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Anxiety and Depression During Periods: Causes, Detection, and Treatment

Depression and anxiety during periods are both common. These symptoms are often part of premenstrual syndrome (PMS). PMS is a combination of physical, emotional, and behavioral symptoms that occur during the premenstrual phase of the cycle and go away after the period begins. PMS can cause depression before and during periods, along with food cravings, headache, fatigue, and tender breasts, among other symptoms.

However, severe depression during periods (or before) may be caused by premenstrual dysphoric disorder (PMDD). If you are already experiencing depression, it may be that your depression worsens before and during periods.

Causes of depression during periods

It’s not known exactly how PMS causes depression, but it’s probably connected to the hormonal fluctuations that occur during the second half of the menstrual cycle, sensitivity of the central nervous system to reproductive hormones, genetic factors, and psychosocial factors such as stress. 

Changes in levels of progesterone and estrogen can affect levels of serotonin. Serotonin is a neurotransmitter that helps regulate appetite, sleep cycle, and mood. Low serotonin levels may lead to feelings of irritability and sadness, unusual food cravings, and trouble sleeping, all of which are symptoms of PMS. In addition to these symptoms and depression while on your period you may also have:

  • Anxiety
  • Increased anger
  • Forgetfulness 
  • Increased crying
  • Absentmindedness
  • Decreased libido
  • Sleeping too little or too much
  • Eating too little or too much
  • Nausea
  • Tiredness or fatigue ​

Why does depression worsen during periods?

Depression may also be exacerbated during your period due to PMDD. PMDD is quite similar to PMS, but its symptoms are more severe. Many people who experience PMDD report extreme depression before and during their periods. According to estimates, around 30 percent of people who get periods experience PMS in their reproductive years, and anywhere from three to eight percent experience PMDD. 

If you already have depression, then your symptoms may get worse before and during your period. Depression commonly occurs alongside premenstrual syndrome. About 50 percent of people who receive treatment for PMS also experience either anxiety or menstrual depression.

Can depression affect your period?

Yes, depression may affect your period. Depression can cause missed or irregular periods. During periods of stress or depression, hypothalamus function is suppressed. The hypothalamus is the part of the brain that controls the functioning of the pituitary gland, which in turn controls the ovaries, so when the hypothalamus isn’t functioning correctly, it can lead to ovarian dysfunction. Ovarian dysfunction can affect ovulation and the production of estrogen. When the ovaries aren’t working properly, ovulation may be delayed or stopped. This may result in irregular periods or missed periods.

Can depression stop your period? Yes, depression can stop your period. Not having your period for three months or more without pregnancy is called secondary amenorrhea. When the cause of amenorrhea is depression and chronic stress, it’s called functional hypothalamic amenorrhea.

Signs of severe depression during period

You may experience severe depression before and during periods due to premenstrual dysphoric disorder (PMDD). PMDD is similar to PMS, but it’s severe and sometimes disabling. PMDD can cause extreme mood shifts, which can interfere with your daily life, relationships, and work. Symptoms usually start a week before menstruation and continue a few days after your period begins. Apart from severe depression before and during periods, other symptoms and signs of PMDD are:

  • Tension or anxiety
  • Feeling out of control or overwhelmed
  • Extreme moodiness
  • Marked anger or irritability
  • Mood swings
  • Social withdrawal
  • Sudden tearfulness or sadness
  • Hopelessness with extremely negative thoughts
  • Trouble concentrating
  • Problems sleeping
  • Binge eating or food cravings
  • Fatigue 
  • Lack of interest in relationships and daily activities
  • Loss of interest in sex

Coping with depression on your period

You may manage depression during your period by making certain lifestyle changes and taking specific medications.

Track your symptoms 

Keep track of your symptoms throughout the phases of your menstrual cycle. This may help you determine whether your symptoms of depression are connected to your cycle. Having a detailed log of symptoms from your last few menstrual cycles can also come in handy when you want to discuss depression before and during periods with your health care provider. Thorough documentation of your symptoms may make it easier to explain to your health care provider what you’re experiencing. 

While tracking depression before and during periods, make sure that you note the following symptoms:

  • Sadness
  • Crying spells
  • Anxiety
  • Irritability
  • Loss of appetite
  • Food cravings
  • Sleeplessness or insomnia
  • Trouble concentrating
  • Lack of interest in daily activities
  • Lack of energy, tiredness

Hormonal birth control

Hormonal birth control methods — including the pill or the patch — may help with physical symptoms of PMS like tender breasts and bloating. For some people, they also help relieve emotional symptoms like depression before and during periods.

For some, hormonal birth control can make symptoms of depression worse. You might have to try different types of birth control before you find a method that works for you. If you’re interested in taking the pill, a continuous one that doesn’t have a week of placebo pills might be best for you. Continuous birth control pills can eliminate your period, which sometimes helps eliminate PMS, too.

