Why do I get anxiety before my period? 6 tips to ease your mind
Clinically reviewed by Dr. Chris Mosunic, PhD, RD, CDCES, MBA
Explore why you might get increased anxiety before your period, and if PMS and PMDD can be the cause. Plus, 6 tips to help you treat anxiety before your cycle.
Many of us experience heightened anxiety before our periods, a condition often linked to hormonal changes associated with our menstrual cycles. This can have a significant impact on daily life and wellbeing. Understanding the underlying causes of premenstrual anxiety and the steps you can take to mitigate symptoms can help you live a more balanced life—whatever the time of the month!
Why do I get anxiety before my period?
In the days leading up to your period you may recognize a noticeable increase in anxiety levels. This shift may come from the biological and hormonal changes that precede menstruation.
Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD)
Premenstrual syndrome (PMS) affects the vast majority of people who menstruate, with symptoms ranging from mild to severe. It encompasses a variety of symptoms—both physical and emotional—that can disrupt daily life. These symptoms typically emerge in the week or two before menstruation and usually subside once your period starts.
Premenstrual dysphoric disorder (PMDD) represents a severe form of PMS, characterized by particularly acute emotional symptoms. You may experience debilitating anxiety, depression, and mood swings that can significantly impair your ability to function in everyday situations. PMDD is diagnosed based on specific criteria that include the severity and timing of your symptoms.
Hormonal fluctuations: the underlying culprit
The primary drivers behind both PMS and PMDD are the hormonal fluctuations that occur throughout your menstrual cycle. Estrogen and progesterone—two key hormones—rise and fall dramatically in the days leading up to menstruation. These fluctuations can affect neurotransmitters in the brain, such as serotonin, which plays a critical role in regulating mood. When serotonin levels are impacted by these hormonal changes, it can lead to feelings of anxiety and mood instability. Estrogen levels, both high and low, may also increase anxiety levels.
The impact on mental health
The impact of these hormonal shifts is not just physical. They can profoundly affect mental health, leading to increased anxiety and other emotional symptoms. This is why anxiety before your period may not simply be a matter of feeling a bit more stressed or worried. It could be a significant change in emotional state driven by your body's natural rhythms.
Understanding that these feelings of anxiety are tied to your menstrual cycle may provide a sense of relief and validation. It's a reminder that your feelings are part of a broader physiological process.
PMDD vs PMS
You may already have heard of premenstrual syndrome (PMS) or experienced symptoms associated with it as part of your menstrual cycle. It’s also important to understand the distinction between PMS and its more severe counterpart, premenstrual dysphoric disorder (PMDD), in order to properly recognize and address premenstrual anxiety.
Understanding PMS and PMDD
Premenstrual syndrome (PMS) presents a collection of symptoms that many menstruating people experience to some degree. Though uncomfortable, for most of us, the symptoms are manageable and don't significantly interfere with our daily lives.
PMS symptoms may include:
Emotional and behavioral symptoms such as mood swings, irritability, anxiety, and tearfulness.
Physical symptoms like breast tenderness, bloating, fatigue, and changes in sleep and eating habits.
Premenstrual dysphoric disorder (PMDD), however, stands on the more severe end of the spectrum. It affects a smaller percentage of people who menstruate and is associated with much more intense symptoms. PMDD can be debilitating, affecting personal relationships, work, and overall quality of life. The emotional symptoms are particularly severe and can mimic those of major depression or anxiety disorders. They are tied to the luteal phase of the menstrual cycle and should significantly improve within a few days of the onset of menstruation.
PMDD symptoms are characterized by:
Severe emotional symptoms including intense sadness, despair, anxiety attacks, persistent irritability, and feeling overwhelmed or out of control, which significantly impact daily functioning.
Physical symptoms may include significant fatigue, sleep disturbances, and physical pain.
The impact of symptoms
The distinction between PMS and PMDD lies not only in the severity of symptoms but also in their impact on your life. While PMS can be a nuisance, PMDD requires more significant intervention, often necessitating a combination of lifestyle changes, counseling, and sometimes medication.
Understanding whether you are experiencing PMS or PMDD is essential for seeking appropriate care. Recognizing the signs of PMDD is particularly important because its treatment strategies can be different and more intensive than those used for PMS.
Seeking professional medical advice is crucial if you are experiencing symptoms of PMDD or if your PMS symptoms are particularly challenging. A healthcare provider can offer a diagnosis and tailored treatment plan.
