Why They Happen, Treatments, and Finding Support

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Premenstrual syndrome (PMS) can cause mood swings about a week before your period. You might wake up in great spirits but find yourself becoming irritable an hour or two later for no reason. This is likely related to hormonal fluctuations.

PMS is a collection of physical and emotional symptoms that start a week or so before your period. It makes some people feel moodier than usual and others bloated and achy.

Other emotional symptoms of PMS can include:

• sadness
• irritability
• anxiety
• anger

Two related conditions can also make you feel moodier before your period:

• Premenstrual dysphoric disorder (PMDD). PMDD is very similar to PMS, but its symptoms are more severe and tend to involve emotions. For some, it causes intense mood swings that interfere with daily life. While recent research estimates about 75 percent of women have PMS during their reproductive years, only 3 to 8 percent have PMDD.
• Premenstrual exacerbation. This refers to when symptoms of an existing condition, including anxiety, bipolar disorder, or depression, become worse in the weeks or days leading up to your period. About half of all women who receive treatment for PMS also have either depression or anxiety.

Read on to learn more about the connection between PMS and mood swings.

Experts aren’t sure about the exact cause of PMS, but it’s likely linked to hormonal fluctuations that happen during the second half of the menstrual cycle.

Ovulation happens about halfway through your cycle. During this time, your body releases an egg, causing estrogen and progesterone levels to drop. A shift in these hormones can lead to both physical and emotional symptoms.

Changes in estrogen and progesterone levels also influence serotonin levels. This is a neurotransmitter that helps regulate your mood, sleep cycle, and appetite. Low levels of serotonin are linked to feelings of sadness and irritability, in addition to trouble sleeping and unusual food cravings — all common PMS symptoms.

Mood swings are one of the most common and most severe PMS symptoms.

Track your symptoms

If you don’t already, start keeping track of your menstrual cycle and your emotions throughout its different stages. This will help you confirm that your mood swings are indeed linked to your cycle. Knowing there’s a reason you’re feeling extra moody can also help keep things in perspective and offer some validation.

Having a detailed log of your last few cycles is also handy if you want to bring up your symptoms with your doctor. There’s still some stigma around PMS. Having documentation of your symptoms might help you feel more confident about bringing them up. It can also help your doctor get a better idea of what’s going on.

You can track your cycle and symptoms using a period-tracking app on your phone. Look for one that allows you to add your own symptoms.

You can also print out a chart or make your own. Across the top, write the day of the month (1 through 31). List your symptoms down the left side of the page. Put an X in the box next to the symptoms you experience each day. Note whether each symptom is mild, moderate, or severe.

To track mood swings, make a note when you experience any of these symptoms:

• sadness
• sudden, unexplained changes in your mood
• crying spells
• irritability
• poor sleep or too much sleep
• trouble concentrating
• lack of interest in your daily activities
• tiredness
• low energy

Hormonal birth control

Hormonal birth control methods, like the pill or patch, can help with bloating, tender breasts, and other physical PMS symptoms. For some people, they can also help with emotional symptoms, including mood swings.

But for others, hormonal birth control can make mood swings worse. If you go this route, you might have to try out different types of birth control before you find a method that works for you.

If you’re interested in the pill, opt for a continuous one that doesn’t have a week of placebo pills. Continuous birth control pills can eliminate your period, which sometimes helps eliminate PMS, too.

Natural remedies

A couple of vitamins may help relieve PMS-related mood swings.

A clinical trial found that a calcium supplement helped with PMS-related feelings of sadness, irritability, and anxiety.

Many foods are good sources of calcium, including:

• milk
• yogurt
• cheese
• leafy green vegetables
• fortified orange juice and cereal

You can also take a daily supplement containing 1,200 milligrams of calcium, which you can find on Amazon. Don’t be discouraged if you don’t see results right away. It can take about three menstrual cycles to see any symptom improvement while taking calcium.

Vitamin B-6 might also help with PMS symptoms.

