Anxiety and Periods: How to Reduce Menstruation-Related Anxiety

Out of nowhere, your heart starts racing, your brain feels like someone is squeezing it, your mind goes to dark places, and you just don’t feel quite right. The anxiety may be related to a specific cause or it may be a free-floating sense of doom. Instead of occurring at any time, like generalized anxiety disorder, this prickly feeling seems to coincide with the onset of menstruation.

No, you are not losing your grip: You are experiencing a very common spike in anxiety due to hormonal fluctuations. Sometimes the shift in hormones can cause you to experience premenstrual syndrome (PMS) or even premenstrual dysphoric disorder (PMDD). According to American Family Physician, “around 85 percent of menstruating women report having one or more premenstrual symptoms, and 2 to 10 percent report disabling, incapacitating symptoms.”

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The Link Between Anxiety and Your Menstrual Period

According to the Anxiety and Depression Association of America, between the ages of 14 to 50, women are at double the risk of anxiety compared with men. Part of the reason may be the hormonal flux of the menstrual cycle, says Yael Nillni, PhD, an assistant professor at the Boston University School of Medicine and a clinical research psychologist at the National Center for PTSD at the VA Boston Health Care System.

“Right before your period starts, estradiol and progesterone are declining rapidly," Dr. Nillni explains. "Researchers have speculated that rapid hormonal withdrawal might underlie those symptoms. However, reactions to these normal hormone changes are unique; some women experience mood changes across their menstrual cycles, while some experience minimal changes in their mood related to their menstrual cycle.”

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Is Feeling Anxious During Your Cycle Normal?

For some women, anxiety is par for the course, says Nillni. “A large portion of women will feel some sort of mood or affect change before their period. It’s not necessarily anxiety — it could also be feeling more irritable, sad, or having mood swings.” Or you could feel no different at all. Only a small minority of women, about 3 to 8 percent, will experience mood changes around the menstrual cycle that cause significant disruption in their daily lives.

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Is Anxiety Part of PMS and PMDD?

“Some women with anxiety problems may experience a premenstrual exacerbation of their anxiety symptoms. Also, some of the factors that predict anxiety-related problems also predict PMS, suggesting a potential link between these two problems,” says Nillni. She adds that for a diagnosis of PMDD, you need to have one or more of the following mood symptoms: mood swings, depressed mood, anxiety, or irritability, along with other physical symptoms such as fatigue, appetite, and sleep changes. Additionally, these symptoms must occur during most menstrual cycles and cause significant distress or impairment.

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Getting Help for Your Anxiety During Your Menstrual Cycle

Are you experiencing PMS or PMDD? Nillni says you should ask yourself how distressing or impairing the symptoms are: Is it interfering with your ability to work or go to school, engage in your hobbies, interact with your family and friends, or socialize? Those are signs that something unusual is going on and you should seek help.

Home Remedies to Alleviate Feeling Anxious With Your Period

Laurie Steelsmith, ND, a naturopathic doctor, acupuncturist, and author of Natural Choices for Women’s Health recommends the following self-care strategies.

  • Exercise You don’t have to go to the gym. Dance at home, go for a walk or run. Move in all directions, not just up and down. “You increase your oxygen intake and circulation through movement, which increases blood flow to your liver. This helps your liver break down your hormones,” says Dr. Steelsmith.
  • Restorative yoga This practice puts you into a parasympathetic (calm) state. “It takes you right out of that fight-or-flight anxious feeling,” she says.
  • Avoid caffeine This stimulant can cause your heart to race, which mimics a panic attack.
  • Magnesium The crucial mineral can balance the neurotransmitters glutamate and GABA (gamma aminobutyric acid). The first is a stimulating neurotransmitter or brain chemical; the second is a calming one. Consult your doctor before you add this or any supplement to your regular diet.
  • Vitamin B6 According to the National Institutes of Health, there is some preliminary data showing that this B vitamin can help with PMS symptoms.
  • L-theanine Found in green tea, this amino acid has been shown to relax the mind without making you sleepy, according to research published in the Asian Pacific Journal of Clinical Nutrition.

Medications and Therapies That Can Help With Menstrual-Associated Anxiety

If self-care doesn’t work, talk with your physician about prescription medications, says Thalia Robakis, MD, PhD, the codirector of the Women’s Mental Health Program at Icahn School of Medicine at Mount Sinai in New York City.

  • Anti-anxiety and anti-depression medications such as selective serotonin reuptake inhibitors (SSRIs), buspirone, propanolol, and benzodiazepine.
  • Hormonal birth control, such as the pill, ring, or patch, can be useful to women whose irritability is specifically premenstrual. Women whose anxiety or irritability is not related to their menstrual cycle may find that hormonal birth control affects their mood adversely.
  • Cognitive behavioral therapy (CBT) This form of psychotherapy helps you to replace negative thoughts with positive ones.

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