Phases Of The Menstrual Cycle
It can help to know a bit about the main phases of the menstrual cycle. Heres a quick rundown:
- Menstrual phase. You get your period during this first stage of the cycle. When your period is over, this stage ends.
- Follicular phase. This phase also begins with the first day of your period, but it lasts until ovulation. During this phase, your body has lower levels of the hormones estrogen and progesterone. As your period ends, your body begins to rebuild the lining of the uterus in preparation for ovulation, or egg release, and hormone levels begin to rise once more.
- Ovulation. This happens in the middle of the menstrual cycle. Your estrogen levels rise, reaching a high point just before ovulation, and then they drop immediately afterward.
- Luteal phase. This phase begins after ovulation. The second half of your cycle involves a significant spike in progesterone, which helps prepare the uterus for pregnancy. When the released egg goes unfertilized, this peak is quickly followed by a drop, and your period begins.
Before ovulation, dopamine levels increase alongside rising estrogen levels. Incidentally, this fluctuation could help explain why you might notice changes in working memory and concentration during your period.
Both dopamine and estrogen decline again after ovulation, and right before your period starts, theres another drop in estrogen and progesterone.
For some people, the post-ovulation drop in estrogen leads to a corresponding drop in serotonin.
Finding A Way Forward
For Lily, finding out that she had PMDD was a lifesaver. Before I understood what was going on it was like Id spend three weeks feeling more and more panicky, like oh, its coming, and the fourth just losing my mind. But after being diagnosed, she says, things have become brighter and easier. Lilys gynecologist put her on birth control and shes learned some techniques to help her manage her emotions. Before it was like a tsunami, she says, uncontrollable and just totally devastating. Now its more like little waves. Its not perfect, but it is a lot easier and I can deal with that.
Depression And Your Period: What You Need To Know
Depression during your period, month after month, is frustrating to deal with. Experiencing depression on your period is largely caused by hormonal fluctuations that occur as a normal part of the menstrual cycle. In the week or two leading up to your period, and lifting shortly after your period, you might experience a pervasive sadness, irritability, anxiety, a loss of interest in activities you normally enjoy, sleep problems, and weight changesall symptoms of major depressive disorder. Does this mean you have clinical depression for a week or two a month? Possibly, but not necessarily. Heres what you need to know about depression and your period.
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What Is The Difference Between Pms And Pmdd
. PMS is less serious than PPMD. Typically, PMS doesn’t generally interfere with daily functioning, and the symptoms are less intense. For a diagnosis of PMDD to be made, a minimum of five symptoms specified in the DSM-5 are required to be present.
Whats more, although women may experience some fluctuation in mood in the days before their period, the psychological symptoms of PMDD such as severe depression, anxiety, and suicidal thoughts are not associated with PMS.
Premenstrual Dysphoric Disorder And Mental Health Comorbidities
PMDD is a serious disorder that can improve with treatment including medication, if necessary. Because it can look like depression, anxiety, and other conditions , PMDD can be difficult to diagnose.
PMDD is distinguishable from a mental health disorder in that worsening symptoms only occur at the time of menses. Mood disorders, on the other hand, are constant over time. Keeping track of your symptoms can be a helpful way to see if they subside in the absence of the menstrual cycle. Premenstrual dysphoric disorder generally resolves during pregnancy and after menopause. Mood disorders are chronic and persist throughout the course of a lifetime.
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Recognize The Importance Of Self
Self-care is essential for good physical and mental health. Self-care activities are any actions that help people look after their wellbeing.
Self-care means taking time to relax, recharge, and connect with the self and others. It also means saying no to others when overwhelmed and taking space to calm and soothe oneself.
Basic self-care activities include eating a healthful diet, engaging in creative activities, and taking a soothing bath. But any action that enhances mental, emotional, and physical health can be considered a self-care activity.
Serotonin Reuptake Inhibitors For Pmdd
Antidepressants that slow the reuptake of serotonin are effective for many women with PMDD. Usually, the first choice is one of the selective serotonin reuptake inhibitors such as sertraline , citalopram , escitalopram , or fluoxetine . Another option is the serotonin and norepinephrine reuptake inhibitor venlafaxine .
Other types of antidepressants, which target neurotransmitters other than serotonin, have not proven effective in treating PMDD. This suggests that serotonin reuptake inhibitors work in some way independent of their antidepressant effect but their mechanism of action in PMDD remains unclear.
These drugs also alleviate symptoms of PMDD more quickly than symptoms of major depression, which means that women don’t necessarily have to take the drugs every day. Instead, women can take them on an intermittent basis, also known as luteal-phase dosing because it coincides with the roughly 14-day span that begins just after ovulation and ends when menstruation starts.
