Period Blues: Is It PMS or Something More?

Premenstrual syndrome (PMS) is an umbrella term for the physical and emotional symptoms that occur leading up to your period, after your body has gone through ovulation and as it prepares to shed the uterine lining.

PMS is different for everyone — some people feel really strong symptoms, while others notice only mild discomfort or no symptoms at all.

PMS is extremely common, but surprisingly, we know very little about what causes it.

“The understanding among most experts is that PMS is related to natural, cyclical changes in sex hormones (estrogen and progesterone) leading up to and during the early part of menstruation,” explains Dr. Mary Jacobson, chief medical director at Alpha Medical. “Hormonal fluctuations can lead to many different symptoms, and an abnormal central nervous system response to these changes contributes to PMS and PMDD.”

Here’s what you may notice in the week or so before your period:

• breast tenderness
• cramping
• irritability
• fatigue
• GI symptoms and bloating
• food cravings
• headache
• sleep problems
• anxiety or depression
• mood changes

These symptoms are linked to the hormonal fluctuations happening in your body.

“When you ovulate, your body releases an egg, and estrogen levels drop and progesterone levels increase,” Jacobson says. “If that egg isn’t fertilized, estrogen continues to drop and progesterone levels decrease, which trigger shedding of the uterine lining (aka your period).”

She explains that these hormonal shifts trigger a decrease in serotonin, a chemical that regulates your mood, appetite, and sleep cycle.

“Changes in these hormones can lead to physical symptoms like sore breasts, bloating, cramps, and food cravings, as well as emotional symptoms like mood swings, anxiety, and irritability,” Jacobson says.

That explains why you may feel the overwhelming urge to snap at your significant other when they eat the last serving of ice cream left in the freezer.

Yes and no. Depression is a mental health disorder affecting more than 264 million people worldwide. Its symptoms range from mild to severe, and they can interfere with your day-to-day life. Symptoms can last anywhere from a few weeks to a few years.

A variety of factors are linked to the onset of depression, including biochemistry, genetics, and environmental triggers. Luckily, depression is widely studied and extremely treatable — 80 to 90 percent of people respond positively to treatment.

Depression takes many forms, and the experience varies from person to person, but here are the most common symptoms:

• persistent sadness or feelings of emptiness
• lack of energy, constant fatigue
• loss of interest or pleasure in activities
• sleep problems
• appetite and/or weight changes
• headaches or GI problems

As you can see, depression and PMS share some symptoms, including mood changes, fatigue, appetite changes, and sleep problems. Depression, like PMS, is related to a decrease in serotonin.

But while moderate PMS is typically manageable and temporary, depression often has a more severe impact on your daily life.

“PMS itself is a multi-symptom response to changing hormone levels in the body,” Jacobson says. “When these symptoms don’t interfere with daily work and life, PMS is normal and healthy. But PMS can lead to more severe symptoms and trigger other conditions, including PMDD. Low levels of serotonin, caused by ovulation, are often linked to feelings of sadness, irritability, and trouble sleeping.”

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects about 5 percent of menstruating women.

Psychological symptoms include irritability, anxiety, insomnia, severe fatigue, confusion, forgetfulness, and emotional sensitivity. Physical symptoms include (but are not limited to) cramps, bloating, nausea, acne, headache, dizziness, hot flashes, and decreased sex drive.

“PMDD causes drastic mood shifts, and symptoms include extreme sadness, hopelessness, irritability, or anger,” Jacobson explains. “You may even have thoughts about suicide or stop feeling interested in activities you usually love. These mood changes are layered on top of common PMS symptoms like breast tenderness and bloating.”

If you think that all sounds terrible, you’re not wrong — PMDD can make it difficult to keep up your usual daily activities. The severity is what distinguishes it from regular PMS.

If your pre-period symptoms are so bad you have to regularly cancel everything on your calendar, and you experience extreme behavioral symptoms that are different from your typical personality, you may have PMDD.

“If you think you have PMDD, consult your doctor,” Jacobson urges. “They will likely ask you to record your symptoms and mood changes. Lifestyle changes may help manage symptoms, but if you do have PMDD, your doctor may recommend medication as well.”

Luckily, you don’t have to live with the symptoms of PMDD without help. Treatment can seriously improve your overall quality of life.

Since there’s no one-size-fits-all treatment option, your best bet is to work out an individualized plan with your healthcare provider.

Here are the most common treatment options:

Hormonal birth control

If you’re not looking to have a baby right now, hormonal contraception could be a great way to prevent pregnancy and manage your severe PMS or PMDD symptoms.

Most of these birth control methods work by suppressing ovulation, thus inhibiting the hormonal changes that cause PMS symptoms. However, studies of hormonal birth control for PMS symptoms have found that results vary significantly from person to person.

SSRIs (antidepressants)

If your depression-like symptoms are consistent every month, your doctor might prescribe an SSRI to raise your serotonin levels. This is a common treatment for anxiety and depression, and research has shown it also works for PMDD.

Nutrition and supplements

It’s true that what you put into your body has a major effect on your mood and overall health. Eating whole foods rich in protein, fat, and complex carbs and limiting alcohol and caffeine may help decrease your symptoms.

Research has also shown that supplements such as vitamin B-6 and calcium may diminish PMS symptoms.

Lifestyle changes

Little adjustments to your daily routine can go a long way toward making you feel more like yourself before your period arrives.

Jacobson recommends light exercise, meditation and deep breathing, getting 7 to 8 hours of sleep nightly, and avoiding those pesky snack cravings when possible.

Over-the-counter medication like ibuprofen and naxopren can help with cramps. Try to limit the stress in your life and just allow yourself time for rest and self-care.

We can’t say this enough: Talk to your doctor if you have symptoms of depression that you think could be linked to PMS. It can be tough to distinguish “normal” pre-period symptoms from ones that might mean you have a chronic depressive disorder.

“The key element that differentiates PMS and PMDD from other forms of depression is the cyclical pattern of symptoms that arrive every month after ovulation and then resolve during your period,” Jacobson explains.

For the most part, if your symptoms correspond directly with your menstrual cycle, they’re probably related to PMS. But either way, your healthcare provider can help you figure out a treatment that works for you.