Premenstrual Syndrome (PMS): Getting to know Aunt Flo
Premenstrual syndrome. Fun fact: in Victorian times, it was possible for a woman to be institutionalized if they experienced any kind of menstruation-related anger. This might sound crazy, but back then it really wasn’t that uncommon for a woman to be mistreated just because it was her time of the month. The fact is, we didn’t really know that much about the brain and the menstrual cycle. But recent technology is changing all of that. So if you’ve ever wondered why you’re feeling so moody, or why you’re forgetting everything, this is the article for you!
Premenstrual Syndrome: The brain and the menstrual cycle
Before telling you everything you need to know about the premenstrual syndrome we have to set some context to how the brain and the menstrual cycle work. Way, way back in the day, ancient Egyptians used to believe that the uterus had the ability to roam about the female body. They believed that this roaming caused mental and physical ailments to the woman, depending on the location it was in. So, if you were having respiratory problems your uterus would be in your lungs, or if you were having digestive issues your uterus was hiding in your intestines.
Sounds pretty funny, right? To us it does, but for centuries people believed that the wandering uterus caused everything from seizures to depression. Since the beginning of recorded history, the uterus was blamed for hysteria– a female-centric “disease” causing out of control emotions, unregulated behavior, and irrational fears. Hysteria became such a feared illness that women often had a hysterectomy. It wasn’t until 1951 when the United States dropped hysteria as a medical diagnosis and picked up the term PMS instead.
But it doesn’t stop there. In the 1930s, the mental illness called Premenstrual Dysmorphic Disorder, or PMDD came into the spotlight. This was due to to the work of gynecologist Dr. Robert T. Frank, who claimed that hormonal imbalances in women caused irrational and impulsive behaviors that needed to be considered if women were to enter the workforce. His work brought about conversations on experiencing depression, sadness or anxiety during menstruation, where a severe form of these symptoms was called PMDD. But the actual existence of PMDD has been in serious debate, as some point out that there is no evidence that it actually exists. Yet, PMDD remains a problem that about 3 to 9 percent of women are diagnosed with. We will later explain the difference between PMDD and premenstrual syndrome.
Premenstrual Syndrome: How does your menstrual cycle work?
Your menstrual cycle is divided into three phases called the menstrual period, the follicular phase, and the luteal or premenstrual phase. Depending on which phase you’re in, your hormone levels fluctuate causing you to feel different things.
The three phases
The menstrual period is day one of your cycle, where the thick lining of the uterus (called the endometrium) begins to shed. This part typically lasts 4 to 6 days. It’s likely the phase where you feel cramps, bloating or back aches. In the first day of this phase, the hormones estrogen, progesterone, and prostaglandin are as low and balanced as they can be. But all too soon, prostaglandin hormones increase and cause cramping and nausea, as the unfertilized egg is being released and you start to bleed. Estrogen increases as well, which helps to release endorphins and clear up any fogginess you might feel during PMS.
During the follicular phase, the pituitary gland releases follicle stimulating hormone (FSH). This causes the follicles (containing your eggs) in your ovaries to mature. Towards the end of this phase, the endometrium is thickening in preparation for a fertilized egg. At the end of this phase is the ovulation period. This is the time in your cycle where you’re most likely to become pregnant. Estrogen and testosterone also increase during this phase, causing many changes in your mood (we’ll talk about this later).
In the luteal phase, a fertilized egg can attach to the endometrium. When none attaches, then the endometrium begins to break down in the menstrual period. The hormones testosterone and estrogen start to decline, while progesterone increases. This might cause PMS-like symptoms, such as bloating, mood swings, or pain in your abdomen, legs or back.
The brain and the menstrual cycle
Some studies show that estrogen increases synaptic density in the hippocampus. The hippocampus is responsible for decision making and short term memory. So this increase means that you are likely to be sharper and clearer with your memory. Estrogen also helps with verbal fluency, causing women to feel more social, flirtatious, extroverted, and energetic.
