For some of us, monthly periods are easy breezy. But for others, “premenstrual syndrome” (which most of us know as PMS) is a total drag. PMS can show up in very different ways, ranging from the physical — such as bloating and cramps — to the emotional, like PMS mood swings, which many people find take the biggest toll on their well-being.
Ever noticed yourself sobbing at a TV commercial one minute and fighting the urge to launch your phone across the room the next? Yup, you’re probably one of the three in four women who experiences PMS-related symptoms. For most people, these are mild, but that’s not to say they don’t cause disruption. Mood swings during PMS can cause “fatigue and depression” for some, explains OB-GYN (obstetrician and gynecologist) Barbara Levy, MD, while it can lead others to “become less patient and more intolerant to small irritations.” It’s also typical to feel sad, hopeless, lonely, overwhelmed, guilty, or restless as part of PMS. Not fun for you or the people around you.
As with most menstrual-related conditions, you can probably guess what’s at the heart of your changing temperament: hormones. “Mood swings are common whenever hormones change,” says Dr. Levy. “It turns out that hormones have an effect on our brain chemistry, increasing some neurotransmitters and decreasing others.” That’s why PMS mood swings always seem to hit around the same point in your cycle. The sudden dip in hormones that happens before your period can cause you to be irritable for seemingly no reason at all.
For your symptoms to be medically classified as PMS, they need to appear five days before your period and end within four days of it starting. They also need to occur in three or more cycles in a row and affect your daily life. But some people also get PMS symptoms starting at the beginning of the luteal phase, which can be around 14 days before their period starts. If you want to better understand your premenstrual emotions, try logging your symptoms with an app like Flo. It’ll give you a clearer picture of when mood swings typically start and how long they last, and will arm you with all the right information if you decide to see a health care professional about it.
We all react to hormonal changes in different ways, of course, which is why not everyone who has periods experiences mood swings. PMS symptoms like mood swings are most common in people in their 30s. They may also get worse later into your 30s and 40s, or as you enter perimenopause (the transitional period before menopause).
There are some other risk factors when it comes to who experiences PMS. Those who have high levels of stress, a family history of depression, or personal experience with depression or postpartum depression may be more likely to notice unsettled emotions in the run-up to their period.
Society tends to speak about PMS in two very binary (and pretty harmful) ways. First: It’s a universal experience, one that everyone who has periods endures every cycle. Second: It isn’t even a thing, just an excuse for our bad moods and irritability. The first normalizes pain and discomfort, suggesting it’s just a part of life we should simply put up with. The second trivializes the very real impact PMS has on some people’s lives.
While it is very common, and therefore “normal,” to experience mood swings as part of PMS, that’s not to say you should always have to accept that it’s just a part of your life. For many, it’s just an inconvenience, but others experience more severe symptoms that require some help. Up to 8% of women of reproductive age have something called premenstrual dysphoric disorder (PMDD). Often incorrectly referred to as “just bad PMS,” PMDD is actually a severe type of PMS that can totally affect someone’s ability to function during the luteal phase — and a large part of that is related to mood. Commonly, it’s characterized by severe symptoms like a marked loss of energy, feeling out of control, feeling hopeless, or having suicidal thoughts.
“If you are unable to function well at work or at home, if you have feelings of overwhelming sadness, or like you may want to hurt yourself or someone else, it’s time to get help,” advises Dr. Levy.
Whether you’d classify your premenstrual moodiness as severe or not, there are things you can do to help manage it and make everything more bearable all around. They include:
If you know your mood is likely to dip in the few days before your period and your cycle is fairly regular, try to plan for it by working with your PMS. Fill your premenstrual week with stress-busting activities, such as an exercise class, a massage, or a weekend of downtime, and surround yourself with things (or people!) that make you feel great. That might be wearing your favorite PJs or booking a table at that restaurant you’ve been dying to try.
Also take into account the hardest days of the month, and if you have flexibility in your schedule, try to avoid any big work projects or stressful trips around the times you’re likely to be a little more vulnerable.
While you might make a beeline for the chocolate aisle in your pre-period days, a study published in The Journal of Reproductive Medicine found that might not be a winning strategy. Sugary foods and drinks may actually make PMS worse because they cause erratic blood sugar levels that can impact your mood. Your best bet? Eat fiber-rich foods throughout the month — think whole grains, oatmeal, brown rice, and leafy greens. These help your gut health and balance out your blood sugar.
Heading to the gym might be the last thing you feel like doing on the days leading up to your period, but a study in BMC Women’s Health found that women who did eight weeks of aerobic exercise reduced both the physical and psychological symptoms of PMS. Exercise can also help you get a great night’s sleep, which is especially important, not only for improving your mood, but also because people with PMS are twice as likely to experience insomnia, according to the Sleep Foundation.
If you’re one of the small percentage of people who experiences PMDD, you may need more than a few simple lifestyle changes to see noticeable improvements. Often, this means medication. Some people find that birth control can help. A study published in the Open Access Journal of Contraception has shown that taking combined hormonal contraceptive pills continuously can improve symptoms of PMDD, so it could be worth chatting with your health care provider about options.
If the psychological symptoms of PMDD are leaving you struggling to manage, antidepressants could also be worth trying. That same study from the Open Access Journal of Contraception found that 60% to 70% of people who took selective serotonin reuptake inhibitors noticed improvements.
Cognitive-behavioral therapy (CBT) may work alongside, or as an alternative to, medication for anyone with PMDD dealing with severe premenstrual mood swings. One randomized, controlled trial published in Psychotherapy and Psychosomatics found that an 8-week online CBT program was highly effective at reducing the emotional burden that comes with PMDD, and it improved coping skills too. So that’s another avenue to explore if you feel you need help.
Many supplements on the market haven’t been researched enough to prove whether they’ll help with PMS, so don’t assume this is a sure-fire solution to your emotional symptoms. But there are a few supplements with some research behind them that suggests they might help your PMS. For example, one study suggests that taking 1,200 mg of calcium a day could help reduce PMS mood symptoms, as well as some of the physical ones. Another study in the Iranian Journal of Nursing and Midwifery Research also showed that vitamin E may help reduce symptoms of PMS. Always seek the advice of a health care provider with any questions you may have regarding a medical condition or treatment.
While it would be amazing if PMS didn’t exist, hormonal changes are a normal part of the menstrual cycle, so we’d always encourage exploring what you can do to make mood swings easier to deal with.
As well as the lifestyle changes and treatment options mentioned above (which can be beneficial throughout your whole cycle, FYI, not just in the run-up to your period), it may also be helpful to consider some of the more positive sides to a monthly premenstrual meltdown. You might just find it’s not all bad. For example, PMS can make you more sensitive to both your own and others’ emotions, meaning you might find yourself feeling closer to your loved ones. Alternatively, your PMS mood swings might give you the urge to spend more time alone, which can provide room for thought, reflection, and ideas to thrive.
Ultimately, your premenstrual days are a time for self-care, patience, and kindness to yourself. So make sure you remember that the next time you become irritated at yourself for welling up at a TikTok video of kittens, okay?