So it happens to me a lot, that I feel stable and ok most of the time, but shortly before I get my period and sometimes during, my hormones are just kicking my selfesteem in the nuts. Like up until yesterday I felt good looking forward to the next couple of days and weeks, but today I just got nothing done,feel like a complete failure, hate the way I look, what I ate, etc. while I'm getting cramps and other physical signs telling me, oh it is this time of the month.
Now it comes to no surprise that I hate my period, because no matter how good I'm coping with my life, I will feel like shit once a month. And I don't feel up for anything really.
So I know that many women go a bit weird during their period but is it really normal to have such extreme moodswings and less selfworth. Things that don't occur as badly at any other time during a month?
And if it is not normal, should I mention it to my psychiatrist or gynecologist?
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Totally have that, mood all over the place and bloated / feel fat etc etc. hate it hate it! But talk to your gp about how you are feeling, no harm there xx
Abolutely! When I'm not on meds I get one day, towards the end of every period, where I cry at anything and everything. It's dreadful. Thankfully, the tablets I take for my depression seem to curb that, too! X
Hi Luna. I totally relate to how you are feeling. I am past my change of life now thank goodness! I found that 24 hours before my period was due I was so emotionally unstable it was terrifying. I would burst into tears at work and just be an emotional wreck. I remember being in Venice trying to get some money out of the bank. After joining 2 long queues I was refused due to not having my passport on me. I came out and remember grabbing one of my male friends on the neck and shouting and yelling because he annoyed me. My female friend said - kick the wall - so I did and everyone was staring. Me and my female friend then walked off laughing hysterically arm in arm. Thank God she understood. My male friend? ever since then he has thought I am unstable...
So I do sympathise. The best advice I can give is to try and keep a record of when you are due on and be aware of when you are going to feel like that. Try to keep that time as stress free as possible.
I am with you on this! I always get a bit moody around my period but since taking citalapram and cileste my moods were off the rictor scale so I've dropped the cileste for the time being. I think different combinations of meds and new medication etc can affect how you feel. It's definitely worth talking to your gp.
I also get like that when I am near due my period, or during my period. I get very angry easily, and I start to get wound up so tight inside. I've learned to contain it a little, but I can't help but scream out what I'm feeling sometimes.
I hope that it all fades soon, you know. And that you are stress free soon!
Hi
I'm now too old for periods but certainly used to get the mood swings every month with my period - I switched from being reasonably stable to feeling completely irrational every time. I found Prozac was useful but there are lots of different meds that stabilise mood and hormones, also there can be physical causes such as high blood loss. It's worth seeing your GP and discussing.
It helps me a lot to know that I'm not alone not that there are in fact meds that could help.
I only recently made the connection that it is not just me being messed up, but being unstable because of hormones. If I think back I only ever had big mental breakdowns before or during my period, even when I was depressed, things got even worse during my period.
I'll talk to a GP (I still have to register with one) sometime next week.I'm a little nervous but I hope it will go alright,
Also as it is my luck I have a first date tonight and couldn't feel less ready. :-\
Premenstrual Dysphoric Disorder ( PMDD ) is currently diagnosed when a woman's premenstrual symptoms are so severe that debilitating mood and behavioural changes impair basic daily activities such as work or social relationships, resulting in a form of clinical depression.
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To be diagnosed, a woman must suffer from at least four of the following 11 symptoms:
_ markedly depressed mood
_ marked anxiety or tension
_ persistent irritability or anger
_ difficulty in concentrating
_ decreased interest in usual activities
_ noticeable lack of energy
_ marked change in appetite
_ insomnia or hypersomnia
_ sense of being overwhelmed or out of control
_ sudden sadness or depression
_ physical symptoms such as joint pains, headaches, breast tenderness or "bloating."
The symptoms must occur a week before a menstrual cycle begins and disappear a few days after the menstrual cycle starts. The symptoms must recur in at least two consecutive menstrual cycles and must also "markedly interfere" with work, basic functioning or social relationships.
The defining of PMDD is an important breakthrough because it enables women to cateforise their symptoms in terms of a specific set of clinical criteria for the first time. This will enable clinical treatment protocols to be developed and should lead to women with PMS receiving more focused diagnosis and treatment. NAPS will be campaigning to get GPs to encourage women to keep a menstrual chart and to work with women to develop the most appropriate treatment tailored to individual needs.