The decision about whether to take a serotonin reuptake inhibitor every day or on an intermittent basis depends on the type of symptoms a particular woman experiences and if the symptoms of PMDD are superimposed on a more persistent depression. Intermittent dosing is sufficient for treating irritability or mood, but daily medication may be necessary to control somatic symptoms such as fatigue and physical discomfort.
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Depression During Period: Everything You Need To Know
Feeling depressed before and during a menstrual period is common. Experts believe that these emotional changes occur as a result of fluctuating hormone levels.
Most people who menstruate will experience some symptoms of premenstrual syndrome , including moodiness and headaches.
However, some individuals can develop more severe symptoms, such as depression and anger. Hormones can also cause people to feel nauseated during their period.
Severe PMS symptoms may indicate another condition, which is called premenstrual dysphoric disorder . Additionally, existing mental health conditions may temporarily worsen during a menstrual period.
In this article, we explore why some people feel depressed during a period. We also list home remedies and treatment options.
Hormonal changes during the second half of the menstrual cycle, called the luteal phase, may cause a low mood and irritability in some people.
After ovulation, which occurs midcycle, the levels of the female sex hormones estrogen and progesterone begin to fall.
Rising and falling levels of these hormones can affect brain chemicals called neurotransmitters.
Examples of these neurotransmitters are serotonin and dopamine, which are both chemicals that influence mood, sleep, and motivation.
Low levels of serotonin and dopamine can cause:
All of these are common symptoms of PMS and PMDD.
Why Do You Feel Sad
PMS is thought to be linked to hormonal fluctuations occurring in the second half of your menstrual cycle. When you begin ovulating, the body releases an egg, which triggers estrogen and progesterone levels to drop, and thus serotonin levels.
Serotonin is a neurotransmitter that helps regulate mood, sleep and appetite, so when levels are lowered, things like sleep and food cravings are affected, and feelings of sadness occur.
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How Is Pmdd Diagnosed
Your healthcare provider will take a medical history and evaluate your symptoms. You may need to track your symptoms through one or two menstrual cycles. To diagnose PMDD, your provider will look for five or more PMDD symptoms, including one mood-related symptom. Your provider will rule out or diagnose other conditions such as anxiety, depression or reproductive disorders.
How To Talk To Someone About Depression
Sometimes it is hard to know what to say when speaking to someone about depression. You might fear that if you bring up your worries the person will get angry, feel insulted, or ignore your concerns. You may be unsure what questions to ask or how to be supportive.
If you dont know where to start, the following suggestions may help. But remember that being a compassionate listener is much more important than giving advice. You dont have to try to fix your friend or family member you just have to be a good listener. Often, the simple act of talking face to face can be an enormous help to someone suffering from depression. Encourage the depressed person to talk about their feelings, and be willing to listen without judgment.
Dont expect a single conversation to be the end of it. Depressed people tend to withdraw from others and isolate themselves. You may need to express your concern and willingness to listen over and over again. Be gentle, yet persistent.
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Depression And Your Period: Just A Bad Mood Or Something More
The experience of depression before a period is different for each person. Some women experience only mild symptoms, a few days of being slightly down in the dumps and grouchy. Others, though, have clinical depression that is life-disrupting for one to two weeks every cycle.
Moderate depression that is bothersome but doesnt shut you down is often part of premenstrual syndrome . A more severe form of PMS that affects approximately five- to 10 percent of women is called premenstrual dysphoric disorder . PMDD can be extremely disruptive and cause women to miss work or school, withdraw from friends or family, cry frequently, and even have difficulty getting out of bed and otherwise practicing self-care. When their period begins, these symptoms disappear, but they return in the middle of the next cycle.
About 40 percent of women who seek treatment discover that there is more to their cyclical depression than PMS or PMDD . In these cases, the issue is not menstrual-related depression but an underlying mood disorder that is made worse by hormonal fluctuations each month.
If you experience monthly depression symptoms, its important to talk with your doctor about what is happening. Whether you experience very mild depression with your menstrual cycle, or you have PMS, PMDD, or an underlying mood disorder, there are things you can do to lessen depressions impact on your life.
Pmdd Risk Factors And Diagnosis
Brain areas that regulate emotion and behavior are studded with receptors for estrogen, progesterone, and other sex hormones. These hormones affect the functioning of neurotransmitter systems that influence mood and thinking and in this way may trigger PMDD. But it’s not clear why some women are more sensitive than others. Genetic vulnerability likely contributes. Other risk factors for developing PMDD include stress, being overweight or obese, and a past history of trauma or sexual abuse.
