You can thank your hormones for the fact that PMS and depression tend to go hand-in-hand. The intense hormonal fluctuations that happen around the luteal phase of your cycle can simply cause you to feel like you’re in a funk, or they can exacerbate existing mental health issues (something called premenstrual exacerbation, or PME). Or, more starkly, these hormonal changes can bring on severe depression, which is usually indicative of another condition: premenstrual dysphoric disorder (PMDD). Experiencing some form of depression during your period is very common—and, needless to say, zero fun. Period-related depression can affect 50% of women treated for PMS. Here’s how to deal.
Why Your Period Can Cause Depression
When estrogen and progesterone surge and then subsequently dip during your luteal phase (the 10-14 days before your period starts, when PMS hits), it can cause your neurotransmitters (signaling molecules in your brain) 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 (leading to feelings of sadness and anxiety), but also sleep issues and energy levels, appetite and food cravings. These symptoms may start to fade after PMS ends—a few days after the start of your period—and when your estrogen levels start to rise back up.
In simpler terms: There’s a real physiological explanation for why you might feel depressed around your period. And if you’ve 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 struggles—and could bring on an episode of depression.
You might notice that if you’ve 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.
The good news? You should hopefully feel a bit more leveled out and able to better adapt to life stressors by the end of your period (technically the start of your follicular phase).
All About Premenstrual Exacerbation (PME)
PME is a term that describes the exacerbation of existing mental health conditions during your period—and for some time after. Again, thanks to shifting hormones, you may find that bipolar disorder, depression, generalized anxiety disorders and panic disorders all seem to be heightened around your cycle. The major factor here is that the existing condition seems to improve as your cycle ends, after your menstrual phase. Research on PME is somewhat limited, but if you find that your cycle is compromising your mental health stability, there are treatment options available—talk to your doc.
How to Tell If You Have PMDD
If you have a history of depression, you’re at higher risk for PMDD, but it’s still pretty rare. Of the 85% of menstruators who experience PMS, only about 3-5% experience PMDD. That said, PMDD is serious. If your PMS symptoms are significantly disrupting your life, whether that’s through severe cramps, intense fatigue, feelings of depression, or other physical/psychological symptoms, seek help from a care provider to discuss your best options.
How to Cope with PMS and Depression
There’s no one-size-fits-all cure for depression or PMS—or for the combination of conditions. It’s all about trial and error and figuring out what works best for your body and your lifestyle. We frequently fall back on the four M’s when we need a boost: meditation, movement, magnesium and medication.
- Meditation: Finding an outlet for stress relief can mean the difference between a rocky luteal phase and a smooth one. PMS is an “inconsistent syndrome,” meaning your symptoms can change from month to month—and are tied *not only* to physiological stressors (like those hormone fluctuations we mentioned earlier) but also life stressors. Having a stress-relieving tool to utilize in times of acute stress can help your physical body deal with those psychological factors. If you’re new to meditation, try the Headspace app, and start to practice a few minutes of mindfulness daily so that it becomes routine.
- Movement: Physical activity has been well studied for its benefits on mental health. For mild depression, walking has been shown to confer major benefits—especially walking in nature. The mechanism at play is that walking may help regulate the hypothalamic-pituitary-adrenal axis (HPA axis), which is the feedback loop initiated when we’re experiencing stress. The physical act of walking can calm the mind, allowing you to shut off your brain for a while—which can help you make clearer decisions later. Even just 15 minutes per day can improve your wellbeing—but try for 30 minutes or more for the biggest benefits.
- Magnesium: We’ve waxed on about our love for this mineral before, but magnesium really can be a magic bullet for stress and hormone support when you need it. Because high levels of sustained stress cause your body to release magnesium in your urine, it needs to be replenished if you’re dealing with chronic stress (who among us!?). Magnesium is known to help with more than 300 different actions in the body—and it’s the closest thing we’ve got to a cure-all for the litany of symptoms PMS brings. It can also help normalize the effect of progesterone. Try upping your intake of magnesium-rich leafy greens, chickpeas and dark chocolate, and add Marea to your daily routine, too—it packs a whopping 355 mg of easily absorbed marine-derived magnesium.
- Medication and therapy: It’s so important to recognize that not all mental health conditions can be fully supported by lifestyle changes and alternative therapies alone—many cases will significantly benefit from medication and therapy. We’re all for erasing the stigma around these treatment options, and believe that help should be accessible for all. Many insurance plans now cover mental health services and some therapists offer treatment on a sliding scale—don’t be afraid to ask your primary care or OB/Gyn for referrals and recommendations.
Hi, you! We just want to say *we see you*—those who feel blue or sad or downright depressed when your period hits, and those whose mental health feels fragile whether you’re menstruating or not. Help is out there. Here are a few resources that can get you back to feeling like yourself:
- Video chat or text with a therapist at betterhelp.com or talkspace.com
- Join an online support group at support.therapytribe.com
- Text HOME to 741741, a free crisis textline
- Talk to your primary care doc or OB/Gyn about treatment options and support resources in your neighborhood.
Potter J, Bouyer J, Trussell J, Moreau C. Premenstrual syndrome prevalence and fluctuation over time: results from a French population-based survey. J Womens Health (Larchmt). 2009;18(1):31-39. doi:10.1089/jwh.2008.0932
Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as Treatment for Anxiety: Systematic Review and Analysis. Ann Behav Med. 2015;49(4):542-556. doi:10.1007/s12160-014-9685-9