top of page
Search

Premenstrual Mood Changes

Premenstrual Mood Changes

90% of women with regular menstrual cycles report unpleasant physical and psychological symptoms before menstruation. 


Woman in white tank and yellow shorts sits on bed, clutching stomach, head on knees. Background: plant, book, and glass on table.
A woman sits on a bed clutching her stomach, appearing to be in discomfort or pain, with a book, glass of water, and plant on a nearby table, creating a serene yet concerned atmosphere.

Premenstrual Syndrome (PMS)

Physical, emotional and behavioral symptoms that occur 1-2 weeks before menstruation. 

It affects 30-80% of reproductive age women. 


Psychological Symptoms: Anger, Anxiety, Depression, Irritability, Sense of feeling overwhelmed, Sensitivity to rejection, Social withdrawal


Physical Symptoms: Abdominal bloating, Appetite disturbance (usually increased), Breast tenderness, Headaches, Lethargy or fatigue, Muscle aches and/or joint pain, Sleep disturbance (usually hypersomnia), Swelling of extremities


Behavioral Symptoms: Fatigue, Forgetfulness, Poor Concentration


Premenstrual Dysphoric Disorder (PMDD)

PMDD is a more severe form of PMS. It is commonly associated with irritability and causes impairment in relationships or work. PMDD affects 3-8% of reproductive age women. Symptoms usually start in the twenties and worsen over time especially during perimenopause. 


Psychological Symptoms: Anxiety, Feeling overwhelmed or out of control, Increased depressed mood, Irritability, Mood Swings, Sense of feeling overwhelmed, Sensitivity to rejection, Social withdrawal, Sudden sadness or tearfulness


Physical Symptoms: Abdominal bloating, Appetite disturbance (usually increased), Breast tenderness, Headaches, Lethargy or fatigue, Muscle aches and/or joint pain, Sleep disturbance (usually hypersomnia), Swelling of extremities


Behavioral Symptoms: Fatigue, Forgetfulness, Poor Concentration


Premenstrual exacerbation (PME)

Depression and bipolar disorders can worsen in the premenstrual period. This is called premenstrual exacerbation (PME). 40% of women who seek treatment for PMDD actually have PME. The best way to tell the difference is by charting symptoms.  If mood symptoms are present only during the luteal phase or days 14-28, then the diagnosis is PMDD. 


Confirming the Diagnosis of PMDD

Daily mood charting with one of the following tools:


What Causes PMS and PMDD?

We actually don’t know yet. Women with premenstrual mood changes do not have abnormal hormones. When ovarian cycling is suppressed with medications like Lupron (gonadotropin releasing hormone agonist), the symptoms of PMDD resolve completely. The change in hormones levels throughout the cycle is what likely affects the brain and mood more so than the actual levels. Serotonin and GABA likely play a big role in PMS and PMDD. 


Non-Pharmacologic Treatment for PMS and PMDD


Monthly Mood Charting


Lifestyle Modifications (limited evidence) 

Decrease or eliminate intake of caffeine, sugar, sodium, alcohol and nicotine

Get adequate sleep

Exercise may be helpful


Nutritional Supplements (limited evidence)

Calcium 1200mg once daily may reduce symptoms of PMS or PMDD. 

B6 50-100 mg once daily may reduce PMS, but doses greater than 100 mg a day may cause peripheral neuropathy. 

Magnesium 200-360 mg a day may reduce symptoms. 

Vitamin E 400 IU a day may reduce symptoms. 


Herbal Remedies (limited evidence)

Chasteberry may be helpful for reducing symptoms of PMS and PMDD. 

Gingko biloba may reduce symptoms especially breast tenderness and fluid retention. 


Light Therapy (limited evidence)

May help reduce symptoms 


Psychotherapy or Cognitive-Behavioral Therapy


Pharmacologic Treatment for PMS and PMDD

Psychotropic Medications: SSRI Antidepressants

SSRIs are first line treatment. They can prescribed throughout the whole month, during the luteal phase or at an increased dose in the luteal phase. 

Other options may be: clomipramine, venlafaxine, or duloxetine. 

Antidepressants should be used cautiously in women with bipolar disorder due to the risk of hypomania/mania. 


