A lot of women suffer from depression and/or anxiety as part of PMS symptoms. And if you struggle with low mood or a restless, anxious mind before your period then this episode is for you.
Mood changes before your period are common and yet for some women are felt very deeply and make life really hard.
In this episode I delve into all things period: What actually happens during your cycle, what is PMS, what is PMDD, why do some women get it – and of course most importantly: What to do about it. I talk you through some of the holistic treatments I use in my work with my clients.
Or read the episode transcript:
If you struggle with low mood before your period then this episode is for you. Or perhaps you notice a lot of anxiety before your period and you just can’t calm down those racing thoughts and switch your mind off. Maybe you get really irritable and angry in the lead up to your period. And some women get these mood changes so badly that they almost can’t recognise themselves anymore. The intense low mood, the severe anxiety, the huge feelings of irritability: they start to really interfere with life and make the day to day living just really tough.
And if you are listening and going “Hey yes, that’s me: My mood and mental health drops significantly before each period” then I hear you. You’re not making this up. You’re not being hysterical. You’re not weak. You’re not a crazy woman who needs to get herself under control.
In fact, speaking of control: A lot of the women that I work with tell me that their goal is to start feeling in control again. To stop having to wait for the bad phases to go away and to stop having to wait for the good days to just simply come. They’re tired of waiting, tired of not feeling in control over their bodies and minds and they just want to feel better.
So in this episode, I want to talk about PMS – but specifically as it relates to mood and mental health. A huge topic that you could write entire courses about, but I want to give an overview of what’s going on with PMS, what the research says, and then fundamentally provide you with tools to help yourself feel better.
Because whilst PMS and these mood changes are really very common, there is a lot you can do through lifestyle changes and natural supplements and remedies.
As always, I want it to be a clear that I obviously don’t diagnose anyone. If you have a diagnosed condition or you are taking any kind of medication, you need to always check with your primary healthcare provider before making any big changes.
So when it comes to our reproductive cycles, we think of our sex hormones. And anything to do with hormones is vastly complex and complicated and even science doesn’t fully understand everything that’s happening hormonally within our bodies. But we do know, and you’ve probably heard of these two hormones, that oestrogen and progesterone play a critical role within your monthly cycle.
So your oestrogen and progesterone are primarily produced inside your ovaries. You’ve got two of these glands sitting down inside your lower abdomen. And your ovaries are very clever: They not only secrete these reproductive hormones but they also protect all the eggs you were born with and then with each cycle release one of those eggs in case you wanted to get pregnant.
Now, really briefly, I just want to go over what actually happens with your oestrogen and progesterone levels within each cycle because that will help you understand a bit better why your mental health can worsen before the start of a new period – as well potentially a whole host of other more bodily symptoms showing up then.
So your cycle begins on day one of your first full day of your bleed. A lot of women don’t know this! So the start of your new cycle is the first full day of your bleed. And most women bleed for around 5 days, but it can vary between 3 and 8 days. The first two days are the heaviest.
Now the thing with your hormones is that they don’t just stay the same during your cycle. They fluctuate. However, if you are taking hormonal contraceptives, such as the pill, then ovulation (the release of an egg) is suppressed and your hormones don’t follow that natural fluctuating pattern as much anymore.
But what happens naturally is this: Your sex hormones fluctuate.
Whilst you bleed, your levels of oestrogen and progesterone (again, that’s the two main sex hormones for us women) are low.
But that changes as you progress through what’s called the follicular phase of your cycle where your body is working hard to release an egg and in this part, oestrogen rises.
And typically in this phase of your cycle a lot of us women feel like Superwomen. A lot of us notice that we have far more energy, feel far more confident within ourselves and are happier.
Why’s that? Likely because of oestrogen! Because remember oestrogen rises in this first part of your new cycle.
Oestrogen stimulates our mood and libido by boosting the neurotransmitters serotonin (which makes us feel welly and happy) and dopamine (which makes us feel motivated and get a sense of pleasure and reward).
And this makes sense evolutionary: In order to reproduce as a species, we need to feel confident and vibrant around the time when we’re fertile. So, in a very simplified way, we then seek out a male partner to have a baby with.
