I’m gonna be honest, folks. They didn’t teach us about this one in grad school. This is something I have wondered about, particularly in recent months, when I have noticed a significant change in myself around my period. My anxiety becomes worse, I cry for seemingly minimal-to-no reason, and I even note the signs and symptoms of depression, which are usually not present for me.
The one aspect of connection between periods and mental health that I was made aware of in my training as a therapist is a diagnosis called Premenstrual Dysphoric Disorder (PMDD). According to the DSM-V, in order to diagnose someone with PMDD, the following criteria must be met:
“In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses
Symptoms
One or more of the following symptoms must be present:
1) Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
2) Marked irritability or anger or increased interpersonal conflicts
3) Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
4) Marked anxiety, tension, and/or feelings of being keyed up or on edge
One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from criterion B above
1) Decreased interest in usual activities
2) Subjective difficulty in concentration
3) Lethargy, easy fatigability, or marked lack of energy
4) Marked change in appetite; overeating or specific food cravings
5) Hypersomnia or insomnia
6) A sense of being overwhelmed or out of control
7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain
Severity
The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.”
It’s important to note that PMDD is different from Premenstrual Syndrome (PMS) which is a normal condition that occurs in many people, and is not a mental health diagnosis requiring any type of treatment by mental health professionals. The Mayo Clinic notes that PMS symptoms may be worse in people with undiagnosed depression, and that treating underlying depression can ease some of the symptoms of PMS. However, the Mayo Clinic notes that PMS is experienced at some point by seventy-five percent of menstruating women (the article did not make mention of gender minorities). In contrast. According to Halbreich, Borenstein, Pearlstein, and Kahn (2003), PMDD only affects three to eight percent of women (the study also did not make mention of gender minorities). The bottom line is that PMDD is a relatively rare mental health diagnosis, while PMS is a common experience that occurs in the majority of people who experience menstruation.
Okay, on with the show. We know that PMDD can have severe affects on mood and functioning. What if you don’t have PMDD? How does your period affect your mental health then, and what can you do about it? According to the Mayo Clinic, emotional symptoms of PMS can include tension or anxiety, depressed mood, crying spells, mood swings and irritability or anger, appetite changes and food cravings, trouble falling asleep (insomnia), social withdrawal, poor concentration, and change in libido. That’s not all, folks! Physical symptoms can include joint or muscle pain, headache, fatigue, weight gain related to fluid retention, abdominal bloating, breast tenderness, acne flare-ups, constipation or diarrhea, and alcohol intolerance (Mayo Clinic). So, it’s a fucking miserable shit show, to use the clinical terminology.
All of the symptoms listed above, which are probably not an all-inclusive list (as everyone is different) could potentially worsen just about any mental health concern I can think of. Not feeling well does not make you feel good mentally, either. I know that these issues worsen my anxiety, and I am guessing that others relate to the worsening of their mental health concerns before and during their periods. So, what can we do about it?
As I mentioned earlier, this isn’t something I learned a whole lot about in graduate school. Luckily for all of us, Mayo Clinic really came through on this one, so I am going to share their tips about how to manage your PMS symptoms. First and foremost, if this is a major issue for you, it’s worth talking to your doctor. Even if you don’t have PMDD (which is worth eliminating as a potential issue), you may have underlying depression, and treating that depression can ease PMS symptoms. Oral contraceptives can also ease PMS symptoms. I personally take oral contraceptives to control cramps and other PMS symptoms, and while it is not a cure-all, it has improved my symptoms compared to when I was not taking these. Mayo Clinic also recommends diuretics and NSAID pain relievers, which you should definitely check with your doctor before starting on a regular basis.
Mayo Clinic also recommends eating smaller meals more frequently if you struggle with bloating in order to reduce discomfort (and, in turn, crankiness- that’s my editorializing). Limiting salt and avoiding caffeine and alcohol are also recommended. Have any of you wonderful readers ever had the one-drink-hangover on the first day of your period? I have. Yup. One drink and I woke up with a massive headache. Nothing like waking up to ruined sheets and a surprise hangover, AMIRITE? Now I know why! Calcium-rich foods can also be helpful, and according to my psychiatrist you should be taking a B3 supplement with calcium anyway, so check with your doc and pop it in if they say it’s okay.
