Anxiety while on period

Why Anxiety Spikes With Your Periods

Fluctuations in powerful hormones that regulate menstruation, such as estrogen and progesterone, can affect your appetite, digestion, and energy levels, all of which can, in turn, affect your mood. “This may have an impact on psychological functioning,” notes Dr. Goodstein.

Additionally, women who have had difficult periods in the past, due to intense cramping or heavy bleeding, may worry about recurrent pain and discomfort prior to menstruation, and this can also cause added anxiety, says Goodstein.

Anxiety and Your Periods: Getting Help

Fortunately, there are steps you can take to help alleviate menstruation-related anxiety. Actively reducing stress in your life can play an important role, advises Goodstein.

To manage stress and diminish anxiety during your period:

  • Exercise on a regular basis.
  • Eat a well-balanced diet with plenty of fruits and vegetables.
  • Be sure to get enough sleep; seven to eight hours a night is optimal for most people.
  • Minimize your alcohol and caffeine intake.
  • Avoid tobacco.
  • Spend time relaxing with friends and family.
  • Express your thoughts and emotions by writing in a journal.
  • Consider meditation and deep breathing exercises.

For women who continue to experience significant anxiety symptoms, medication is also an option.

“Medication is not a necessity for all. But in some cases, assuming that the anxiety level is quite manageable during the remainder of the month, and high anxiety is truly limited to the time of the period, the judicious use of low doses of anti-anxiety medications may be helpful,” notes Goodstein. Another option, he says, are the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs).

Women who already take anti-anxiety or antidepressant medications for disorders that are not menstruation-related are more likely to suffer from psychological symptoms during their periods. For these women, an increase in medication around the time of menstruation can help manage symptoms, says Goodstein.

Anxiety is a common PMS symptom for many women, but just like cramps and bloating, anxiety can and should be managed. Don’t be afraid to talk to your doctor about your symptoms. Medication can help control severe anxiety, but there are also plenty of things you can do to help yourself. Minimizing stress, exercising regularly, and eating well can help alleviate many PMS symptoms, including anxiety.

This Explains Why Your Anxiety Could Be At Its Worst Right Before Your Period

I dread the anxiety spike I experience right before I bleed.

Anyone who lives with anxiety knows how unpredictable the condition can be. Rather than purely being a mental health concern, anxiety has a ripple effect through the whole body, and for women, this can be especially noticeable before, and during, menstruation. Plus, as depression and anxiety are recognized symptoms of PMS, it makes sense that someone who already lives with either of these conditions might experience mood changes. I, for one, dread the anxiety spike I experience right before I bleed.

While there are over-the-counter remedies for cramps, and suggested lifestyle changes to help PMS symptoms, when combined with an existing anxiety diagnosis (which I have), the rulebook is no longer valid. I can medicate the pain of menstruation, rest, exercise to help relieve stress and PMS symptoms, but when my anxiety flares, literally nothing helps.

HelloFlo spoke to Dr. Prudence Hall, a gynecologist and surgeon, who specializes in Bioidentical Hormones and Regenerative Medicine. Her recently published book, Radiant Again and Forever, even has a chapter dedicated to periods, called “Perimenopause and PMS Blues—Get Me Out of Here!” Of the connection between PMS and anxiety, Hall told HelloFlo:

“Low estrogen can create anxiety. The time of a period is when estrogen reaches the lowest point in a woman’s cycle. This results in all the symptoms of PMS, including anxiety. It is not the period that causes anxiety, but low levels of estrogen that occur during a period. Low estrogen causes anxiety, depression, fatigue, body aches and a huge case of the grumpies.”

As a person who has experienced the lows that most women face during, and before, their periods, it’s reassuring to hear the medical explanation for it. And as a woman who also lives with anxiety, knowing that low estrogen can cause “anxiety, depression, fatigue, body aches,” as Dr. Hall puts it, makes it possible to rationalize my feelings and thoughts when my anxiety spikes prior to menstruation.

When it comes to ways to treat the emotional rollercoaster, there’s no one-size fits all answer.

Fahimeh Sasan, an OB-GYN at Mount Sinai Hospital in New York, spoke to Women’s Health about how contraception methods such as the Pill can help ease PMS symptoms.

“If you’re not ovulating, you’re not experiencing a change of hormones, so that should certainly help with PMS,” stated Sasan.

While this recommendation is often made to women as a means of getting unruly periods under control, synthetic hormones don’t work for everybody. Personally, I’ve tried several different Pills, but each of them brought its own set of negative side effects. But this is certainly one method for potentially controlling the negative symptoms associated with PMS, including anxiety, for those who want to use hormonal contraception.

