This Is Why You're So Anxious During PMS

Like 90 percent of women who menstruate, I experience PMS. I’m pretty sure I have been blessed with every possible PMS symptom: bloating, moodiness, cravings, headaches, weepiness, irritability, tender boobs, nausea, clumsiness, fatigue, diarrhea. I've been blessed with all of these, respectively and together, every month.

I honestly thought I’d seen it all until a few months ago, when I began to experience some of the worst anxiety and panic I'd ever felt right before my period.

I didn’t immediately notice a correlation between PMS and my spiking anxiety. I was diagnosed with anxiety and panic disorder when I was eight years old and I’m used to experiencing bouts here and there; it’s just one of those things that’s always in my life. But after the third consecutive month of it, I realized that there was a connection between my anxiety and my cycle.

Part of what tipped me off was that there was more of a physical aspect to my anxiety and panic. Usually when I experience anxiety, it starts with racing thoughts, then progresses to physical signs like sweating, queasiness, and a rapid heartbeat. In this case, I walked around the house and suddenly felt my heart beating loudly out my chest, or woke in the middle of the night, my heart and gut doing somersaults.

Chatting with a few friends, I found that I wasn’t alone. Many of them had experienced heightened anxiety during PMS. When I Googled “anxiety and PMS,” there was a ton about irritability and general crankiness, but not so much about full-blown anxiety.

Luckily, just as the symptoms emerged out of the blue, they left after a few cycles, so I didn’t feel it was necessary to bring the whole thing up with my doctor (although if they return, I most definitely will). However, on doing some research, I learned that PMS-related anxiety is a relatively common experience among women, albeit one that is rarely discussed. It turns out that, for some women, there is a correlation between the fluctuating hormones in the menstrual cycle and the chemistry of anxiety and panic.

Mary Jane Minkin, an OB-GYN and clinical professor at Yale School of Medicine, said anxiety is a “core symptom” of premenstrual dysphoric disorder (PMDD), a more severe version of PMS that affects about five percent of people who menstruate. Although it’s not entirely known what causes PMDD, it may involve a decrease in serotonin, which does correlate in certain cases with increased anxiety.

According to Minkin, it is not PMDD if the symptoms are “an exacerbation of symptoms already present.” Rather, the clearest cases of PMDD are where one is “totally symptom-free in the first part of the cycle.”

Minkin cautioned against self-diagnosing PMDD, and said that you only really have PMDD if your symptoms only occur during the second half of your menstrual cycle (yeah, not at all the case for me). She recommends keeping a chart of the menstrual cycle so you can clearly observe any correlation between PMS and anxiety.

Tristan Bickman, an OB-GYN in Santa Monica, agreed that a drop in serotonin during the second half of the menstrual cycle is what causes most PMS symptoms. Bickman explained that, for women who experience PMS, declining estrogen also causes the serotonin to drop, which causes PMS symptoms.

It’s not only hormones that are at play here: Having anxiety in general is a prerequisite for PMS-related anxiety. “Pre-existing anxiety or depression is a risk factor for PMS,” Bickman said. “Other risk factors for PMS are a family history of PMS, high stress, lack of exercise, increased caffeine consumption, and poor diet.”

Bickman also cited stress, which can crop up in your life whether you have an anxiety disorder or not, as a potential cause of PMS-related anxiety. “Stress is directly correlated with PMS,” she said. “Higher stress levels are a risk factor for the development of PMS.”

Could having heightened stress in general—not just when you're PMSing—cause your PMS to be overall more panicky and anxious? Most definitely yes, said Iram Kazimi, an MD and psychiatrist with McGovern Medical School at UTHealth in Houston. “Any chronic stress and anxiety is believed to make PMS symptoms worse,” Kazimi said. “If you're experiencing a period of stress and anxiety before your PMS symptoms occur, this may increase your PMS symptoms, which in turn will increase your stress and anxiety symptoms.”

BINGO. The months I had wicked PMS-anxiety were also the months that my husband was waiting to find out about a job, our car was wrecked in an accident, my kid was rushed to the ER with an asthma attack, and we put an offer on a new home.

Kazimi believes one major factor is the rise in cortisol levels, which occurs right before menstruation. “It's possible that women suffering from this type of PMS anxiety have lower levels of anxiety throughout the month that are simply exacerbated by cortisol, rather than PMS,” said Kazimi. She added that, in some cases, PMS anxiety might stem from a fear of PMS itself. Some of us get such bad symptoms during PMS that we dread and fear that time of the month (*raises hand*), which contributes to our anxiousness.

OK, so regardless of where the anxiety comes from, how can we make it better? Obviously, an OB-GYN or other healthcare professional is your best bet for advice on this, but the experts pointed to a few general guidelines.

Since your overall stress levels can affect the intensity of your PMS symptoms, de-stressing throughout your menstrual cycle is key. Minkin recommended mindfulness, journaling, therapy, and exercise. Bickman said that dietary changes, like reducing caffeine and eating more omega-3 fats, are a good idea. If lifestyle and dietary changes don’t help, said Bickman, and your PMS-related anxiety is particularly intense, speak to your doctor about trying a selective serotonin uptake inhibitor (SSRI) or an oral contraceptive to balance your hormones.

Interestingly, more than one doctor mentioned vitamin and mineral deficiencies can contribute to this issue. Bickman said that deficiencies in calcium, B6, and magnesium have all been linked to PMS.

The causes and cures of PMS anxiety aren’t always cut and dry, Kazimi reminded me. “Both premenstrual syndrome and anxiety are incredibly complex,” she said. “What may cause anxiety in one woman may not cause anxiety in another, or may cause anxiety in a completely different way.”

Either way, anxiety is most definitely a legit PMS symptom, and while it may not top the list in the same way that moodiness and cravings do, it’s quite common. I'm not very happy about adding yet another potential PMS symptom to my list, but knowing that what I'm experiencing is real may be the first step toward reducing my stress about and finding help for it.

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