As much as I hate to be the one to tell you this, Mayo Clinic and my personal experience state that a little bit of exercise will make you mad as hell and hurt like a bitch at first, but it will make you feel better afterwards. Even thirty minutes of brisk walking can significantly reduce fatigue and improve mood, especially during your period. I know, I know, I’m sorry, okay! You can eat Cheetos on the couch later. Except maybe not, because salt. Just have a few, it’s all about balance.
So, what causes this wild roller coaster ride of absolute bullshit that we take on each month? Well, researchers are unclear, but I’m sure they appreciate the scientific way in which I posed the question. Anyway, according to Healthline.com, it’s likely due to the fact that menstrual cycles affect both sex hormones and serotonin levels, which is one of the main chemicals that affects mood, and the one commonly altered using medication to relieve depression. It’s no wonder periods and mental health are so intricately connected.
Speaking of which, if periods and mental health are so closely linked, why the hell aren’t we talking about it more? Why aren’t people aware that it’s actually fairly common to have spikes in anxiety and depression around their periods? That would be helpful to know so that you don’t think that you’re, oh, I don’t know, developing an entirely new mental health issue, wouldn’t it? Well, periods are just about as stigmatized as mental illness, and I’m guessing that has something to do with it.
We usually focus on mental health stigma on the blog and podcast, but I’d like to tell you about an awesome organization called PERIOD. Check out their website, PERIOD.org, and use #FREETHEPERIOD to show support for their cause. According to their website:
“1 in 5 teens have struggled to afford period products, 84% of teens have either missed or know someone who has missed school due to period poverty, and 60% of people of all genders believe that period stigma continues to persist. In the first city-wide study on period poverty, 46% of low-income women had to choose between a meal and period products. Periods make human life possible – and yet, still today, basic menstrual hygiene is thought of as a luxury. As a result of outdated gender-biased legislation, 33 states still tax menstrual products as luxury items. Ironically, products such as Rogaine and Viagra are considered medical necessities and are exempt from the state sales tax. We’re here to change that.”
With the knowledge that periods and mental health are so intricately connected, let's join forces and end period stigma AND mental health stigma together!
by Leora Mirkin, LCSW
TOOLS
Be aware of Premenstrual Dysphoric Disorder (PMDD), and talk to your doctor or therapist if you think this may be affecting you.
Know that underlying depression can worsen Premenstrual Syndrome (PMS), and consider being evaluated for depression if you notice a significant change in yourself around your period but you don’t have PMDD
Know the potential emotional symptoms that can occur around your period:anxiety, depressed mood, crying spells, mood swings and irritability or anger, appetite changes and food cravings, trouble falling asleep (insomnia), social withdrawal, poor concentration, and change in libido.
Use lifestyle changes to manage emotional symptoms around your period. This can include: eating smaller meals more frequently, limiting salt and avoiding caffeine and alcohol, increasing calcium intake, and exercising regularly around your period (even gentle exercise).
Talk to your doctor about using oral contraceptives and/or NSAID pain relievers to reduce period symptoms
Be kind to yourself! This is a hard time, and there's a good reason for it. Your brain chemicals legitimately change around your period, and you may need extra self-care.
CITATIONS
Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, 2017.
“Free the PERIOD.” PERIOD., www.period.org/freetheperiod.
Halbreich, Uriel, et al. “The Prevalence, Impairment, Impact, and Burden of Premenstrual Dysphoric Disorder (PMS/PMDD).” Psychoneuroendocrinology, U.S. National Library of Medicine, Aug. 2003, www.ncbi.nlm.nih.gov/pubmed/12892987.
Higuera, Valencia. “Premenstrual Syndrome: Causes, Symptoms, and Treatments.” Healthline, Healthline Media, 11 May 2019, www.healthline.com/health/premenstrual-syndrome.
“Premenstrual Syndrome (PMS).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Apr. 2018, www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787.
“Premenstrual Syndrome (PMS).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Apr. 2018, www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780.