If you’re reading this, you probably menstruate. 🩸 This means you’ve probably also heard of and experienced premenstrual symptoms (PMS for short). Oftentimes, we only hear about the intense cramps and bloating, but there are several other symptoms included in PMS that don’t get talked about enough. One of these hallmark symptoms is anxiety. Surprised? We’re not! 

If you’ve ever dealt with intense nervousness, excessive worrying, or sudden tension right before your period, chances are you’re suffering from PMS related anxiety. Depending on the severity of these symptoms, your doctor may even find that you have other underlying conditions. Don’t worry, we’re going to dive right into what PMS anxiety is and what you can do about it 😮‍💨. 

What causes anxiety before your menstrual cycle? 

The simple answer is hormonal fluctuations. Your menstrual cycle is broken up into two phases: the follicular phase and luteal phase. Your period falls into the first phase -- the follicular phase. Menstrual bleeding is triggered by the rapid decline in estradiol and progesterone levels at the end of the luteal phase, as a result of a mature egg not being fertilized. The drastic drop in these hormone levels, specifically estrogen, causes your uterine lining, the unfertilized egg, and the corpus luteum to shed in the form of your period. 

Here’s the catch! 😅 The sudden change in hormone levels does not automatically lead to PMS anxiety. Some of you may have experienced other symptoms like irritability, depression, or mood swings and some of you may not have PMS at all. It’s all up to the individual body. What we do know, however, is that estrogen is involved in regulating your mood, sleep, eating, and cognition because it interacts with an important hormone called serotonin. Serotonin is called the “feel-good” hormone for a reason.😌 Any kind of shift in your serotonin levels will immediately reflect in your overall happiness and well-being. 

As estrogen levels, specifically estradiol, begin to drop in the 1-2 weeks leading up to your period, your mood can be disrupted. The exact mechanism of how this works is still being studied, but what we know so far is that estrogen helps the brain to recognize serotonin and absorb it. As estrogen levels drop, serotonin cannot be absorbed in the same way. 

Like we said before, not everyone will suffer from PMS or PMS-related anxiety. 

Some of you may suffer from small bouts of anxiety leading up to your period, and some of you may suffer from intense periods of anxiety that can feel debilitating. Those who have more severe symptoms may have an underlying health condition. 

1. Premenstrual Dysphoric Disorder (PMDD): PMDD is usually described as an intense form of PMS -- one that causes you to have psychological symptoms like:

• Drastic mood shifts
• Unexplainable irritability 
• difficulty focusing
• Panic attacks
• Food craving including binge eating
• Feeling on “edge”
• Intense sadness 
• Feeling like you’re not in control

These psychological symptoms may take a physical toll on your body causing worsened bloating, cramping, or headaches 😭. While researchers do not know the exact cause of PMDD, it is likely that those who have a family history of medically diagnosed depression or anxiety might be more at risk for developing PMDD.  Or, you might have a personal or family history of medically diagnosed depression or anxiety. Since the symptoms of PMDD are more severe and stay around longer, it typically means that serotonin levels are not only disrupted in the days leading up to your period, but also throughout your cycle. 

1. Premenstrual Exacerbation (PME): While the symptoms of PMDD and PMS are similar, the causes can be quite different. In the case of PME, the person has a pre-existing history of the psychological conditions like generalized anxiety disorder, major depressive disorder, alcohol abuse, schizophrenia, or eating disorders. What this means is that serotonin levels might be scattered throughout their whole cycle and not just during PMS. So, the main difference between PME and PMDD is that PME is the worsening of symptoms relating to pre-existing mental health conditions while PMDD only occurs leading up to and throughout the period itself. 

*Note: According to the Anxiety and Depression Association of America, the risk of females between the ages of 14-50 developing anxiety is twice as high as males. This is likely due to menstrual cycles that already predispose females to having periodic hormonal shifts. 

Don’t be afraid though! We wouldn’t give you all this information just to scare you! In the case of PMS-related anxiety, there are several recommended activities that can help you alleviate your anxious thoughts and feelings. Here are some of them:

1. Exercise 💪: Serotonin and another hormone called endorphin falls into the category of “happy hormones”. These two hormones alongside dopamine and oxytocin control your overall well-being. When you exercise, your body releases more endorphins as a way of coping with the muscle pain that results from working out. So, as you work out more, you release more endorphins that make you feel good. Getting some exercise, even if it’s just a 30 minute walk will also release serotonin alongside endorphins! Getting your serotonin and endorphin levels up will definitely help your mood! 
2. Yoga & Meditation💆‍♀️ : Stretching your muscles and focused mediation can help relieve stiffness within your body. You’ve probably heard that mental stress can manifest into physical symptoms like stiff or sore necks. Stretching and lengthening out these muscles promotes serotonin release. 
3. Diet 🤤: Carbs are your friends! 🍝, 🍞, 🍚 - they’re all going to promote serotonin release. With that being said, try eating it moderately so you don’t get a food coma from loading up on the carbs. A food coma, medically known as reactive hypoglycemia, will give your blood sugar levels a sudden jolt followed by an intense crash. It usually leaves you feeling less energized than before you ate. To avoid this, try eating complex carbs like whole-grain pasta and bread or quinoa. This way you get the satisfaction of carbs with prolonged energy and no sugar crash. 

When should you talk to your doctor? 🤔

You should definitely talk to your doctor when you feel that lifestyle changes like the ones listed above aren’t helping. In such cases, you might be suffering from PMDD or PME, so it’s good to get it checked out! 

In the case that your symptoms do reflect one of these conditions, your doctor may prescribe your medications like selective serotonin-reuptake inhibitors (SSRIs) or birth control. SSRIs will help keep your serotonin levels stabilized directly, while birth control will help reduce the drastic shifts in hormones throughout your period. Whatever the case may be, consulting with your doctor, a licensed professional, is your best bet!

The most important thing you should be doing is tracking your symptoms! 📅 How often do you feel anxious? Is it everyday or just around your period? Are there any other symptoms you’re feeling?  

If you’re experiencing irritability, tension, or nervousness for the first time, it may be a result of other lifestyle factors. Maybe you were stressed about an exam, and that exam just happened to be around the same time as your period? You wouldn’t know whether the anxiety was caused by your period or the stress of your upcoming exam. This is why monitoring and tracking is so important, and you can do this SO easily with Aavia! 💜 Keeping track of your mood is the best way for you to notice whether your mood constantly changes right before your period or whether it changes randomly throughout your whole cycle.