and triggers, making it easier to manage your anxiety. Keeping a journal or using a tracking app can be useful tools.