Hormonal Interventions: Oral Contraceptives

Continuous treatment with OCPs (skipping menstruation) may be effective for treating PMS and PMDD. 

Drospirenone containing OCPs may be more effective. 

OCPs carry risks and may not be appropriate for all women. 


Hormonal Interventions: Leuprolide and Danazol

Medications that suppress ovarian function can reduce symptoms of PMS and PMDD, but they do carry the risk of a lot of side effects.


Surgical Intervention

Complete hysterectomy can reduce symptoms for women who respond to medical ovarian suppression. 


Comments

Tally Reproductive Psychiatrist, LLC

Private Practice of Jamie Sorenson, MD

​

​

​

3689 Coolidge Court Unit 5

Tallahassee, FL 32311

​

​

Call or Text: 850-694-2008

Fax: (786) 590-1485

Email: info@tallyrepropsych.com

​

Online Scheduling:

https://tallyrepropsych.clientsecure.me/

  • Youtube
  • Instagram
  • Threads
  • TikTok
  • Facebook
  • Linkedin

Telemedicine appointments available only in: Florida, Georgia, Tennessee, Colorado, and Massachusetts

If you are experiencing thoughts of self-harm or are in crisis, please do not use this website. Instead, call or text 988 to reach the Suicide and Crisis Lifeline, or go to your nearest emergency department. If you are outside the United States, please contact your local emergency number.

Conditions Dr. Sorenson has expertise in:

  • Attention Deficit Hyperactivity Disorder (ADHD)

  • Autism Spectrum Disorder (ASD)

  • Obsessive Compulsive Disorder (OCD)

  • Depression or Major Depressive Disorder (MDD)

  • Anxiety or Generalized Anxiety Disorder (GAD)

  • Panic Disorder with and without agorophobia

  • Bipolar Disorder

  • Bipolar 2 Disorder

  • Post Traumatic Stress Disorder (PTSD)

  • Chronic Post Traumatic Stress Disorder (CPTSD)

  • Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Exacerbation of a mood disorder (PME)

  • Perinatal Depression and Postpartum Depression

  • Perinatal Anxiety and Postpartum Anxiety

  • Perinatal OCD and Postpartum OCD

  • Perinatal Psychosis and Postpartum Psychosis

  • Perimenopause/Menopause Mood and Anxiety Disorders

  • Perimenopause/Menopause Cognitive Disorders

  • Gender Dysphoria

  • LGBTQI Mental Health

  • Mood and anxiety disorders while undergoing infertility treatments

Comorbidities not directly treated by Dr. Sorenson that will routinely be considered in your individualized treatment plan and recommendations:

  • Ehlers-Danlos Syndrome

  • Hypermobility Spectrum Disorders

  • Mast Cell Activation Syndrome (MCAS)

  • Postural Orthostatic Tachycardia Syndrome (POTS), dysautonomia, and Mitral Valve Prolapse

  • Fibromyalgia 

  • Chronic Pain

  • Chronic Fatigue Syndrome (CFS)

  • Insomnia and Sleep Apnea

  • Narcolepsy and Idiopathic Hypersomnia

  • Chiari Malformation

  • Small Fiber Neuropathy

  • Pelvic organ prolapse, incontinence, chronic pelvic pain, pelvic floor dysfunction, hernias

  • Irritable Bowel Syndrome (IBS), gastroparesis, gut dysmotility

  • Bladder Pain Syndrome (previously interstitial cystitis)

  • Osteoporosis/Osteopenia

  • Dental Problems/TMJ

  • Migraines and Headaches​

  • Hormone Replacement Therapy (HRT)

  • Infertility Treatment

  • Endometriosis 

  • Polycystic Ovarian Syndrome (PCOS), Now Polyendocrine Metabolic Ovarian Syndrome (PMOS)

  • Thyroid Disorders: Hypothyroidism and Hyperthyroidism

  • Raynaud's Disease

  • Autoimmune disorders: Lupus (SLE), Sjogren's Syndrome, Hashimoto's thyroiditis and Grave's Disease, CREST Syndrome, Scleroderma, Celiac Disease and Ulcerative Colitis (UC), Psoriasis/Psoriatic Arthritis, Rheumatoid Arthritis (RA), Multiple Sclerosis (MS) and Neuromyelitis optica (NMO)

bottom of page