Combined with the surge in testosterone, women can also experience an increase in sex drive. And because testosterone is associated with competitive behavior, you’re likely to feel more threatened by other women. Even your sense of smell is heightened, allowing you to be more sensitive to pheromones.
Sadly, estrogen’s effects don’t stick around for too long. When the prostaglandin levels start to rise, and estrogen levels decrease, that’s when activity in the hippocampus starts to decrease. Meaning that the confident, extroverted person you become in your follicular phase is subdued in the luteal phase. In addition, activity in the frontal cortex, which is your self-control center, begins to decline in the follicular phase. This means that women are more likely to perceive male faces differently and engage in a risky sexual behavior.
But believe it or not, there’s an evolutionary purpose to feeling all these different emotions. Having all of these fluctuating hormones allows you to attract suitable mates when you need it the most. And while you might not be worrying about that now, it’s still nice to know that your mood swings aren’t all for nothing.
Ok now to what this whole article is about:
What is the Premenstrual Syndrome?
Premenstrual syndrome (PMS) is a condition that affects women’s emotions, behavior, and physical health during certain days of their menstrual cycle. This usually occurs in the days prior to menstruation.
Premenstrual syndrome is quite common and affects around 85% of fertile women. Premenstrual syndrome symptoms begin about 11 days before the period and usually disappear at the beginning of the period. Some women begin to have a premenstrual syndrome in adolescence, however other women don’t notice it until 30 and up.
Symptoms may worsen as they approach menopause. Premenstrual syndrome is not a disease. However, it can sometimes become so severe that it can interfere with daily life. In the most extreme cases, we may be faced with a Premenstrual Dysphoric Disorder (PMDD).
Risk Factors for Premenstrual Syndrome
There are certain factors that may influence the severity of PMS symptoms:
- History of depression or mood disorders
- Family history of premenstrual syndrome
- Family history of depression
- Domestic Violence
- Substance abuse
- Physical and/or emotional trauma
Causes of premenstrual syndrome
Although the cause is unknown researchers believe it may be related to estrogen hormone changes and serotonin levels at the beginning of the menstrual cycle.
Serotonin is a neurotransmitter that affects mood, emotions, and thoughts. Estrogen and progesterone levels increase at certain stages of the month. Increases in these hormones can lead to changes in mood, anxiety, and irritability.
Doctors don’t know why PMS affects some women more than others, but often genetics can play a key role. Not taking enough vitamin B6, calcium, or magnesium in your usual diet can increase your chances of having premenstrual syndrome.
Stress, lack of exercise and too much caffeine can make your symptoms worse.
Premenstrual Syndrome: Symptoms
Symptoms of premenstrual syndrome are usually mild or moderate. According to the following study, about 80 percent of women report having one or more symptoms that do not substantially affect daily functioning. From 20% to 32% report moderate to severe symptoms.
The severity of symptoms may vary depending on the month. The most frequent symptoms are:
Premenstrual Syndrom Symptoms: Psychological
- Changes in sleep patterns
- Food cravings, changes in appetite
- Accesses of weeping
- Emotional outbursts
- Concentration problems
Premenstrual Syndrome Symptoms: Physical
- Abdominal pain
- Abdominal swelling
- Pain or tenderness in the breasts.
- Sensitivity to light or sound Fatigue
Premenstrual Syndrome: When to go to the doctor?
Visit your doctor if physical pain, mood changes, and other premenstrual symptoms begin to affect your daily life or if the symptoms do not go away.
The diagnosis will be made if you have more than one recurring symptom in the days before the beginning of your period and if they are severe enough to interfere with your daily functioning and if they don’t happen between two periods and ovulation.
Your doctor will also rule out other causes such as anemia, endometriosis, thyroid problems, pregnancy. It is also necessary to rule out other psychological disorders such as depression or other mood disorders.
What is Premenstrual Dysphoric Disorder (PMDD)?
