Dr. Tariq Jagnarine
Family Medicine, Endocrinology /Diabetes
Mood changes and other psychological symptoms are common before a period. For some people, the symptoms of premenstrual syndrome (PMS) can be severe enough to interfere with their relationships and daily life.
• CAUSES
According to the MGH Center for Women’s Mental Health, some people are hypersensitive to natural hormone changes that happen during the menstrual cycle. This hypersensitivity may predispose a person to premenstrual mood swings.
Severe premenstrual mood swings can sometimes indicate an underlying health condition.
• Premenstrual syndrome (PMS)
The term premenstrual syndrome (PMS) describes a variety of physical, emotional, and behavioral symptoms that occur before menstruation. Many females who menstruate experience symptoms of PMS, and it is not uncommon for these to be mild. However, a proportion of those with PMS may experience more severe or clinically significant symptoms.
Premenstrual dysphoric disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) is an extreme form of PMS. The chief difference between PMS and PMDD is the severity and duration of symptoms. A person with PMDD will have significant mood swings that can interfere with personal and professional relationships. According to the Child Mind Institute, these symptoms can continue after a period has ended.
Premenstrual
exacerbation (PME)
A female who has a preexisting mental health condition may find that the condition worsens prior to a period. The medical term for this is premenstrual exacerbation (PME). Some mental health conditions that may become more severe shortly before a period include:
• Anxiety
• Depression
• Bipolar disorder
According to the International Association for Premenstrual Disorders, it can be difficult to distinguish between PMDD and PME. However, it is important for a person to receive the correct diagnosis, as the treatment options for each condition differ.
Symptoms
The symptoms and signs of PMS and PMDD are similar. The key differences between the two conditions are the severity and duration of symptoms. A person who has either condition may experience physical, behavioral, or psychological symptoms or a combination of symptoms.
These include the following:
Physical symptoms
• Headaches
• Increased or decreased appetite
• Abdominal bloating
• Fatigue or lethargy
• Breast tenderness
• Swelling of the feet or hands
• Joint or muscle aches or pains
• Difficulty sleeping
• Behavioural symptoms
• Difficulty concentrating
• Fatigue
• Forgetfulness
Psychological symptoms
• Mood swings
• Feeling overwhelmed or out of control
• Crying without knowing the reason
• Loss of interest in most activities
• Sudden sadness
• Sensitivity to rejection
• Social withdrawal
• Anxiety
• Depressed mood
• Irritability
Mood swings and other symptoms associated with PMS are very common. According to one estimate, at least 90% of those who have a menstrual cycle experience physical or psychological symptom of PMS. For most women, the symptoms are not severe.
However, PMDD is also not uncommon, affecting between 3–8% of people in their reproductive years. The symptoms usually develop when someone is in their 20s, and may worsen over time.
Some major risk factors for PMDD include:
• Stress
• Pre-existing mood or anxiety disorder
• Family history of PMDD
Treatment and management
There are several potential treatment and management options for people dealing with mood swings prior to their period. Some common options include the following:
• Natural treatments and lifestyle changes
Certain nonmedical treatments might help to reduce the frequency and severity of premenstrual mood swings. Examples include:
• Keeping a mood diary: People can try keeping a record of their mood swings and when they occur during the menstrual cycle. This can help a person recognize the hormonal causes of their mood swings and anticipate them happening.
• Eating a balanced diet: A balanced diet, low in added sugars, sodium and caffeine, could help to reduce mood swings.
• Exercising regularly: According to the MGH Center for Women’s Mental Health, regular aerobic exercise can lessen the emotional and physical symptoms of PMS and PMDD.
• Reducing stress: Yoga, meditation, or talking therapy can help to reduce stress levels and balance mood.
• Taking herbal supplements: According to a 2017 review of eight randomized controlled trials, the herbal medicine known as chasteberry Tea is a safe and effective treatment for PMS and PMDD.
• Taking calcium supplements: A 2017 study found that calcium supplements improved anxiety, depression, and emotional changes connected with PMS.
Medications
There are several medications that may help to treat mood swings before a period.
One option is an oral contraceptive. Some people notice an improvement in their PMS symptoms when taking an oral contraceptive, while others find that their symptoms worsen. As such, a person should monitor their symptoms closely, and return to their doctor for alternative treatment if necessary.
If a person has severe PMS or PMDD, their doctor may prescribe one of the following medications:
• Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs): The brain chemicals serotonin and norepinephrine are important for regulating mood. SSNRIs, such as venlafaxine and duloxetine, increase levels of these chemicals in the brain. They are usually the first-line treatment for PMDD.
• Benzodiazepines: These are a type of sedative drug. They relax muscles and help to slow down certain types of brain activity. Doctors may prescribe benzodiazepines to treat sleep and anxiety disorders. The benzodiazepine known as diazepam, lorazepam, alprazolam appears beneficial in treating PMDD.
Antianxiety medications: According to a 2015 review, the antianxiety medication buspirone may be a useful treatment for PMDD.
People should talk to their doctor if they experience mood swings or other symptoms of PMS or PMDD. If the mood swings are severe or disruptive, a person should talk to their doctor as soon as possible.
During the consultation, a doctor may try to rule out possible psychological disorders, such as depression or anxiety. This will be an important step in differentiating PMDD from PME.
After making a diagnosis, the doctor may recommend certain lifestyle changes, or may prescribe medical treatments. If a person continues to experience mood swings, they should return to the doctor for a change of treatment.
