Premenstrual Mood Changes

Premenstrual Mood Changes

90% of women with regular menstrual cycles report unpleasant physical and psychological symptoms before menstruation. 

A woman sits on a bed clutching her stomach, appearing to be in discomfort or pain, with a book, glass of water, and plant on a nearby table, creating a serene yet concerned atmosphere.

Premenstrual Syndrome (PMS)

Physical, emotional and behavioral symptoms that occur 1-2 weeks before menstruation. 

It affects 30-80% of reproductive age women. 

Psychological Symptoms: Anger, Anxiety, Depression, Irritability, Sense of feeling overwhelmed, Sensitivity to rejection, Social withdrawal

Physical Symptoms: Abdominal bloating, Appetite disturbance (usually increased), Breast tenderness, Headaches, Lethargy or fatigue, Muscle aches and/or joint pain, Sleep disturbance (usually hypersomnia), Swelling of extremities

Behavioral Symptoms: Fatigue, Forgetfulness, Poor Concentration

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a more severe form of PMS. It is commonly associated with irritability and causes impairment in relationships or work. PMDD affects 3-8% of reproductive age women. Symptoms usually start in the twenties and worsen over time especially during perimenopause. 

Psychological Symptoms: Anxiety, Feeling overwhelmed or out of control, Increased depressed mood, Irritability, Mood Swings, Sense of feeling overwhelmed, Sensitivity to rejection, Social withdrawal, Sudden sadness or tearfulness

Physical Symptoms: Abdominal bloating, Appetite disturbance (usually increased), Breast tenderness, Headaches, Lethargy or fatigue, Muscle aches and/or joint pain, Sleep disturbance (usually hypersomnia), Swelling of extremities

Behavioral Symptoms: Fatigue, Forgetfulness, Poor Concentration

Premenstrual exacerbation (PME)

Depression and bipolar disorders can worsen in the premenstrual period. This is called premenstrual exacerbation (PME). 40% of women who seek treatment for PMDD actually have PME. The best way to tell the difference is by charting symptoms.  If mood symptoms are present only during the luteal phase or days 14-28, then the diagnosis is PMDD. 

Confirming the Diagnosis of PMDD

Daily mood charting with one of the following tools:

• Calendar of Premenstrual Experiences (COPE)

• Daily Record of Severity of Problems (DRSP)

• Prospective Record of the Severity of Menstruation (PRISM).

What Causes PMS and PMDD?

We actually don’t know yet. Women with premenstrual mood changes do not have abnormal hormones. When ovarian cycling is suppressed with medications like Lupron (gonadotropin releasing hormone agonist), the symptoms of PMDD resolve completely. The change in hormones levels throughout the cycle is what likely affects the brain and mood more so than the actual levels. Serotonin and GABA likely play a big role in PMS and PMDD. 

Non-Pharmacologic Treatment for PMS and PMDD

Monthly Mood Charting

Lifestyle Modifications (limited evidence) 

Decrease or eliminate intake of caffeine, sugar, sodium, alcohol and nicotine

Get adequate sleep

Exercise may be helpful

Nutritional Supplements (limited evidence)

Calcium 1200mg once daily may reduce symptoms of PMS or PMDD. 

B6 50-100 mg once daily may reduce PMS, but doses greater than 100 mg a day may cause peripheral neuropathy. 

Magnesium 200-360 mg a day may reduce symptoms. 

Vitamin E 400 IU a day may reduce symptoms. 

Herbal Remedies (limited evidence)

Chasteberry may be helpful for reducing symptoms of PMS and PMDD. 

Gingko biloba may reduce symptoms especially breast tenderness and fluid retention. 

Light Therapy (limited evidence)

May help reduce symptoms 

Psychotherapy or Cognitive-Behavioral Therapy

Pharmacologic Treatment for PMS and PMDD

Psychotropic Medications: SSRI Antidepressants

SSRIs are first line treatment. They can prescribed throughout the whole month, during the luteal phase or at an increased dose in the luteal phase. 

Other options may be: clomipramine, venlafaxine, or duloxetine. 

Antidepressants should be used cautiously in women with bipolar disorder due to the risk of hypomania/mania. 

Hormonal Interventions: Oral Contraceptives

Continuous treatment with OCPs (skipping menstruation) may be effective for treating PMS and PMDD. 

Drospirenone containing OCPs may be more effective. 

OCPs carry risks and may not be appropriate for all women. 

Hormonal Interventions: Leuprolide and Danazol

Medications that suppress ovarian function can reduce symptoms of PMS and PMDD, but they do carry the risk of a lot of side effects.

Surgical Intervention

Complete hysterectomy can reduce symptoms for women who respond to medical ovarian suppression. 

Source: https://womensmentalhealth.org/specialty-clinics/pms-and-pmdd/