If we felt flat, low and depressed as well as unattractive and were really lacking in confidence, well we’d never really get ourselves into a situation where baby making was possible.
So then the follicular phase of your cycle ends when you ovulate, meaning your egg is released and if you don’t get pregnant now then you’ll have your next period after about two weeks.
And now we’re in the second half of our cycle, called the luteal phase:
In this part of your cycle, progesterone rises. Why? Well, just in case you got pregnant. If a sperm fertilises the egg, then progesterone would help maintain pregnancy.
But most cycles of your life, or even all, the egg won’t get fertilised and you won’t get pregnant. So then your progesterone and also your oestrogen levels start to drop. And that’s when a lot of women start to experience uncomfortable, and in some cases debilitating, symptoms:
There are up to 150 documented official symptoms of PMS and typically a woman will know whether it’s premenstrual syndrome if:
The symptoms start during the 2 weeks leading up to the period
They get better when the period starts
They come back each month.
Now, I don’t think we need to make the female cycle something that we see as a problem. I hate that idea. It’s a beautiful part of being female and should absolutely be celebrated. I believe it’s fine to notice a shift in how you feel depending on where you are in your cycle.
But if you know or you suspect that you have really bad period related changes and you only really feel healthy and well for 1 to 2 weeks of each cycle, then that can create so much misery. And make you feel like you have no control.
So classic PMS symptoms are anxiety, depression, mood swings, crying spells, tension and irritability, trouble with concentration, food cravings, tiredness, trouble sleeping, diarrhoea & bloatedness, spotty greasy skin, breast tenderness and backache or headaches. These are classic common symptoms but there could be a whole range. Perhaps you get a sore throat before your period starts- that can happen.
But typically the ones women often really suffer from are the changes to their mental and emotional health. Those are the ones that are so tough to deal with: the low mood, the crying, the despair, the hopelessness, the anxiety, the overwhelm, the exhaustion, the irritability… those are really tough. And those are the ones that often affect the other people around you as well.
Now if you don’t actually know whether there is a link between how you’re feeling and where you are in your cycle, then I’d really recommend tracking your cycle and how you’re feeling. It can be life-changing to become aware of potential patterns! And just help to avoid thinking that there’s something wrong with you or something wrong in your life, when in fact your period is about to start.
Or maybe you’re listening and perhaps you’re constantly struggling with anxiety or depression or lack of energy but you know that these these symptoms get worse before your period (as opposed to only occurring then). So that would be premenstrual magnification!
Around 5-8% of women suffer from a severe form of PMS, known as PMDD: Premenstrual dysphoric disorder.
So PMDD is typically diagnosed (although this is still relatively new) when women get extreme changes within their mental health in the lead up to their period: Particularly with regards to feelings of depression, anxiety and anger and a feeling of being out of control before the period, in the luteal phase. And these symptoms and feelings are so intense that they become highly disruptive to personal relationships.
So if towards the end of each cycle you feel like murdering your husband (or indeed wife) and throwing away your whole life (and yet you get on really well with him/her normally and feel fine around your ovulation), know that you’re not going mad. It could be your hormones!
So of course the big question is:
What causes your mood to worsen before your period? Why the link between PMS, depression and anxiety?
This is where even science isn’t fully sure. However: People who have been diagnosed with PMS or PMDD seem to be sensitive to fluctuations in hormones like progesterone and oestrogen.
So it’s about the changes in hormones during the second part of your cycle that a lot of women are sensitive to.
Interestingly and in line with this, when women with PMDD have an anovulatory cycle (so where ovulation of an egg didn’t occur for various reasons and therefore no egg was released), your progesterone levels then don’t fluctuate. And the lack of these hormone fluctuations then also leads to no PMDD symptoms for that cycle.
So it’s really the hormone fluctuations.
And interestingly, it’s been found that two women can have identical hormonal patterns and yet can have vastly different symptoms. It could be at least partly explained by differences in how each body deals with the hormones, detoxifies them etc.
But as I’ve said; it’s not all easy. All in all, it seems to be down to hormone fluctuations in the second part of your cycle and how sensitive you as an individual are to those!
But even though we don’t fully understand the exact causes and mechanisms of mood changes before the period, we do know that your lifestyle has HUGE HUGE implications for your cycle.