You can find it in the following foods:

• fish
• chicken and turkey
• fruit
• fortified cereals

Vitamin B-6 also comes in supplement form, which you can find on Amazon. Just don’t take more than 100 milligrams a day.

Lifestyle changes

Several lifestyle factors also seem to play a role in PMS symptoms:

• Exercise. Try to be active for at least 30 minutes more days of the week than not. Even a daily walk through your neighborhood can help with feelings of sadness, irritability, and anxiety.
• Nutrition. Try to resist the junk food cravings that can come with PMS. Large amounts of sugar, fat, and salt can all wreak havoc on your mood. You don’t have to cut them out completely, but try to balance out these foods with fruits, vegetables, and whole grains. This will help keep you full throughout the day and help avoid drops in blood sugar, which can make you irritable.
• Sleep. Not getting enough sleep can kill your mood if you’re weeks away from your period. Try to get at least seven to eight hours of sleep a night, especially in the week or two leading up to your period. See how not getting enough sleep affects your mind and body.
• Stress. Unmanaged stress can worsen mood swings. Use deep breathing exercises, meditation, or yoga to calm both your mind and body, especially when you feel PMS symptoms coming on.

Medication

If other treatment options aren’t helping, taking an antidepressant may help. Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressant used to treat PMS-related mood swings.

SSRIs block the absorption of serotonin. This increases the amount of serotonin in your brain. Examples of SSRIs include:

• citalopram (Celexa)
• fluoxetine (Prozac and Sarafem)
• paroxetine (Paxil)
• sertraline (Zoloft)

Other antidepressants that work on serotonin might also help treat PMS mood swings. These include:

• duloxetine (Cymbalta)
• venlafaxine (Effexor)

Work with your doctor to come up with a dosage plan. They might suggest you only take an antidepressant during the two weeks before your symptoms tend to start. In other cases, they might recommend taking them every day.

Your gynecologist might be the first person you turn to for help when you start noticing mood swings before your period. It’s important that your doctor is someone you trust and who takes your symptoms seriously. If your doctor doesn’t listen to you, search for another provider.

You can connect to a physician in your area using the Healthline FindCare tool.

You can also turn to the International Association for Premenstrual Disorders. It offers blogs, online communities, and local resources that can help you find a doctor familiar with PMS and PMDD.

Menstrually Related Mood Disorders – Center for Women’s Mood Disorders

Menstrually-related mood disorders are mood disorders associated with the menstrual cycle. Menopause and cycles of menstruation are time of intense hormonal fluctuation that can cause increased vulnerability to depression. Perimenopausal Depression, Premenstrual Syndrome (PMS), and Premenstrual Dysphoric Disorder (PMDD) are menstrually-related mood disorders treated in our program.

Premenstrual Syndrome (PMS)

Premenstrual Dysphoric Disorder (PMDD)

Perimenopausal Depression

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Many women experience symptoms of Premenstrual Syndrome (PMS). In some instances the mood symptoms and emotional components of PMS are the most troubling. To women in such cases, PMS is often referred to as Premenstrual Dysphoric Disorder (PMDD).

Premenstrual Dysphoric Disorder is a more severe form of PMS, affecting 5-10% of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance that can seriously impact relationships and impair functioning. Many women with PMDD experience clinical levels of depression or anxiety during the week or two before each menstrual cycle. It is not uncommon that the emotional symptoms of depression anxiety and irritability can seriously interfere with normal functioning and relationships.

Common symptoms include: irritability, depressed mood, anxiety, or mood swings. Mood symptoms are only present for a specific period of time, during the luteal phase of the menstrual cycle. Symptoms emerge one to two weeks before menses and resolve completely with the onset of menses. Women with PMDD should experience a symptom-free interval between menses and ovulation. An estimated 40% of women who seek treatment for PMDD actually have a premenstrual exacerbation of an underlying mood disorder rather than PMDD. Therefore, it is important for patients to be carefully evaluated for the presence of an underlying mood disorder in order to develop the best treatment plan.

