Why Do I Feel Different on or Near my Period?
Each month during a menstrual cycle there can be high variability in how you feel physically and emotionally day to day. It is important to be gentle with yourself during this time, and allow yourself space to create good habits and coping mechanisms to meet your individual needs. There are real, physical changes occurring in the body that may lead to a range of symptoms throughout the month. In this article, our goal is to provide education about these changes and normalize the fluctuations that many people feel. We hope this information empowers you to celebrate this cycle.
What are hormones?
Hormones are molecules released from various organs into the blood following a signal from the brain. Each hormone has its own unique functions and actions. Think of them as the brain’s messengers that tell your organs what your brain wants them to do. The most important hormones to the menstrual cycle are estrogen and progesterone, which are produced by the ovaries (a small pair of organs next to your uterus).
What hormones change during the menstrual cycle?
The Big Picture: Estrogen levels are highest just before and during ovulation, and progesterone levels are highest just before the start of your period. Both estrogren and progesterone levels are lowest while on your period.
The Specifics: A normal menstrual cycle is an average of 28 days, with Day 1 being the first day of your period. The hormonal phases are as follows*:
Menstrual phase (Days 1-5): Estrogen and progesterone levels are both at their lowest while the uterine lining sheds and bleeding/menstruation occurs.
Follicular (aka Proliferative) phase (Days 6-14): Estrogen levels are rising to prepare for ovulation.
Ovulation (Day 14): Estrogen levels peak as one of the ovaries releases an egg.
Luteal (aka Secretory) phase (Days 15-28): Estrogen levels fall and progesterone levels increase, peaking around Day 21. This causes the uterine lining to begin breaking down to prepare for menstruation.
*Days are an estimate based on an average menstrual cycle.
How do estrogen and progesterone change my mood, emotions, or mental state?
The low levels of both hormones in the premenstrual and menstrual phase can make people feel more withdrawn and irritable, as well as experience the physical discomfort of abdominal cramps that often come with a period.
Estrogen typically makes people feel more energetic and increases sex drive, so these are commonly reported symptoms at the pre-ovulation peak.
Progesterone increases are associated with a general increase in fatigue, presenting mostly before the premenstrual phase.
What is PMS?
Premenstrual Syndrome (PMS) is an umbrella term for the symptoms many people notice in a predictable pattern, usually just before their period starts. The most common symptoms are mood swings, tender breasts, food cravings, fatigue, and irritability. About 75% of menstruating people experience some form of PMS, though the severity varies greatly.
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a condition in which the brain is abnormally sensitive to the normal hormonal fluctuations of the menstrual cycle. This results in psychological distress that correlates with phases of the person’s menstrual cycle. Roughly 6% of people who menstruate experience PMDD.
What causes PMS and PMDD?
The exact cause of PMS and PMDD is likely due to the chemical imbalance of neurotransmitters in your body, including serotonin. (Neurotransmitters are similar to hormones in that they are also small messenger molecules.) For PMDD, we do know that it is a drastically abnormal reaction of the body to the normal menstrual cycle.
What symptoms might I experience if I have PMS/PMDD?
PMS symptoms include increased appetite, weight gain, abdominal bloating and pain, low back pain, breast tenderness, nausea, headache, irritability, mood swings. PMDD symptoms include more drastic presentations including anxiety, symptoms of depression, and trouble concentrating and completing daily activities.
What’s the difference between PMS and PMDD?
PMDD falls under the umbrella term of PMS. However, the severity of psychological symptoms in PMDD includes a much greater severity than most PMS symptoms. Premenstrual syndrome (PMS) is a normal constellation of symptoms that people experience with their periods monthly. Premenstrual dysphoric disorder (PMDD) is a disabling extension of PMS that interferes with people's daily lives. It is crucial to recognize there is a distinction.
How do I know if I have PMS or PMDD?
This diagnosis should be made by a doctor. Try tracking your mood symptoms daily in a journal to see if they correlate with your menstrual cycle. Ultimately, speak with your physician if you are concerned about PMS or PMDD.
Are there treatments for PMS and PMDD?
Yes! Nonpharmacological treatments (aka things other than drugs/pills) may be sufficient for mild symptoms including mindfulness practices, warm showers and baths, herbal supplements and teas, and cognitive behavioral therapy and social support. For more moderate and severe presentations, there are medications that can be prescribed to help. Finding the treatment that works best for you is a decision to be made between you and your doctor. However, some people find improvement in their symptoms with use of oral birth control pills or antidepressants (ex. SSRIs like Lexapro, Prozac, or Zoloft). Serotonin has a positive effect on emotion, mood, and sleep. Another way to take your health into your own hands is through tracking your symptoms to notice any correlations with triggers throughout the month. Seeing a mental health professional such as a counselor and making certain lifestyle changes like an exercise routine and increased social support may also be helpful.