Before I go into strategies to ease PMS symptoms, I do just want to mention this though:
When people talk about balancing their hormones, it brings up this idea that you just take something around the time when your symptoms show up.
That is so not what it’s really about.
As we’ve seen, the fluctuations are normal and necessary. Both oestrogen and progesterone are vital for our health. Oestrogen increases serotonin and dopamine alongside other neurotransmitters which make us feel happy and motivated. Progesterone has soothing and calming properties as it connects with GABA receptors in our brain – the neurotransmitter that helps us feel calm.
But being more resilient to these fluctuations, or in other words suffering less, has to do with looking after yourself for the entire length of your cycle, cycle after cycle. It’s not about a one-pill solution, or a stick a plaster on it and you’ll be fine. That might relieve things short-term but long-term it’s really about getting to a place where your periods no longer bring pain and misery.
And just to say, some women experience a deficiency in progesterone and that’s related to certain conditions such as PCOS, heavy periods, fibroids, acne, endometriosis and more… a blood test can help here.
But in general, what you want to do is to address your lifestyle and physical health. So I’m talking about food and nutrition, lifestyle, stress management, dealing with inflammation and your gut health, and where beneficial supplementing with key nutrients or using herbs as remedies.
So you need to look at stabilising your blood sugar levels – I have a previous episode on this titled “Episode 5- Depression & Anxiety and the incredible link to blood sugar imbalances”.
So do check that out. But fundamentally it’s about reducing the sugar, reducing processed foods and meals, and eating at regular times of the day and making sure that all meals include protein. Look at the amount caffeine in your diet and reduce alcohol. Increase your vegetable intake and eat nuts and seeds and oily fish.
The standard modern western style diet rich in beige foods, so refined carbs and rich in processed meat and lacking in fibre and veg and colour and healthy fats…. Well that’s a massive PMS contributor for you there. If you’re suffering with your mental health, whether it’s premenstrually amplified or not, you just want to stay away from that as much as you can.
There are specific nutrient deficiencies related to PMS as well including magnesium, vitamin B6, vitamin D, calcium and zinc. So look for foods rich in those (think of the Mediterranean diet and lifestyle) or consider a supplement. That’s the approach I take with my clients, depending on what else is going on there.
And exercise and moving your body throughout your cycle is great news to help reduce PMS symptoms.
And a big, big, big absolute huge contributor to PMS is stress. Personally, I don’t often get PMS symptoms although I used to particularly when I was younger. But I had this one cycle a few months ago where I had just the worst PMS symptoms and I knew that had to do with the huge amount of stress that I was personally dealing with within that same cycle.
It was actually pretty eye-opening to me just how much of an effect stress has on your hormonal health. Normally I don’t get many PMS symptoms – often the period simply starts without me noticing much beforehand (but my cycle tracking app will let me know where I am in my cycle).
So looking at reducing stress and finding better ways to cope with stressful things (and stressful thoughts inside your head) is key.
And then sleep, a.k.a. your overnight therapy. A lack of sleep contributes to both high cortisol levels (your stress hormones) and disrupts your blood sugar balance which as I’ve mentioned above is critical for your hormonal health.
It’s also important to consider inflammation. A lot of us are chronically inflamed these days because of processed and sugar rich diets, lack of fibre and veg, food sensitivities and allergies, gut health imbalances, high exposure to toxins coupled with reduced detoxification capabilities, high stress, certain medications etc… So that’s where personalised interventions really come in.
But as with most chronic health conditions and symptoms, including PMS, getting better addresses the whole host of your symptoms typically. Everything is connected. And typically what happens with my clients is that they notice improvements in all kinds of areas: for example their skin conditions improve or even clear up, their digestion is the best it’s been for years, their energy levels are far better, they sleep much deeper, their mood is more stable and PMS symptoms reduce.
And the best about all of it is this wonderful sense of knowing yourself more: knowing what works, feeling in control and having this huge toolkit available in order to help yourself heal.
So, I hope this episode has been useful. We took quite a deep dive into all things sex hormones, and there’s so much more that we could cover! But my main takeaway point about this PMS, depression and anxiety related episode is this: You can feel better. You can have better periods!