For more information:

Watch these videos about PMDD:
The Biology behind PMDD
Oral Contraceptive relief for PMDD

Or read these articles about PMDD research at UNC:
Oral Contraceptives May Ease Suffering of Women with Severe PMS
Study finds hereditary link to premenstrual depression

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Perimenopausal Depression

Menopause is defined as the permanent cessation of the menses. Perimenopause is defined as the transitional period from normal menstrual periods to no periods at all. At this time menstrual periods gradually lighten and become less frequent. The transition to complete menopause may last anywhere from a few months to a few years.
During the perimenopausal transition you may experience a combination of PMS and menopausal symptoms or no symptoms at all. Some normal symptoms of the perimenopause period are hot flashes, insomnia, vaginal dryness, and mood problems. Symptoms of perimenopausal depression are emotional flatness, “inability to cope,” irritability, social isolation, tearfulness, decreased energy, and failure to enjoy normal activities and relationships.

Times of intense hormonal fluctuation can cause increased vulnerability to depression. Perimenopause may be a period of increased vulnerability to the onset of depression in women with no prior history of depression. Since symptoms are gradual in onset, women will not recognize symptoms as part of a reversible disorder, but rather will interpret them as a permanent change in their life.

For more information:
UNC researchers investigate estrogen replacement therapy to prevent depression and cardiovascular disease

Why does everything infuriate during PMS?

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October 19, 2015

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Answered by Nikolai Nikolaevich Lutsenko, Ph.D. N.I. Pirogov.

To understand why a woman becomes irritable before her period, it is necessary to understand the cause of PMS. Sometimes doctors themselves do not understand these reasons. But, as a rule, it lies in the way of life of a woman.

Normally, in the second half of the menstrual cycle, a woman releases a large amount of the hormone progesterone, and 4-5 days before menstruation, its decrease begins. Fluctuations in the level of female sex hormones and has an impact on changing the mood of a woman.

So who develops PMS and why? This condition is more typical for women living in large cities (megacities), in rural areas this pathology almost does not occur. Residents of the metropolis are much more susceptible to stress, because it surrounds them everywhere. Women with PMS most often work in the office, where the work is nervous and stressful. With such a load, sleep and wakefulness disorders are often noted, and a woman’s chronic lack of sleep, when sleep is less than 6 hours, sharply increases the irritability that is observed in every woman before menstruation is normal. In addition, any resident of the metropolis suffers from a lack of physical activity, which also negatively affects the mood.

Many women also take combined oral contraceptives (COCs). The most common group of COCs – the so-called “monophasic COCs”, for example, “Yarina”, “Jess”, “Janine”, “Marvelon”, “Rigevidon” can increase the manifestations of PMS. These drugs contain progestogens (female sex hormones that normally appear only 2 weeks after the onset of menstruation and are responsible for mood changes) in each tablet, so irritability is constantly present in women who take these drugs. But “three-phase COCs” do not have such an effect, so if you notice that your irritability has increased when taking birth control pills, you need to contact your gynecologist to select the drugs that suit you.

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Hormones during the menstrual cycle and PMS

Comment from an expert
Gynecologist Anastasia Degteva

“PMS is diagnosed only on the basis of the patient’s complaints and his diary: note the symptoms that bother you in the menstruation app. There are diseases that may be more disturbing before the start of the cycle than on other days: depression, anxiety disorder, thyroid disease. It is important to see a gynecologist to understand if PMS is really bothering you.
If you are told “you just have PMS” to the manifestations of emotions regarding some unpleasant situation, then these are manifestations of gaslighting.

In order to understand what PMS is, it’s worth first understanding what female hormones are and how they affect a woman’s reproductive system, because they govern all the processes associated with the menstrual cycle—from the first period to the very last, each cycle without exceptions depend on hormones.

Hormones affect not only menstruation, but also mood, ability to perform physical work, and even food preferences. Despite the fact that the menstrual cycle in all women depends on the same hormones, someone tolerates such changes easily and imperceptibly for themselves, and for some it becomes a monthly test.

What is PMS?

PMS is a condition that affects mood, physical condition, and behavior on certain days of your menstrual cycle, usually a few days before your period starts.