Premenstrual Dysphoric Disorder: A Guide for Patients and Families
Margaret L. Moline, Ph.D., David A. Kahn, M.D., Ruth W. Ross, M.A., Lee S. Cohen, M.D., and Lori L. Altshuler, M.D.
Many women experience changes in their bodies or mood before their menstrual flow begins. However, if a woman has moderate or severe symptoms that make it hard for her to function, she may have premenstrual syndrome (PMS) or a more severe condition, premenstrual
dysphoric disorder (PMDD).
WHAT ARE PMS AND PMDD?
Many women experience mild to moderate physical symptoms, such as breast tenderness, pain, or “bloating,” and mild mood changes before their menstrual flow starts. These problems are referred to as PMS.
PMDD is a more severe premenstrual condition that affects about 5% of women during their reproductive years. Although PMDD, like PMS, may include physical symptoms, it always involves a worsening of mood that interferes significantly with the woman’s quality of life. In the days before her period, a woman with PMDD may experience moodiness or anger that seems out of control to her. These symptoms may cause her to avoid friends or relatives during the week before her period. Most researchers consider PMDD a type of mood disorder. Mood disorders are biological illnesses caused by changes in brain chemistry. PMDD is not the fault of the woman suffering from it or the result of a “weak” or unstable personality. It is not something that is “all in the woman’s head.” Rather, PMDD is a medical illness that can be treated.
What are the symptoms of PMDD?
The symptoms of PMDD appear regularly at some time after a woman ovulates in the middle of her monthly cycle. Symptoms generally get worse in the week before her period and then disappear during menstruation. To be diagnosed with PMDD, a woman must have five of the following symptoms* before her menstrual flow begins (although not necessarily the same symptoms each month). The symptoms must occur during most menstrual cycles and must interfere significantly with work, school, social activities, or relationships:
• Markedly depressed mood or feelings of hopelessness
• Marked anxiety or tension, feeling keyed up or on edge
• Marked shifts in mood (suddenly tearful, overly sensitive)
• Persistent, marked anger or irritability, increased conflicts
• Loss of interest in usual activities (e.g., work, hobbies)
• Difficulty concentrating and focusing attention
• Marked lack of energy, feeling very easily tired out
• Marked change in appetite, overeating, or food cravings
• Sleeping too much or having a hard time sleeping
• Feeling overwhelmed or out of control
• Physical symptoms (e.g., breast tenderness/swelling, headache,
PMDD is distinguished from other mood disorders by a characteristic pattern of symptoms. There must be a clear interval of at least 7–10 days during each menstrual cycle when the woman feels well mentally and physically. If a woman is depressed or anxious all month long, even if she feels worse premenstrually, it is more likely that she has another kind of mood problem (such as major depression) rather than PMDD.
When does PMDD begin?
Premenstrual symptoms can begin at any age after a woman begins to menstruate. Some women report that symptoms worsen when they are in their 30s; others associate the onset of symptoms with a reproductive event, such as a baby’s birth or surgery for tubal ligation. Premenstrual symptoms do not occur when a woman is pregnant, breast-feeding (at least during the first few months before menstrual cycles begin again), and after menopause. Therefore, it appears PMDD symptoms can only occur when a woman is having menstrual cycles.
Is PMDD inherited?
No specific genes for PMDD have yet been identified. However, genes may play a role in the development of premenstrual symptoms. Studies have found that it is more likely for two identical twins to be affected than for two non-identical twin sisters. The risk of PMDD also appears to be higher if a woman’s mother had the condition.
What causes PMDD?
We don’t know for sure what causes PMDD, but researchers believe that, like other mood disorders, PMDD may involve an underlying vulnerability in brain chemistry. Because of this vulnerability, monthly fluctuations in hormones (oestrogen and progesterone) have a negative effect on the way nerve cells in the brain function, leading to premenstrual symptoms.
HOW IS PMDD EVALUATED?