Vitamins and supplements

Some supplements may help relieve symptoms of depression before and during periods. In a clinical trial, it was found that a calcium supplement may reduce PMS-related tiredness, appetite changes, and depression. Great sources of calcium include milk, cheese, yogurt, fortified cereals, orange juice, and leafy green vegetables. A daily calcium supplement is another way to get enough calcium. 

Lifestyle changes

You can make the following lifestyle changes to relieve the symptoms of depression before and during periods:

  • Exercise: Try to be physically active for a minimum of 30 minutes most days of the week. Even going for a daily walk through your neighborhood might improve your symptoms of fatigue, difficulty concentrating, and depression with your period. 
  • Nutrition: Try to resist the cravings that often accompany premenstrual syndrome. For some people, eating excessive sugar, salt, and fat can have a negative impact on mood. You don’t have to avoid these foods completely, but strike a balance with vegetables, whole grains,  and fruits. Avoiding alcohol, stopping smoking, and cutting back on caffeine may also help relieve symptoms of depression with periods and before it.  
  • Sleep: Sleep for at least seven to eight hours per night, especially a week or two before your period. Not having enough sleep may make your depression worse during your period. 
  • Stress: Unmanaged stress may worsen symptoms of depression during periods. Use relaxation techniques like meditation, yoga, mindfulness, and deep breathing exercises to calm your body and mind. Avoid emotional and stressful triggers whenever possible. 

Medicine

If other treatment methods aren’t working, then taking an antidepressant medication may help relieve your depression before and during periods. The most common antidepressant medicines used for the treatment of depression before and during periods are selective serotonin reuptake inhibitors (SSRIs). SSRIs block serotonin absorption, increasing the amount of serotonin in the brain. Work with your health care provider to find the right medication and dosage for you.

Finding support

If your symptoms of depression during your period and before it become overwhelming, then your gynecologist might be able to help. You can also refer to the International Association for Premenstrual Disorders, which offers online communities, blogs, and local resources that may help you find a health care provider familiar with depression during periods, PMS, and PMDD. 

If you experience extreme depression before and during periods that is causing suicidal thoughts, it’s very important to get help. If you’re not sure who to contact, a suicide or crisis prevention helpline can be immensely helpful. 

Many people experience symptoms of depression and anxiety before and during their periods. It may be a symptom of PMS. The exact cause of depression due to PMS is unknown, but it may occur as a result of sensitivity to hormonal fluctuations during the second half of the menstrual cycle. Apart from PMS, your symptoms of depression before and during periods may also occur due to premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation of existing depression. Depression may affect your period by causing missed or irregular periods. PMDD may cause severe depression before and during periods along with extreme mood shifts and possibly thoughts of suicide. Symptoms of depression before and during periods can often be managed with lifestyle changes and antidepressants.

Thielen, Jacqueline M. “Premenstrual Dysphoric Disorder (PMDD): A Severe Form of PMS.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Nov. 2018, www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315.

Jacobson, John D. “Premenstrual Dysphoric Disorder.” MedlinePlus, U.S. National Library of Medicine, 25 Sept. 2018, medlineplus.gov/ency/article/007193.htm.

Gordon, Catherine M, et al. “Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology and Metabolism, U.S. National Library of Medicine, 1 May 2017, www.ncbi.nlm.nih.gov/pubmed/28368518.

Hantsoo, Liisa, and C Neill Epperson. “Premenstrual Dysphoric Disorder: Epidemiology and Treatment.” Current Psychiatry Reports, U.S. National Library of Medicine, Nov. 2015, www.ncbi.nlm.nih.gov/pubmed/26377947.

Direkvand-Moghadam, A, et al. “Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study.” Journal of Clinical and Diagnostic Research : JCDR, JCDR Research and Publications (P) Limited, Feb. 2014, www.ncbi.nlm.nih.gov/pubmed/24701496.

Yonkers, Kimberly Ann, and Michael K Simoni. “Premenstrual Disorders.” American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, Jan. 2018, www.ncbi.nlm.nih.gov/pubmed/28571724.

“Premenstrual Syndrome (PMS).” Stanford Children's Health - Lucile Packard Children's Hospital Stanford, www.stanfordchildrens.org/en/topic/default?id=premenstrual-syndrome-pms-85-P00581.

Eisenlohr-Moul, Tory A, et al. “Treatment of Premenstrual Dysphoria with Continuous versus Intermittent Dosing of Oral Contraceptives: Results of a Three-Arm Randomized Controlled Trial.” Depression and Anxiety, U.S. National Library of Medicine, Oct. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5629109/.

Freeman, Ellen W, et al. “An Overview of Four Studies of a Continuous Oral Contraceptive (Levonorgestrel 90 McG/Ethinyl Estradiol 20 McG) on Premenstrual Dysphoric Disorder and Premenstrual Syndrome.” Contraception, U.S. National Library of Medicine, May 2012, pubmed.ncbi.nlm.nih.gov/22152588/.

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