Premenstrual dysphoric disorder is similar to premenstrual syndrome. They share symptoms, causes, and treatment. They differ in that the premenstrual dysphoric disorder is much more serious and interferes way more in daily life (work, school, social relations).
Symptoms of premenstrual dysphoric disorder
The symptoms of the premenstrual dysphoric disorder are the same as those of a common but more severe premenstrual syndrome:
- Mood swings
- Depressive symptoms and feelings of hopelessness
- Intense anger and conflicts with others
- Tension, anxiety, irritability
- Decreased interest in everyday activities
- Difficulty focusing
- Changes in appetite
- Sleeping problems
- Low self-control
- Swelling and menstrual pain
- Breast tenderness
- Muscle and/or joint pain
- Hot flashes
How is a premenstrual dysphoric disorder (PMDD) diagnosed?
To diagnose premenstrual dysphoric disorder, according to the DSM you have to meet the following criteria:
A. In most menstrual cycles during the past year, five (or more) of the following symptoms occurred (including the first of the first three):
(1) marked affective lability (e.g., mood swings; feeling suddenly sad or tearful or increased sensitivity to rejection)
(2) marked irritability or anger or increased interpersonal conflicts
(3) markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
(4) marked anxiety, tension
(5) decreased interest in usual activities (e.g., work, school, friends, hobbies)
(6) subjective sense of difficulty in concentration
(7) lethargy, easy fatigability, or marked lack of energy
(8) marked change in appetite, overeating, or specific food cravings
(9) hypersomnia or insomnia
(10) a subjective sense of being overwhelmed or out of control
(11) other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain
B. The symptoms are associated with clinically significant distress or interferences with work, school, usual social activities or relationships with others.
D. Criteria A, B, and C should be confirmed by prospective daily ratings during at least two cycles.
Tips and treatment for both premenstrual syndrome and premenstrual dysphoric disorder
Although the following tips may help you to improve the symptoms of premenstrual syndrome and your general physical and mental health, there is very little research on this topic.
Since menstruation is such a taboo, for a long time, it has been given little attention.
Women’s suffering during their period has been underestimated therefore much remains to be done as far as non-reproductive female health is concerned.
- Limit salt intake to reduce swelling and fluid retention.
- Eat lots of fruit, vegetables and whole grains.
- Avoid caffeine and alcohol
- Take enough calcium (dairy, legumes, nuts, broccoli, spinach,etc.)
According to this study, intake of sufficient calcium and vitamin D helps decrease the risk of premenstrual syndrome.
In any case, it is your doctor who should prescribe a supplement in case it is necessary.
Perform regular exercise
Perform at least 30 minutes of exercise per day, such as walking, cycling, swimming, skating, dancing, etc. during 4 or 5 days of the week. Regular exercise can help improve overall health and premenstrual syndrome symptoms such as fatigue and depressive mood.
Reduce your stress
Sleep enough and learn to relax. This can help you control headaches, anxiety, insomnia problems. Yoga and mindfulness meditation can also be good exercises to control stress and anxiety.
Keep track of your symptoms
Keeping track of your premenstrual symptoms can help you identify what triggers them, and when. This can help you intervene and create strategies to alleviate them. They can also be very useful to your doctor.
Pharmacological and/or hormonal therapy may also be effective in treating premenstrual dysphoric disorder (PMDD). Over-the-counter medications to relieve menstrual pain are usually effective. Drugs can also be prescribed to treat depressive and anxious symptoms. In any case, it is your doctor and psychiatrist who should make an assessment of your case and see if it is relevant.
Psychological therapy such as Cognitive-Behavioral Therapy can be very helpful in alleviating the psychological and behavioral symptoms of the premenstrual dysphoric disorder (PMDD).
During premenstrual syndrome we are more sensitive, so small conflicts, arguments or our own thoughts can affect us much more. Therapy will help us identify our emotions and manage them. Many times, these emotions are due to our own thoughts or our cognitive distortions.
We hope you enjoyed this article and feel free to leave a comment below!
Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.