Since PMDD symptoms are related to the menstrual cycle, many women may turn to their gynaecologist for help. On the other hand, since the symptoms that usually bother patients the most are depression, anxiety, or irritability, women may instead seek treatment from mental health professionals such as psychiatrists. If a woman decides to see a mental health professional, she should also be evaluated by a gynaecologist, especially if she is over 40. To confirm the diagnosis of PMDD and distinguish it from other conditions that are not related to the phase of the menstrual cycle, the doctor may ask the woman to keep a daily symptom diary. Ideally women should keep such a diary for two months before treatment is begun, although some experts would consider starting treatment earlier if the symptoms are severe.
HOW IS PMDD TREATED?
Many treatments for PMDD have been described in the popular press, but only a few have been evaluated in rigorous, large-scale scientific studies. We therefore recently surveyed 36 leading experts in this field about the treatment of PMDD. The recommendations described in this article are based on the results of this survey. The experts recommend that women with severe symptoms use specific prescription medications, which can be supplemented with behavioral approaches and nutritional strategies. For women with less severe symptoms, it may not be necessary to use all three approaches at once.
What medications are used to treat PMDD?
To treat the emotional symptoms of PMDD (e.g., depression, tearfulness, mood swings, anxiety, anger, irritability, fatigue, difficulty concentrating), the majority of experts recommend antidepressant medications. Research shows that antidepressants help both the emotional symptoms of PMDD and often the physical symptoms as well. While there are many types of antidepressants available, for PMDD, the experts recommend antidepressants called selective serotonin reuptake inhibitors (SSRIs), which affect a brain chemical called serotonin. SSRIs have also been shown in research to be more effective than other antidepressants in PMDD. The recommended SSRIs are fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) as first choices, with citalopram (Celexa) an alternative. For severe symptoms, antidepressants should be taken
throughout the month, although in milder cases, they are sometimes effective if given just during the two weeks before the woman’s period.Medications that are used to treat anxiety, such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and buspirone
(BuSpar), may also help some women. In general, the experts did not recommend birth control pills or other types of hormones as initial treatments for PMDD.
If the woman also has severe physical symptoms (headache, cramps, bloating, or water retention), the experts would combine
the antidepressant with a medication for these physical symptoms, such as a diuretic, an over-the-counter pain medicine such as ibuprofen
(Motrin), or a prescription pain medicine, depending on the particular problems.
What are the side effects of SSRI medications?
SSRIs may cause nervousness, insomnia, restlessness, nausea, diarrhoea, and sexual problems. Side effects differ from one person to
another. Also, what may be a side effect for one person (e.g., drowsiness) may be a benefit for someone else (e.g., a woman with insomnia). Most women with PMDD do not report many problems with side effects from SSRIs. To try to reduce the risk of side effects, many doctors start with a low dose and increase it slowly. If you have problems with side effects, tell your doctor right away. If side effects persist, your doctor may lower the dose or suggest trying a different SSRI.
What nutritional approaches are used to treat PMDD?
A variety of nutritional approaches may be of some benefit. The most important recommendations include limiting consumption of alcohol, caffeine and salt. Some experts also advise avoiding sugar and eating more complex carbohydrates. Although studies have found that calcium supplements are helpful for PMS, the experts did not strongly recommend calcium specifically for PMDD. However, calcium supplements are recommended for women because of other health benefits (e.g., reducing the risk of osteoporosis). The experts give little support to vitamins, herbal preparations, and other dietary supplements for PMDD.
What behavioural approaches are used for PMDD?
Certain activities may help a woman with PMDD be healthier in mind and body and cope better. Regular exercise is strongly recommended. Although exercise has not been studied specifically in PMDD, it has shown benefit in PMS. Other strategies that may be helpful are relaxation techniques, meditation, and yoga. Psychotherapies that are helpful for depression (e.g., cognitive-behavioral and interpersonal therapies, supportive counseling) may also be helpful for PMDD.
What if the first treatment plan does not help?
It is important to give the treatment enough time to work before considering another. It may take two or three menstrual cycles to
tell. If a woman has given one SSRI a fair trial but it has not helped or has caused very troublesome side effects, the experts strongly
recommend switching to a different SSRI. The experts also recommend trying a second SSRI if a woman has had only a partial
response to the first one after several menstrual cycles. Remember that changing medication is a complicated process. Don’t stop or change the dose of your medication without first consulting your doctor.