Are there risk factors to developing PMDD?
You are at increased risk of experiencing PMDD if women in your family have a history of PMS or PMDD. You also are at an increased risk if you have a previously diagnosed mood disorder. There is also an increased association between PMDD with people who experienced a prior traumatic event, have a history of smoking, and an increased body mass index (BMI.)
Here’s what a physician wants you to know:
“It can be helpful to begin tracking your symptoms as they relate to your cycles-for both you and your Ob/Gyn. Oftentimes we see a pattern emerge that can be useful for diagnosing and treating PMDD.”
- Micaela Motzko, Ob/Gyn Resident
Here’s what someone with PMDD wants you to know:
“I thought my symptoms were normal PMS at first and that there was something wrong with me for not being able to handle it in the same way as other women. It felt really validating to receive a diagnosis that explained why my symptoms are so debilitating. I wish more women just knew this existed because tracking your mood symptoms with your cycle can help in diagnosis.”
- Anonymous, diagnosed with PMDD in 2018
When should I get help with my emotions or mood changes during my period?
While the hormonal changes associated with a normal menstrual cycle will naturally cause changes in the body and mind, it is not normal for these changes to control your life and ability to complete daily activities. If you feel symptoms related to your menstrual cycle are negatively impacting your life, you may benefit from speaking with a professional.
Where to go for help with peri-menstrual changes in mood, or PMS/PMDD:
A helpful first step may be speaking with a primary care provider, gynecologist, or psychiatrist. Choose a practitioner that you feel comfortable with. They may refer you to a psychologist or counselor, as therapy can also be very beneficial for mood symptoms. A list of the kind of providers you may receive help from include:
Your obstetrician/gynecologist (a doctor specializing in Womens’ Health)
Your primary care physician (these are typically doctors specializing in Family Medicine or Internal Medicine).
A psychiatrist (a doctor specializing in Psychiatry).
A psychologist (a mental health provider with a PhD or PsyD degree), therapist, or counselor (note that these providers cannot prescribe medications but can provide valuable interventions such as therapy).
If you ever have thoughts or plans of suicide or hurting others, call 911 or go to the emergency room immediately.
When should I definitely go to the doctor?
If you notice your symptoms are getting in the way of living your life (ex. unable to get out of bed, avoiding social interactions, less interest in activities you enjoy, sleep disturbances, etc), you should see your doctor.
When in doubt, see a healthcare provider or mental health professional. They can give you an accurate diagnosis, suggest treatment options, and recommend a different treatment plan if one isn’t working.
I have a doctor’s appointment for PMS/PMDD assessment, how should I prepare?
Think of the best way to explain your symptoms to your doctor. It may help to daily track your mood and other symptoms including menstrual bleeding for about a month or two. Even though it is hard, try to be as honest as you can with your doctor. They are there to help!
Where can I learn more?
International Association for Premenstrual Disorders has several downloadable PDFs to help track symptoms and create concise care plans.
Natural Womanhood offers several articles on PMS/PMDD/Depression
Disclaimer: The information above is intended to provide education regarding PMS & PMDD. It is not medical advice and should not be used for medical diagnosis. For questions regarding diagnosis, treatment, and more regarding any mental health conditions, contact a mental health professional.
Published: April 14, 2024.
Written by: Natalie Sipes (Medical Student) and Tillie Schumann (Medical Student), Edited by: Alexandra Lawlor (Medical Student).
References:
Gudipally PR, Sharma GK. Premenstrual Syndrome. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809533.
Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry, 30(2), 100–117. https://doi.org/10.1097/HRP.0000000000000329
Le, Tao and Bhushan, Vikas. First Aid for the USMLE Step 2 CK, Eleventh Edition. New York: McGraw-Hill Education, 2023.
Mills, K. (Host). (2023). Speaking of Psychology: How Hormones and the Menstrual Cycle Affect Mental Health, with Tory Eisenlohr-Moul, PhD. [Audio Podcast]. American Psychological Association. https://www.apa.org/news/podcasts/speaking-of-psychology/menstrual-cycle
Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www-ncbi-nlm-nih-gov.proxy.kansascity.edu/books/NBK532307/
Mayo Foundation for Medical Education and Research. (n.d.). Premenstrual syndrome (PMS). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780