Also, it’s important to rule out other conditions that cause symptoms similar to PMDD, such as depression, dysthymia, anxiety, and hypothyroidism.
A key challenge in PMDD diagnosis is differentiating between mild premenstrual symptoms, which may be annoying but are not disabling, and those severe enough to interfere with daily life.
Proposed criteria for premenstrual dysphoric disorder
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Breathe Deeply And Relax The Muscles
Deep breathing techniques are an effective way to calm anxiety and soothe the bodys stress response. Slowly inhaling and exhaling has physical and psychological benefits, especially when done on a daily basis.
Anyone can practice deep breathing, whether in the car, at work, or in the grocery store. Plenty of smartphone apps offer guided deep breathing activities, and many are free to download.
Progressive muscle relaxation is another helpful tool for those experiencing depression and anxiety. It involves tensing and relaxing the muscles in the body to reduce stress. Again, many smartphone apps offer guided progressive muscle relaxation exercises.
We have reviewed some meditation apps that can help with depression and anxiety.
Is It Really Just Pms
Certainly, for some people PMS involves nothing more than mild symptoms, like light cramping, bloating, or increased tiredness.
Keep in mind, though, that this isnt the case for everyone. Many people who experience PMS have more intense symptoms, including:
- major changes in mood
These symptoms can easily affect your daily life. In other words, theres no just about it.
Yet PMS, as uncomfortable as it can feel, isnt the only explanation for depression during your period. Here are some other potential causes.
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How To Cope With Pms And Depression
Theres no one-size-fits-all cure for depression or PMSor for the combination of conditions. Its all about trial and error and figuring out what works best for your body and your lifestyle. We frequently fall back on the four Ms when we need a boost: meditation, movement, magnesium and medication.
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The Other Side Of Antidepressants And Perimenopause
Although antidepressants are linked to an earlier onset of perimenopausal depression, they also help relieve one of its most uncomfortable symptoms.
A 2011 study found that escitalopram reduced the severity of hot flashes and also reduced their occurrence by half when compared to a placebo.
Escitalopram belongs to a group of drugs called selective serotonin reuptake inhibitors .
The study found Lexapro to be three times as effective at relieving depressive symptoms as hormone replacement therapy . Additionally, only 31 percent of the women who received HRT reported relief for their hot flashes compared with 56 percent of the women who took the antidepressant alone.
This is good news for anyone concerned about the 2004 Womens Health Initiative study which found HRT raises the risk of heart attack and stroke.
Its still unknown why escitalopram works. However, the findings reported no serious adverse effects on women participating in the study.
Nevertheless, antidepressants may have their own side effects, including:
A number of home remedies and lifestyle changes can help you deal with the symptoms of perimenopausal depression.
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Why Your Period Can Cause Depression
When estrogen and progesterone surge and then subsequently dip during your luteal phase , it can cause your neurotransmitters to go haywire.Because of the direct connection between these hormone fluctuations and neurotransmitters, the week leading up to your period can mean you have lower levels of the neurotransmitters serotonin and dopamine, which can influence not only your mood , but also sleep issues and energy levels, appetite and food cravings. These symptoms may start to fade after PMS endsa few days after the start of your periodand when your estrogen levels start to rise back up.
In simpler terms: Theres a real physiological explanation for why you might feel depressed around your period. And if youve got other major life stuff going on, it can make for a really rocky time of the month. Researchers found that the association between stressful life events, such as the loss of a loved one, a recent breakup, work or financial difficulties or illness may also result in parallel PMS strugglesand could bring on an episode of depression.
< < READ MORE: How Your Emotions Shift Throughout Your Cycle> >
You might notice that if youve had a super stressful month, your PMS symptoms and depression around your luteal/menstrual phase can get worse. You might experience bigger emotional swings or even more severe symptoms, like anger and aggression.
Insufficient Response To Serotonergic Antidepressants
The overall response of PMS/PMDD patients to SSRIs is approximately 60% in controlled trials, but up to 40% may not have sufficient response. No strong predictors of response have been identified.19 An expert consensus group recommended the common clinical practice of shifting to a second SSRI when the patient has an insufficient response or is intolerant to the initial SSRI.58 Augmenting an SSRI with other medications has not been tested in PMS/PMDD studies. Switching to another class of medication that has shown efficacy for PMS/PMDD, such as anxiolytics or gonadotropin-releasing hormone agonists, is suggested, but there are no data that indicate whether nonresponders to an SSRI will respond to another class of medication. Nonresponse may also be due to other comorbid disorders. A thorough review of the diagnosis and adjustments of the premenstrual doses of medication for the primary disorder should be considered before pursuing other treatments for PMS.
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