If a woman with PMDD has not responded to a variety of recommended treatments, consultation with another medical
speciality (gynaecology, psychiatry, or reproductive endocrinology) may be valuable if she is not already under such care. Further treatments that may be considered are hormonal medications (e.g., oestrogen and birth control pills). For severe symptoms that have not responded to any other strategies, the doctor may also discuss using medication to block ovulation (creating a “chemical menopause”).
What if I need help paying for medications?
• Pharmaceutical Research and Manufacturers Association: your doctor can request a directory of programs for those who cannot afford medication by calling (202) 835-3450
• Lilly Cares Program: (800) 545-6962
• Pfizer Prescription Assistance: (800) 646-4455
• SmithKline Paxil Access to Care Program: (800) 536-0402 (patient requests); (215) 751-5722 (physician requests)
MARCH 2001 • A POSTGRADUATE MEDICINE SPECIAL REPORT •
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Premenstrual dysphoric disorder (PMDD): Different from PMS?
What's the difference between premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS)? How is PMDD treated?
Answer
from Mary M. Gallenberg, M.D.
Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling form of premenstrual syndrome (PMS). Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships. About 30 percent of menstruating women have PMS. Up to 8 percent of women with PMS have symptoms that meet the diagnostic criteria for PMDD.
In both PMDD and PMS, symptoms occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins. Both PMDD and PMS may also cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, the following emotional and behavioral symptoms stand out:
Anxiety
Feelings of being "keyed up" or "on edge"
Persistent irritability
Marked anger
The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the normal physical changes that trigger a menstrual period somehow exacerbate mood disorders.
Treatment of PMDD is directed at preventing or minimizing symptoms and may include:
Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, others) and sertraline (Zoloft, others), reduce symptoms such as fatigue, food cravings and sleep problems. You can control PMDD by taking SSRIs all month or only in the interval between ovulation and the start of your period.
Birth control pills. Taking birth control pills stops ovulation and stabilizes hormone fluctuations. Birth control pills containing drospirenone and packaged with a four-day placebo interval after 24 days of combination hormones may be more effective than are standard birth control pills.
Nutritional supplements. Consuming 1,000 milligrams of dietary and supplemental calcium daily may reduce the physical and emotional symptoms of PMDD. Vitamin B-6, magnesium and L-tryptophan also may help.
Herbal remedies. Clinical trials suggest that chasteberry may reduce irritability, mood swings, anger and headaches associated with PMDD.
Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Cutting back caffeine intake can alleviate anxiety and irritability. Also, eating more carbohydrates in the week before your period may improve mood and memory.
It's important that you review your symptoms with your doctor. A thorough medical evaluation can determine if symptoms are due to PMDD or some other condition. If you are diagnosed with PMDD, your doctor can recommend specific treatments to help minimize the impact PMDD has on the days you experience symptoms.
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References
Casper RF, et al. Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder. uptodate.com/home/index.html. Accessed May 20, 2010.
Casper RF, et al. Treatment of premenstrual syndrome and premenstrual dysphoric disorder. uptodate.com/home/index.html. Accessed May 20, 2010.
Lopez LM, et al. Oral contraceptives containing drospirenone for premenstrual syndrome (Review). Cochrane Database of Systematic Reviews. 2009:CD006586.
Chasteberry. Natural Medicines Comprehensive Database. naturaldatabase.com. Accessed June 16, 2010.
Gold CE, et al. Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women's Health Across the Nation (SWAN). Journal of Women's Health. 2007;16:541.
Sayegh R, et al. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstetrics & Gynecology. 1995;86:520.
Premenstrual syndrome (PMS) was first recognised by the medical community in 1931.
It is a combination of psychological, emotional and physical changes prior to the onset of menstruation. It is characterized by mood swings, depression, anxiety and irritability, usually in the two weeks before ovulation and menses. It is often accompanied by physical symptoms such as bloating and cramping, fatigue, breast tenderness, acne and food cravings. Hot flushes, heart palpitations and weight gain are also common. Emotional symptoms can include crying, memory problems, insomnia, a lack of concentration, withdrawal, anger and possible aggression.
Up to 80% of women will experience at least some of these symptoms.