Before I was diagnosed with anxiety, the PMS I experienced pre-period often made me feel crazy, like I was losing control of my emotions, giving me a feeling of intense panic that shook my core. But now, knowing that there’s a reason for my heightened sense of anxiety, and that it’s part of my body’s natural cycle and will soon pass, has helped me cope better with PMS and its side effects. We all have different coping mechanisms—mine are TV and food—so if you’re dealing with the heady combination that is anxiety and PMS at the very same time, you have zero to apologize for. Just remember to self-care like there’s no tomorrow.

Cover image courtesy of Getty Images.

By Amy Mackelden on October 18, 2017
Amy Mackelden is a weekend editor at ELLE, Harper’s BAZAAR, and Marie Claire. She’s written for Cosmopolitan, Bustle, Ravishly, The Independent, The Guardian, xoJane, and Hello Giggles. She’s currently working on a show called MS Is My Boyfriend, about what multiple sclerosis is really like.


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How to Cope with Premenstrual Anxiety

Source: Unsplash. Creative Commons Zero.

When people talk about PMS (Premenstrual Syndrome) or PMT (Premenstrual Tension) most of the focus is usually on the person being cranky and irritable around the time of their period.

However, premenstrual anxiety is also part of the picture too, and is often overlooked.

Check out these practical tips for coping.

1. Consider the pros and cons of monitoring your cycles.

If you know when to expect your period, it can help you understand why you’re experiencing spikes of anxiety or other emotional distress at particular times of the month. Sometimes, people also notice changes in their emotions around ovulation, so tracking your cycles will help you identify this too.

For some people, monitoring their cycles leads to dreading the week their period is due. This added anticipatory anxiety may outweigh the benefits of monitoring, for some people. You’ll need to consider what’s best for you.

2. Treat physical pain.

If you get cramps or other physical discomfort, treat this pain. You’ll feel more anxious if you’re also trying to tough out physical pain.

In general, you’ll experience more pain messages just before your period and/or in the first day or two of your period. This can take different forms. For example, if you’re prone to overuse-type pain, then you might experience more of that. Use whatever strategies work for you to deal with this type of discomfort (medication or natural strategies)—but don’t just “tough it out.”

You might want to avoid going to the dentist around the time of your period, since your pain sensitivity will be heightened.

Source: Unsplash. Creative Commons Zero.

3. Less is more.

When it comes to managing anxiety, less is more. Since you can’t completely avoid anxiety, doing too much to try to control or avoid anxiety tends to backfire.

A good strategy is to be extra kind to yourself but don’t change your life too much. For example, if you attempt to avoid all stress during your vulnerable time of the month, this will likely backfire.

It’s okay to do a little bit of avoidance of stress. For example, if you need to have a difficult conversation that isn’t urgent, you might choose to delay that rather than have it when you’re feeling extra emotional.

4. Go for walks.

Physical activity is a fantastic antidote to premenstrual anxiety. It doesn’t need to be intense. For example, if you’re feeling anxious in the evening, consider taking a 20 minute stroll.

If you try any suggestions from this post, I’d recommend this one goes at the top of your list.

5. Consider that your emotions will usually change faster than you expect.

Let’s say you’re feeling premenstrual anxiety and you get into a yucky interaction with someone. You feel terrible. You’re wound up and feel very jarred. Often times, by the next day, you’ll feel much calmer. This is especially true if you happen to get some good news that counteracts your negative experience. Sometimes you just need to wait out your feelings.

6. Keep an eye on your caffeine use.

At the risk of TMI, for me, premenstrual anxiety feels like I’ve drunk three cups of coffee in a row. When you’re already feeling overstimulated, it’s not a great idea to add extra stimulants on top of this. If your body is accustomed to coffee or caffeinated sodas, then you won’t want to experience withdrawal either. Therefore, you might just drink a bit less than usually do.

This Is Why You’re So Anxious During PMS

Like 90 percent of women who menstruate, I experience PMS. I’m pretty sure I have been blessed with every possible PMS symptom: bloating, moodiness, cravings, headaches, weepiness, irritability, tender boobs, nausea, clumsiness, fatigue, diarrhea. I’ve been blessed with all of these, respectively and together, every month.

I honestly thought I’d seen it all until a few months ago, when I began to experience some of the worst anxiety and panic I’d ever felt right before my period.

I didn’t immediately notice a correlation between PMS and my spiking anxiety. I was diagnosed with anxiety and panic disorder when I was eight years old and I’m used to experiencing bouts here and there; it’s just one of those things that’s always in my life. But after the third consecutive month of it, I realized that there was a connection between my anxiety and my cycle.

Part of what tipped me off was that there was more of a physical aspect to my anxiety and panic. Usually when I experience anxiety, it starts with racing thoughts, then progresses to physical signs like sweating, queasiness, and a rapid heartbeat. In this case, I walked around the house and suddenly felt my heart beating loudly out my chest, or woke in the middle of the night, my heart and gut doing somersaults.