How to treat anxiety before your period: 6 ways to calm your mind
Premenstrual anxiety doesn't have to be a debilitating part of your month. Incorporating these strategies might help you find relief:
1. Exercise regularly to relieve stress
Regular exercise not only helps in releasing natural mood lifters in the body but also aids in mitigating the physical symptoms of PMS and PMDD. Aim for at least 30 minutes of moderate exercise—such as brisk walking, cycling, and swimming—most days.
💙 Walk It Out, a Daily Move session, will teach you stretches to make sure you’re working out with ease.
2. Practice mindfulness
Meditation and mindfulness can significantly reduce stress and anxiety by promoting relaxation and presence of mind. Techniques such as guided imagery, deep breathing exercises, and mindfulness-based stress reduction (MBSR) can be particularly beneficial.
💙 Explore this Guided Breathing to Release Tension meditation from the Overcoming Stress and Anxiety Series.
3. Eat well to feel well, all month
Some studies suggest that calcium, magnesium, and B vitamins may help reduce PMS symptoms, including anxiety. These can be found in a balanced diet rich in whole foods, fruits, vegetables, whole grains, and lean proteins. Limiting the intake of sugary foods can also potentially help stabilize mood fluctuations.
4. Improve sleep quality to regulate your mood
Establish a regular sleep schedule by going to bed and waking up at the same time every day, even on weekends. Create a relaxing bedtime routine to signal your body it's time to wind down. Avoiding screens and heavy meals close to bedtime can also improve sleep quality and reduce anxiety.
💙 Turn on the Soften Into Sleep meditation at bedtime to help you release tension and rest.
5. Cut back on coffee and cigarettes
Caffeine and alcohol can exacerbate anxiety symptoms. Reducing or eliminating these substances, especially in the week or two before your period, can help manage anxiety levels. Smoking is also associated with heightened anxiety, and quitting can improve overall health and help reduce anxiety symptoms.
6. Talk about your feelings to find positive coping strategies
Whether it's friends, family, or a support group, sharing your struggles can provide comfort and understanding. Professional therapy, such as cognitive-behavioral therapy (CBT), can also offer strategies to cope with anxiety and improve mental health.
💙 If naming your feelings is hard, let the Emotions series help you understand and soothe negative feelings.
Anxiety before period FAQs
Why do I get intrusive thoughts before my period?
Intrusive thoughts before your period can be a distressing symptom of hormonal fluctuations associated with your menstrual cycle. As levels of estrogen and progesterone decline in the week before menstruation, this hormonal shift can impact neurotransmitters in the brain, including serotonin —which plays a major role in regulating our mood and thoughts. Fluctuating serotonin levels may lead to increased anxiety, mood swings, and the emergence of intrusive thoughts. The stress and discomfort of premenstrual symptoms can also exacerbate these thoughts, making them more frequent or intense. Managing stress, practicing mindfulness—and seeking professional help if intrusive thoughts become overwhelming—are strategies that may help.
How long does PMS anxiety last?
PMS anxiety typically begins in the luteal phase of the menstrual cycle —the time after ovulation and before the start of menstruation. This can be anywhere from five to 11 days before menstruation begins. The intensity and duration of PMS anxiety can vary widely but generally subsides once your period starts. For some, anxiety may begin to ease a few days into menstruation, as hormone levels start to stabilize. If you find that your anxiety persists beyond your period or is particularly debilitating, it may be a sign to seek medical advice for potential PMDD or another underlying condition.
What are the 11 symptoms of PMDD?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies the following 11 symptoms of premenstrual dysphoric disorder (PMDD).
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety or tension
Marked “affective lability,” e.g. feeling suddenly sad or tearful, or increased sensitivity to rejection
Persistent and marked anger, irritability, or increased interpersonal conflicts
Decreased interest in usual activities (work, school, friends, hobbies)
Subjective sense of difficulty in concentrating
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
A sense of being overwhelmed or out of control
Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain
For a diagnosis of PMDD, at least five of these symptoms—including one of the first four—must be noted through at least two menstrual cycles and must significantly interfere with your work, school, usual social activities, or relationships with others.
When is anxiety highest during your cycle?
Anxiety levels are often highest during the luteal phase of your menstrual cycle — the period after ovulation and before the start of menstruation. This phase typically lasts from day 14 to day 28 of a standard 28-day cycle, with anxiety peaking in the days immediately before menstruation due to hormonal changes. Everyone’s experience can vary. Some experience heightened anxiety earlier in the luteal phase and others feel it more acutely closer to the onset of their period.
Calm your mind. Change your life.
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