PMS. Ah, yes. Those few days before a new cycle when you are bloated, irritable, and likely to annihilate anyone who looks at you sideways. No amount of chips and queso or peanut butter M&Ms can fix it-- although each month I keep trying to find the therapeutic dose.
All jokes aside, those days can be emotionally BRUTAL. And what about when it lasts beyond just 2-3 days? Is there a way to know if it’s a response to a hormonal shift versus a generalized anxiety or depression warranting a different treatment plan?
Let‘s look at what is going on hormonally throughout the whole cycle, not just the {awful} final days before a period.
Follicular phase (pre-peak phase): Estrogen is high.
Life. Is. Good.
This is the phase when we will say yes to ALL THE THINGS!
"You need someone to lead that group?" I got you!
"There are five women who had babies last month?" I will make four course meals for all of them!
"Two people need help getting shifts covered later this month?" No problem! I can work for both of them AND organize the work potluck for the going away party that week.
You get the idea. First half of the cycle, we can take on the world and look fabulous doing so. Even women with a rockin' mom bod know they've still got it during this phase of the cycle.
What causes this positive feeling? Estrogen. With a nice hit of testosterone around ovulation.
Unfortunately, that estrogen wave doesn’t last forever. Ovulation marks the shift to the luteal phase of the cycle. After ovulation, the follicle that released the egg (go back to this post if you aren't following that sentence) becomes the corpus luteum and produces progesterone.
Enter: second half of cycle.
Progesterone rules the post-peak phase and is also the source of many uncomfortable symptoms. Constipation? Yup. It relaxes the digestive muscles making everything move through much slower. Progesterone can also have a sedative-type effect, noticed by women who take bioidentical supplementation and enjoy the side effect when taken before bed. Progesterone is attributed to mild feelings of depression, fatigue, and decreased sex drive.
Remember all those commitments you made in the first half of the cycle? Now you wonder what the **** you were thinking because you just don't have the energy for all of that!
Interestingly, this is often at moderate doses. When progesterone is very high (later in pregnancy) women often do not report these symptoms.
The key to estrogen and progesterone is balance. They are in a feedback loop. When progesterone is too low, estrogen becomes dominant. This is common in conditions such as polycystic ovarian syndrome (PCOS). Although estrogen makes us feel good in the first half of the cycle, when it becomes too high, bloating, swelling, mood swings, and headaches can accompany the dominance. Supplementing the luteal phase progesterone can help to lower estrogen levels as these hormones find balance.
The real emotional kicker with these hormones comes the final week of the menstrual cycle. Progesterone rises after ovulation to prepare for a potential pregnancy. If an egg is not fertilized, progesterone and estrogen both fall, and this tells the body to shed the built-up uterine lining (causing the next menstrual cycle to begin). The quick drop in hormone levels is the culprit for the infamous PMS, premenstrual syndrome.
Understanding the effect of hormones on mental health is key. Simply being aware can do wonders to help you take a breath when an overwhelming feeling of despair washes over.
Check out this article on teen girls who learned to track their cycles. They realized delinquent behaviors were associated with PMS. It is super fascinating because they had a significant decrease in legal trouble after learning to track their cycles. Knowledge is power.
"I cannot make a decision on that right now. I'll get back to you next week." That sentence came out of my mouth 3-4 times last week. I recognized the phase of my cycle and understood my strong desire to QUIT EVERYTHING was likely hormonal.
1. Track cycle and moods. Look for correlation.
As weird as I found it when my FitBit app said "your period is predicted to start in 2 days," it was actually the reminder I needed. Hey! You aren't suddenly in a deep depression that will never end! Cut yourself some slack! Your hormones just literally packed their bags and peaced out for a few days. Now put down your (4th) cup of coffee, drink some H2O and go for a walk outside.
I wouldn’t have known the likely cause of my moods if I wasn’t keeping a chart of my cycle.
Learn how to identify ovulation to ensure the post peak phase is long enough for adequate progesterone levels (remember, balance between estrogen and progesterone is key!). Track your moods and symptoms. All of this information is valuable to helping YOU take charge of your mental health effects from your monthly cycle.
2. Ensure you're practicing good self care the days surrounding known hormone drops.
Sleep. Whole foods. Hydration. Sun. Exercise.
We need all of those daily-- especially on days when our hormones are not providing a buffer. Caffeine, alcohol, excessive screen time, sleep deprivation. These will only amplify the effects of the pre-period hormone crash.
There are lifestyle and medication interventions to support your mental health during hormonal transitions. Sometimes you will feel better just knowing life should be bearable again in a day or two. In certain cases, though, a true hormonal abnormality needs to be corrected to help your hormones (and subsequently emotions) find balance.
3. Double check that there are no obvious hormone level red flags in your cycle (short luteal phase, brown spotting for days before period starts. etc.) and supplement deficient hormones, as needed.
Postpartum is another time when hormone shifting is prevalent. Progesterone plummets with the delivery of the placenta. This is only complicated by the newborn sleep schedule (or lack thereof) and minimal self care most women are able to focus on in the initial weeks postpartum.
4. Seek medical care for additional treatment options.
Sure, I knew the hormonal causes of my postpartum anxiety. I wasn't in cycles yet, so I had zero progesterone or estrogen. For MONTHS! It was rough.
I tried self-care...as well as you can with a 2 month old. And in the end, I needed an anti-anxiety medication and a therapist in addition to the supportive lifestyle interventions. Thank goodness that was an option! I needed it!
*Seek medical care immediately for any mental health concerns that are severe.*
A woman’s hormone levels are constantly shifting. Even without an abnormality, there are emotionally tough days each cycle from a bottoming out of progesterone and estrogen. Then, if one hormone goes awry, a cascade effect can take place. Finally, mental health disorders are very real and are likely aggravated by certain hormone changes.
Take care of yourself, learn about your individual cycle, and advocate for what you need for better mental health.