How might your menstrual cycle impact your mental health/mood?

Premenstrual Syndrome (PMS) is a set of symptoms that can occur in the days or weeks after ovulation, leading up to your period and improve within a few days of your period starting.  These symptoms can affect both your physical and mental health and are linked to the natural hormonal changes in the menstrual cycle.

Not everyone experiences PMS, and for those who do, symptoms can range from mild to very distressing. Emotional and psychological symptoms are often the hardest to manage.

Common PMS mental health related symptoms can include:

• Irritability or frustration
• Feeling tearful or low
• Anxiety, restlessness, or feeling “on edge”
• Loss of interest or reduced motivation
• Feeling emotionally overwhelmed
• Trouble concentrating
• Feeling more irritable than usual

These symptoms are real, valid, and, if they affect your quality of life, deserve proper attention.

Physical symptoms of PMS can include breast tenderness, headache, bloating, acne and fatigue.

Premenstrual Dysphoric Disorder (PMDD): When symptoms are severe

Premenstrual Dysphoric Disorder (PMDD), is a severe form of premenstrual disorder and is thought to effect 3 to 8 out of every 100 women.  Symptoms can be similar to those in PMS but it are more intense and can cause profound emotional distress and impact your life.  Symptoms include:

• Intense sadness
• Panic or severe anxiety
• Changes in appetite and/or sleep
• Anger that feels out of character
• Difficulty functioning at work, school or socially
• Thoughts of self-harm or suicide

PMDD is a recognised medical condition and not your fault. If you suspect you may have PMDD, it’s important to seek professional support.

The changing hormones levels in your body during the menstrual cycle are thought to be the cause of PMS.

In the luteal phase (the 1–2 weeks before your period), both progesterone and oestrogen levels fluctuate, and then drop before menstruation. These hormonal shifts can affect neurotransmitters, especially serotonin, which plays a key role in mood, sleep, and appetite.  It seems that some people are more sensitive to these changes than others, this isn’t a weakness but simply a biological difference between people!

What’s happening in your body?

• After ovulation, progesterone rises and can lead to feelings of tiredness, lower mood, or a sense of “slowing down.”
• Oestrogen levels fall, affecting serotonin levels which may lead to symptoms such as irritability, sadness, or anxiety.
• Poor sleep, physical discomfort (bloating, cramps, breast tenderness) and stress can intensify emotional symptoms.
• Within a few days of starting your period as hormone levels change again symptoms tend to improve.

Tracking Symptoms: A Key Step in Understanding PMS

Both UK and US guidance (NICE, NHS, ACOG) recommend tracking symptoms daily for at least two cycles to confirm whether mood changes follow a cyclical pattern.

A simple symptom diary or a period-tracking app that allows daily ratings can help you and your clinician:

• Identify patterns which can potentially help predict symptoms so you can adjust as needed.
• Distinguish PMS/PMDD from conditions like depression or anxiety
• Evaluate whether treatments are helping

Tracking is not about “proving” anything, the health care professional you see should believe you, rather it is to support you in getting the right care.

If PMS mood swings are intense or interfere with your daily life, please seek medical advice. Together with your physician you can come up with a solution to stop PMS mood swings that works best for you.

Lifestyle Approaches That May Help

Lifestyle changes are not a cure for PMS or PMDD, but many people find they offer real relief, especially when used alongside medical treatment.

• Regular exercise - Movement boosts endorphins, improves sleep, and supports mood emotional regulation.  But if you are feeling tired, listen to your body and remember that gentle activities like walking, stretching, yoga, or swimming are also beneficial.
• Reducing caffeine and alcohol as these may worsen anxiety, irritability, and sleep issues.
• Prioritising sleep – sleeping well helps you feel better, so focus on sleep hygiene, for example keeping screens out of the bedroom.
• Balanced nutrition - aim for regular meals and foods rich in fibre (fruit, vegetables, whole grains, beans), complex carbohydrates, lean protein and  Omega-3 fats (e.g., oily fish, nuts, seeds).
• Stress-management strategies – let’s be clear, stress doesn’t cause PMS, but it can amplify symptoms. Trying some deep-breathing techniques, mindfulness or meditation, gentle stretching, spending time outdoors and setting limits with work or social commitments

None of these are “quick fixes,” but small, consistent changes can make symptoms more predictable and easier to manage.

Are there any medications which can help? Evidence-Based Medical Treatments

If mood symptoms have a strong impact on your wellbeing, or if self-care strategies aren’t enough, medical options can help. These include:

• SSRIs (Selective Serotonin Reuptake Inhibitors) - SSRIs (such as fluoxetine or sertraline) are first-line medical treatments for significant PMS symptoms and PMDD. Your doctor may advise you to take them every day, Or only during the two weeks or so before your period is due, which works well for many people.  SSRIs can reduce mood swings, irritability, feel low and depressed and anxiety.
• Combined Oral Contraceptives (COCs) – hormonal birth-control pills can help stabilise hormones and reduce PMS symptoms. Some formulations may work better for some people than others. Continuous regimens (taking pills without a break) may help prevent hormone drops which can trigger symptoms so your doctor may be able to advise you about tailored pill taking to avoid this.
• Cognitive Behavioural Therapy (CBT) - CBT is recommended for managing emotional symptoms of PMS, supporting resilience, and improving coping strategies.

For very severe, treatment-resistant cases (usually PMDD), specialists may consider medications such as GnRH analogues to essentially turn off the menstrual cycle for a period of time to try manage your symptoms, or surgical options, which are used rarely, generally only after all other treatments have been tried). In order to access these, your GP will need to refer you to see a gynaecologist.

Are there any supplements or herbal remedies which can help?

Some people find supplements helpful, but evidence is mixed as to whether they are effective. Always speak to a doctor or pharmacist before starting anything new, especially if you take other medication.

Supplements sometimes used for PMS include:

• Calcium - some evidence for improving mood symptoms
• Magnesium - may help with anxiety or cramps; use recommended doses only
• Vitamin B6 - may help some symptoms but high doses can cause nerve damage, so professional guidance is important
• Omega-3 fatty acids - possible benefits for mood

Herbal options like chasteberry (Vitex) or evening primrose oil have mixed evidence, and product quality varies.

When Should You Seek Medical Advice?

You deserve support and help with your symptoms. If you feel that you are not managing with lifestyle measures at home, and in particular if your symptoms interfere with work, school, relationships, or daily life, you suspect PMDD or you are unsure whether symptoms relate to PMS or something else

Seek emergency help if:

• You have thoughts of harming yourself
• You feel unable to cope or unsafe
• Your mood shifts are sudden, severe, or frightening

Remember that the Samaritans is available 24/7, 365 days a year on 116 123

Experiencing emotional changes around your cycle can be frustrating and overwhelming, especially if you feel misunderstood or told to “just cope.”

Let’s make some points clear:

• Hormonal sensitivity is not a personal failure.
• PMS and PMDD are real conditions with biological foundations.
• Your experience deserves validation and support.
• Effective treatments exist.
• You don’t need to wait until symptoms are severe to ask for help.