How the menstrual cycle can impact mood – & what can help
Amelia Jean Hershman-Jones
Wellness
Reading time: 7 minutes
PMS mood swings can create a huge shift in our lives during the run-up to our period. But what are they, & can we really find some control over the effects of our hormones?
Forget the acne and bloating – we’d argue that of all the symptoms of premenstrual syndrome (PMS), PMS mood swings can be the most impactful.
Pop culture often demonises and pokes fun at these monthly mood disorder symptoms, which according to the NHS can leave us feeling upset, anxious or irritable.
If you’ve ever found yourself wondering ‘Why do I get so angry before my period?’ we’re here to help. We asked experts from The Bronte Clinic – who offer specialised medical care and treatments for women – to talk through this often repressed symptom, and how menstrual cycles and their accompanying changes in hormone levels can be behind those shifts in mood some experience across the month.
What is the menstrual cycle?
Aside from culminating in a monthly event that causes an uptick in period product use and laundry loads, the internal engineering behind the menstrual cycle is a bit more intricate than many of us might realise.
“The menstrual cycle is regulated by hormones; specifically oestrogen and progesterone,” explains GP and associate of The Bronte Clinic, Dr Dani Russell.
“It’s an important part of reproductive health and fertility and involves the shedding of the lining of the womb (resulting in the bleeding associated with a period), which occurs when an egg is released without being fertilised,” says Dr Russell.
What is PMS & why does it happen?
PMS is the group of symptoms that occur in the run up to a period. “The exact cause of PMS is still unknown,” says GP and menopause specialist, Dr Samantha Brown, co-founder and medical director of The Bronte Clinic.
“It’s thought to be linked to the hormonal changes, including oestrogen and progesterone, that occur during the menstrual cycle, which can affect the neurotransmitters or brain chemicals and affect our mood.”
While every person and every period is different – why do some of us sometimes feel like She-Hulk while others seem to breeze through the event?
“It’s thought that women who experience PMS symptoms are more sensitive to progesterone and this over-sensitivity seems to reduce serotonin and another neurotransmitter called GABA (which has a calming effect).”
What are the symptoms of PMS?
First things first: there is no copy and paste set of symptoms, which can make PMS a difficult and isolating journey. According to the NHS, each person's symptoms are different and can vary from month to month.
The most common symptoms of PMS include:
• Mood swings
• Feeling upset, anxious or irritable
• Tiredness or sleep problems
• Bloating or tummy pain
• Breast tenderness
• Headaches
• Acne
• Greasy hair
• Changes in appetite and libido
“The emotional symptoms can vary in severity but can have a severe impact on quality of life,” explains Dr Russell. As well as mood swings, irritability, anxiety, having trouble sleeping and changes in libido, they can also manifest in a difficulty concentrating or focusing, agitation or restlessness.
“Symptoms of premenstrual dysphoric disorder (PMDD) are generally more severe than PMS and interfere with normal life,” Dr Russell informs us.
PMDD is technically listed as a mental health problem. “The criteria for the diagnosis of PMDD require that the person experience at least five of 11 psychological, behavioural, and physical symptoms of PMDD during the final week of the luteal phase that resolve as their period starts”
“Premenstrual exacerbation, meanwhile, is a worsening of pre-existing mental health conditions, such as depression or anxiety, during the premenstrual phase.” says Dr Russell.
How your hormones can affect your mood
Far from being merely a compulsion to snap if someone touches the snacks that are satisfying your food cravings or crying at RSPCA adverts (although those may both feature), hormonal mood swings are complex.
“Hormones can affect the production of neurotransmitters such as serotonin and dopamine, which play a vital role in regulating mood and emotions” explains Dr Russell.
“For example, low levels of oestrogen can lead to a decrease in serotonin and therefore lead to low mood.
She adds: “In the days leading up to the period, the levels of oestrogen and progesterone drop and these changes can affect the neurotransmitters in the brain causing irritability and anger.”
It's important to note that it's not always easy to differentiate between depression and hormonal-induced low mood.
“Hormonal-induced low mood, if due to PMS or PMDD, usually occurs in a cyclical way before periods and then resolves with menstruation,” says Dr Russell.
If you think you may have depression or any other mental health condition, you should speak to a GP.