PMS, like many other aspects of women’s health not directly related to childbearing, is still little studied, and there are still no clear criteria for assessing PMS.

Research shows that PMS is more or less affected by 5 to 97 percent women.

In fact, it is worth distinguishing premenstrual dysphoric syndrome (PDS), which is observed in about 3-8% of women, from the myth of PMS.

PMS is a monthly premenstrual condition in which at least 5 symptoms of PMS are present and are severe enough to interfere with a woman’s daily life.

In one way or another, many women experience monthly symptoms that are related to PMS, and they are quite real.

What are the symptoms of PMS?

Symptoms of PMS are usually mild or moderate.

About 80% of women experience at least one of the symptoms of PMS to a degree that does not interfere with their daily lives. About 20-30% of women experience tangible symptoms that can affect certain aspects of daily life. 3-8% have PDS.

The severity of symptoms may vary from cycle to cycle and also depends on the individual assessment of each woman.

• Breast hypersensitivity

• Puffiness

• Headaches

• Fatigue

• Acne and skin eruptions

• Irritability

• Distended abdomen

• Increased appetite

• Anxiety

• Sadness

• Diarrhea or constipation

• Depressed mood

• Abdominal pain

• Sensitivity to light and sound

Why do PMS symptoms occur?

The cause of PMS is still not clear, but many researchers attribute it to changes in hormone volume and serotonin levels in the period 5-10 days before the onset of menstruation.

Levels of the hormones estrogen and progesterone first rise and then fall sharply just before menstruation, and this is likely to cause anxiety, irritability and mood swings, as they modulate activity in areas of the brain associated with PMS symptoms. Serotonin is one of the neurotransmitters that strongly influences mood and emotions, it is also called the “hormone of happiness”.

How do female hormones work?

The hormone estrogen and progesterone play a huge role in the human body and are part of its endocrine system, which controls almost all the functions of our body.

Moreover, these hormones are also produced by the male body, only in smaller quantities, so they are usually called female hormones. In the female body, they control the reproductive system and sexual health, including libido. It is precisely because they play such an important role that it is important to understand how they work.

Estrogen

Estrogen is a female hormone secreted by the ovaries, the level of which rises during the first two weeks of the menstrual cycle, causing the growth of endometrial tissue in the uterus. This phase of the cycle is called follicular. A sharp drop in estrogen (and progesterone) levels causes menstrual bleeding. It also affects heart and bone health. Active production of estrogen begins in adolescence, and decreases with age until it reaches menopause, when menstruation stops.

Progesterone

Progesterone levels rise after ovulation, during the second half of the menstrual cycle. If conception has occurred, then the level of progesterone continues to rise, maintaining the thickness of the uterine endometrium for the further development of pregnancy. If there was no conception, then the level of progesterone drops, giving a signal to the body to start rejecting the thickened endometrium. Some of the unpleasant symptoms of PMS, such as breast tenderness, acne, and swelling, have been linked to this hormone.

When does PMS usually start?

Symptoms of PMS in women occur in the second half of the cycle, after ovulation. Most often, the strongest both psychological and physical symptoms of PMS are observed 3-4 days before menstruation, and then disappear with the onset of bleeding. PMS symptoms can start and end at other times as well: for example, some women begin to experience symptoms immediately after ovulation, and for some, they may disappear after the end of menstruation, and not with it.

How do I know if I have PMS?

The best way to find out if you have PMS is to use a diary of symptoms, which should be noted on the same calendar that you use to mark your cycle. If you have a smartphone, there are now many applications in which it is convenient to do this and which can even prompt your statistics on their own. If symptoms appear at about the same time each cycle, then PMS is the most likely cause.

When should I see a doctor?

If physical pain or other symptoms persist or seriously interfere with your daily life, you should see a doctor.

PDS is diagnosed if you have one of the symptoms regularly and then disappear on other days. However, such symptoms can be associated with a variety of other conditions, such as endometriosis, thyroid disorders, irritable bowel syndrome, anemia, connective tissue diseases, and rheumatism, and the doctor will need to rule them out.