Causes
It is suggested that a reduction in sex hormones following ovulation is responsible. Changes in serotonin and tryptophan neurotransmitter levels (responsible for mood and emotion) are also linked, whilst these brain chemicals may also fluctuate in response to hormones produced by the ovaries to cause symptoms.
PMS that begins in the late 30s or early 40s is thought to actually be linked to a reduction in male hormones in women. These androgen levels fall in women with age until levels are about half what they were in a woman’s 20s.
Nutrition
Dietary factors heavily influence both the above chemical changes and the severity of symptoms experienced….
Vitamin B-6 is related to an imbalance of estrogen, which in turn can lead to depression or dramatic mood swings;
The lack of a particular fatty acid needed to produce prostaglandin is common in sufferers. (Evening Primrose Oil contains this ‘missing’ fatty acid and supplementation therefore can help to restore balance);
An excess of calcium from too much dairy produce forces a depletion of magnesium as they compete for absorption, leading to deficiency of one and toxicity of the other;
Deficiencies of vitamins A, C, E, other B vitamins and iron and zinc are also contributory factors.
Yes I do, its been a bain of my whole life!!!
Finally, dietary excesses of salt, caffeine, alcohol, smoking and animal fats aggravate symptomatic effects.
Treatment
Replacement of dietary and nutritional deficiencies is vital to rebalance essential organ and reproductive function, as well as the avoidance of aggravating factors, excesses and toxicities.
Also, victims of PMS and hypoglycemia sometimes suffer the same symptoms. Therefore it has been suggested that following a modified version of the hypoglycaemic diet can help.
I have just added this thread, because my doctor had no idea, my life could have been soooo different If I had been refered to a hormone specialist, now my daughters are going through this,, and the grand kids (most all girls)
print this off, and give it to your doctor for a referal. x Linda
So glad I am not the only one. I have suffered long term depression since I was 11 years old. However, although I have been getting so much better, when I am due my period I am a different person!! I have faulty thinking that is beyond reasonable, at times I could divorce my other half, walk out, have a fit at someone, then comes the tears I am in despair, feel abandoned, feel persecuted etc! It is horrible. Plus, I feel so ill with it pain and my legs! My doctor gave me some tablets to take before my period to alleviate some of the symptoms...
I hope you get some resolution and know you are not alone!
Hi x thank you as i thought i was going mad, ive never had bad periods until last year when i had my last baby, im in my late 30s and im just the same as you. I feel hate,angry all the time and very very tearful, crying at silly things, i feel like im going to blow with the anger. What makes it worse is my partner anything he does or says it leads to a shouthing match, it starts a week before my period is due, i dread it coming,
Hi just me again, new member x, also does anybody think that my depression has open this awful door, as my depression also started last year, does depression make my mood swing worse.
hi shelle depression is a major part of pmt / pmdd. when you mention mood swings, do you mean you also get classic highs as well, ,, not just "normal" happy i mean? the hormone balance does change after giving birth which can trigger depression and for some some women it can last quite a while. Not sure if you are using the combined pill now, for me it made a difference and helped with the pmdd, i'm taking it without the usual monthly break, as otherwise even missing one day can turn me into a blubbering wreck the next month
Hi I am 44 years old and I have found that my depression gets very low every 3 - 4 months, its not every month but when I have a severe burst of depression before my periods I sob uncontrollably, become obsessive, quite suicidial and jut wanna pack up and leave it all behind. I have never had this problem before apart from being on anti-depressants for my more years.
My periods are also very irregular as well and they are all over the place which isn't helping, any suggestions, its very hard to cope with it, I dread very month in case I have this issue.
but I know the hormones involved in periods cause hypertension, which is basically a way of saying they cause serious anxiety that causes depression.
Depression is a word people don't understand, its so dark and destructive. hypertension is a word like depression people don't understand but it is actually depression its self but people disguise it behind a big word.
it gets less involved as you get older and older, not necessarily at 40, it just gets more 1 every 3 cycles or so. after a while you have long enough to prepare and can handle them.
just to clarify what I meant in the last part
you wont be hypertensive for every single period you have until your reach menopause, by this I mean it should steady out to a normal amount you can manage and for most its 1 bad depression every 3 periods.
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Newbie here Looking for advice , thanks in advance x
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