What happens when your mental health conditions coincide with PMS?

How existing mental health issues can be intensified in the perimenstrual* phase.

*FYI: Perimenstrual is a more accurate term to describe the broad experiences people may have before and during the time of menstruation. Premenstrual implies there’s a cessation of symptoms once the period begins, which isn’t the case for everybody.

I’ve suffered from anxiety for over a decade and with depression for about a year. I only started paying attention to my cycle when I began practicing the Fertility Awareness Method (FAM)†. FAM gave me an acute understanding of my body. After tracking many aspects of my health for a while using Clue, I noticed some clear hallmarks of cycle phases: I was extra motivated during my follicular phase and felt horny and glowy around ovulation.

Then I noticed my premenstrual experience changed.

I had always experienced cramps, swollen breasts, acne and irritability — but my energy and emotional symptoms began to worsen before my period, each cycle. Intense mood swings, sheer despair, lethargy and a lot of crying. I started to think I had PMDD, but as depression crept into my life and my anxiety grew, I noticed fluctuations in my mood and energy across my cycle. How I would feel and function each day was a gamble, and in the days before my period I noticed the feeling of being utterly overwhelmed was amplified.

PMS is an understudied and largely misunderstood experience. It’s too often humorously generalized despite the unique occurrence it is for each person. There’s an inaccurate notion ascribing negative premenstrual moods to the general population. This ubiquitous belief needs challenging, as it perpetuates harmful concepts associating innate female biology with negative emotionality (1). Not every woman or person with a cycle has a bad perimenstrual experience.

Yes, for some people PMS can be summed up by getting into a crying argument with their partner over what type of non-dairy milk to purchase and 15 minutes later sipping an oat-milk cappuccino, comically saying, “Oh, PMS!”

But it’s not so lighthearted for other people. When my mental health worsened, such trivial quarrels weren’t relative to a time in my cycle — and during my premenstrual phase they seemed way more serious and harder to shrug off.

Am I exhausted because of PMS or depression? Am I debilitated with a sense of doom because of anxiety or PMS? Am I sobbing from depression, PMS or anxiety?

This is the confusion of having mental health conditions and a cycle. Feeling worn out and unstable isn’t specific to the premenstrual phase, but for some people these states can really worsen during that time.

It can seem sexist and degrading to be struggling with emotional upheaval and then be subjected to the question of “PMSing” from yourself or another person. It can also be bothersome when you’re down, you do suffer from premenstrual mood variability and — shocker — yes, you are in the perimenstrual phase. Add depression and anxiety into the mix, and this time is a complete puzzle. I finally felt my uncertainty explained when I discovered the term “premenstrual magnification”: I’m soon to get my period and the symptoms of my mental health conditions are in overdrive.

Premenstrual magnification is when mental and physical health conditions are premenstrually aggravated.
Premenstrually magnified symptoms of anxiety, depression, asthma, inflammatory bowel disease and other mental and physical health conditions may be exacerbated, overlap with and/or be confused for menstrual symptoms (2–4).

Practicing mindfulness has helped me become more aware of what I’m experiencing in my brain and body. Just as FAM requires heightened awareness and diligent tracking of your bodily processes, mindfulness requires heightened awareness of your consciousness.

When I enter the luteal phase, I acknowledge I may be more prone to negative mental and physical symptoms. I’ve learned to give myself the extra personal time and care I require during the premenstrual phase. By honing my consciousness through meditation (without any religious or subculture affiliation), I’ve started to thoroughly recognize pains and patterns of dismal thoughts and accept them as temporary in degrees of severity. This helps slow down the spiral of chaos I used to frequently get lost in.

Being patient and present with myself has eased my suffering. Not judging myself and achieving the sense of being present in the present hasn’t been easy; it takes a lot of meditation practice (and can sound like hippie jargon), but it’s scientifically proven to bring a lot of relief (5–7). Exercise, therapy and nutrition have also immensely helped in improving my mental and overall health.

Treat your mind with great care as you would with the rest of your body.

Emotions and PMS shouldn’t be so inseparable. You don’t have to assume PMS for a justification of a bad mood. Daily stress, physical health, mental conditions and social life are frequently better explanations for mood variability than menstrual cycle phase (1).

It’s important to not make sweeping claims and shallow excuses for changes in a person’s temperament. Remember and respect everybody’s unique experiences. The perimenstrual phase can be a seriously challenging time for some, or an overused basis for misogyny and rationalizing acting-out.

When your experience of mood symptoms regularly impacts your well-being, it can be helpful to talk to your healthcare provider. It can be difficult to come to terms with a mental health condition, but acknowledgement is the first step towards alleviating suffering.

What has been your experience with mental health conditions and your cycle?

Know your body. Track your mental states, emotions, meditation and more in Clue.

†Clue’s predictions are not suitable for preventing pregnancy, and are shown for informational purposes only. It’s not possible to create accurate predictions of ovulation and the fertile window for every cycle based only on the statistics gathered by Clue.


References
1. Romans S, Clarkson R, Einstein G, Petrovic M, Stewart D. Mood and the menstrual cycle: a review of prospective data studies. Gend Med. 2012;9(5):361–84.

2. Steiner M. Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Journal of Psychiatry and Neuroscience. 2000 Nov;25(5):459.

3. Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2011;84(8):918–24.

4. Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual syndrome. Am Fam Physician. 2003;67(8):1743–52.

5. Factor-Litvak P, Cushman LF, Kronenberg F, Wade C, Kalmuss D. Use of complementary and alternative medicine among women in New York City: a pilot study. J Altern Complement Med. 2001;7(6):659–66.

6. Solberg EE, Holen A, Ekeberg O, Osterud B, Halvorsen R, Sandvik L. The effects of long meditation on plasma melatonin and blood serotonin. Med Sci Monit. 2004;10(3):CR96–101.

7. Schliep KC, Mumford SL, Vladutiu CJ, Ahrens KA, Perkins NJ, Sjaarda LA, et al. Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Epidemiology. 2015;26(2):177–84.