How long do PMS mood swings last per month & how often will you experience them?
Since the length of the menstrual cycle varies from person to person, the severity and length of the related symptoms can, too.
“The luteal phase of the menstrual cycle lasts approximately 10-14 days and it’s in this part of the cycle that people often experience symptoms,” Dr Brown advises. “Symptoms can start as early as 14 days before your period.”
7 ways to help manage PMS mood swings
If you suffer from PMS mood swings. Rest assured that it’s common and there’s a range of lifestyle tweaks you can make to help manage them. These include:
1. Keep a record of your symptoms
“Track and keep a diary of symptoms,” says Dr Brown. The NHS recommends doing this for at least two to three menstrual cycles – you can then take this to a GP appointment if needed.
2. Keep physically active
Exercise regularly and reduce the amount of time spent sitting or lying down (the NHS recommends doing 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week, spread evenly over four to five days a week, or every day)*. If you tend to have lower energy during your period, consider adapting the type and intensity of your exercise routine to reflect your cycle, and also compassionately adjust your expectations of yourself.
Check out our guide to the best at-home exercise classes to try from the comfort of the living room.
3. Eat a healthy and balanced diet
Eat small, frequent meals (the NHS recommends eating every two-three hours), avoiding ultra-processed food and reducing caffeine and alcohol intake.
4. Get enough sleep
Get plenty of sleep (the NHS recommends seven to eight hours) and try to create some healthy bedtime habits to help you unwind.
Some effective sleep hygiene tips include going to bed and waking up at regular times, reading or listening to music in the evening and making sure the bedroom is quiet, dark and cool.
For more top sleep advice, watch our Boots Live Well Panel talk with Kathryn Pinkham, insomnia specialist and founder of The Insomnia Clinic.
5. Find ways to relax
Try reducing everyday stress by practising yoga or meditation. Other relaxation techniques include breathing exercises and aromatherapy. And a warm bath can do wonders to help you feel less tense and uncomfortable.
6. Consider painkillers
If suitable for you, consider taking painkillers, such as ibuprofen or paracetamol, if you’re in pain. You’ve got enough to deal with and cramps needn’t add to your load.
7. Quit smoking
There’s a wide range of health benefits to be gained by stopping smoking. And reducing PMS symptoms is just one of them. If you’re looking to give up or cut down, there are several options available to provide a helping hand.
One is to consider nicotine replacement therapies** – products such as gums, patches, lozenges and inhalators and sprays that work by releasing low levels of nicotine into the body, without the carbon monoxide, tar and other chemicals found in cigarettes. If you need advice about what form of NRT might be suitable for you, speak to a GP or pharmacist, who can help you decide.
You could also get recommendations and treatment with our Boots Online Doctor Service. Simply fill in a short questionnaire and one of our clinicians will assess whether the service is suitable for you***.
PMS & perimenopause
There are a few reasons why PMS symptoms may worsen during perimenopause. “Fluctuating hormones, with a decline in the levels of oestrogen and progesterone in the body can trigger PMS symptoms, such as mood swings, irritability, and depression,” explains Dr Russell.
“Perimenopause can be a stressful time for many women and high levels of stress can exacerbate PMS symptoms.
“Many women experience sleep disturbances during perimenopause, which can worsen PMS symptoms such as fatigue, mood swings, and irritability,” she continues.
“Certain health conditions, such as thyroid disorders or depression, can worsen PMS symptoms during perimenopause even further.”
When to seek further help
NHS advice is to see a GP if methods you’re using to help aren't working or the symptoms are affecting your daily life.
One of our Boots Online Doctor Women’s Health Services* may also be able to advise you on treatment options that can help, without needing an appointment, in just a few clicks.
If you suspect you may have PMDD, then it’s best to see a doctor for advice on how to manage your symptoms.
Alongside lifestyle advice, they can advise you on medication options, as well as further support such as talking therapies suited for your needs.
“Medication options include selective serotonin reuptake inhibitors (SSRI) medication, which is an antidepressant, the oral combined pill, the Mirena coil and adding back oestrogen in the form of a patch or gel,” says Dr Russell.
No matter the severity, if you’re suffering from a low mood as a result of PMS, don’t worry, help is at hand – from lifestyle changes to medication and mental health support.