Chatting with a few friends, I found that I wasn’t alone. Many of them had experienced heightened anxiety during PMS. When I Googled “anxiety and PMS,” there was a ton about irritability and general crankiness, but not so much about full-blown anxiety.

Luckily, just as the symptoms emerged out of the blue, they left after a few cycles, so I didn’t feel it was necessary to bring the whole thing up with my doctor (although if they return, I most definitely will). However, on doing some research, I learned that PMS-related anxiety is a relatively common experience among women, albeit one that is rarely discussed. It turns out that, for some women, there is a correlation between the fluctuating hormones in the menstrual cycle and the chemistry of anxiety and panic.

Mary Jane Minkin, an OB-GYN and clinical professor at Yale School of Medicine, said anxiety is a “core symptom” of premenstrual dysphoric disorder (PMDD), a more severe version of PMS that affects about five percent of people who menstruate. Although it’s not entirely known what causes PMDD, it may involve a decrease in serotonin, which does correlate in certain cases with increased anxiety.

According to Minkin, it is not PMDD if the symptoms are “an exacerbation of symptoms already present.” Rather, the clearest cases of PMDD are where one is “totally symptom-free in the first part of the cycle.”

Minkin cautioned against self-diagnosing PMDD, and said that you only really have PMDD if your symptoms only occur during the second half of your menstrual cycle (yeah, not at all the case for me). She recommends keeping a chart of the menstrual cycle so you can clearly observe any correlation between PMS and anxiety.

Tristan Bickman, an OB-GYN in Santa Monica, agreed that a drop in serotonin during the second half of the menstrual cycle is what causes most PMS symptoms. Bickman explained that, for women who experience PMS, declining estrogen also causes the serotonin to drop, which causes PMS symptoms.

It’s not only hormones that are at play here: Having anxiety in general is a prerequisite for PMS-related anxiety. “Pre-existing anxiety or depression is a risk factor for PMS,” Bickman said. “Other risk factors for PMS are a family history of PMS, high stress, lack of exercise, increased caffeine consumption, and poor diet.”

Bickman also cited stress, which can crop up in your life whether you have an anxiety disorder or not, as a potential cause of PMS-related anxiety. “Stress is directly correlated with PMS,” she said. “Higher stress levels are a risk factor for the development of PMS.”

Could having heightened stress in general—not just when you’re PMSing—cause your PMS to be overall more panicky and anxious? Most definitely yes, said Iram Kazimi, an MD and psychiatrist with McGovern Medical School at UTHealth in Houston. “Any chronic stress and anxiety is believed to make PMS symptoms worse,” Kazimi said. “If you’re experiencing a period of stress and anxiety before your PMS symptoms occur, this may increase your PMS symptoms, which in turn will increase your stress and anxiety symptoms.”

BINGO. The months I had wicked PMS-anxiety were also the months that my husband was waiting to find out about a job, our car was wrecked in an accident, my kid was rushed to the ER with an asthma attack, and we put an offer on a new home.

Kazimi believes one major factor is the rise in cortisol levels, which occurs right before menstruation. “It’s possible that women suffering from this type of PMS anxiety have lower levels of anxiety throughout the month that are simply exacerbated by cortisol, rather than PMS,” said Kazimi. She added that, in some cases, PMS anxiety might stem from a fear of PMS itself. Some of us get such bad symptoms during PMS that we dread and fear that time of the month (*raises hand*), which contributes to our anxiousness.

OK, so regardless of where the anxiety comes from, how can we make it better? Obviously, an OB-GYN or other healthcare professional is your best bet for advice on this, but the experts pointed to a few general guidelines.

Since your overall stress levels can affect the intensity of your PMS symptoms, de-stressing throughout your menstrual cycle is key. Minkin recommended mindfulness, journaling, therapy, and exercise. Bickman said that dietary changes, like reducing caffeine and eating more omega-3 fats, are a good idea. If lifestyle and dietary changes don’t help, said Bickman, and your PMS-related anxiety is particularly intense, speak to your doctor about trying a selective serotonin uptake inhibitor (SSRI) or an oral contraceptive to balance your hormones.

Interestingly, more than one doctor mentioned vitamin and mineral deficiencies can contribute to this issue. Bickman said that deficiencies in calcium, B6, and magnesium have all been linked to PMS.

The causes and cures of PMS anxiety aren’t always cut and dry, Kazimi reminded me. “Both premenstrual syndrome and anxiety are incredibly complex,” she said. “What may cause anxiety in one woman may not cause anxiety in another, or may cause anxiety in a completely different way.”

Either way, anxiety is most definitely a legit PMS symptom, and while it may not top the list in the same way that moodiness and cravings do, it’s quite common. I’m not very happy about adding yet another potential PMS symptom to my list, but knowing that what I’m experiencing is real may be the first step toward reducing my stress about and finding help for it.

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Menstrually Related 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) 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

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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

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