Do I Have PMS Or Anxiety & Depression? It’s All So Connected

If you’ve ever had a period, a pregnancy, or a baby, you know how much the hormones involved in your reproductive health can affect your mental and emotional well-being. So, if you notice yourself feeling more irritable, upset, or completely exhausted around the same time each month, you might be wondering: do I have PMS, or is something amiss with my mental health?

You’re not the first person to ask that question and you certainly won’t be the last. Your brain, hormones, and menstrual cycle are all interconnected. Romper spoke with two experts who explain how you can tell the difference between PMS and something like anxiety or depression.

What is PMS?

Premenstrual syndrome (PMS) refers to the physical and emotional symptoms many people experience in the weeks to days leading up to their period, according to the American College of Obstetrics and Gynecology (ACOG).

“Premenstrual syndrome refers to both the physical and the emotional symptoms that people experience that lead up to menstruation,” says Monique De Four Jones, M.D., MBA, OB-GYN and associate chief of Labor and Delivery at Long Island Jewish Medical Center, and associate professor of Obstetrics and Gynecology at the Zucker School of Medicine. “We know that the hormone changes and fluctuations that can happen can cause tension, anxiety, depressive moods, crying spells — just from the hormone changes. Symptoms can start two weeks before and even up to two days before the cycle starts.”

And apparently, there’s a reason people with periods often ask themselves whether they’re dealing with PMS or anxiety and depression: “Depression and anxiety disorders are the most common conditions that overlap with PMS. About half of women seeking treatment for PMS have one of these disorders,” says ACOG’s website.

Symptoms of PMS

ACOG acknowledges that anxiety and depression can be confused with PMS because the conditions all share so many symptoms, but specifies that “women with depression often have symptoms that are present all month long.” These symptoms may worsen before or during their periods, according to both ACOG and De Four Jones, but they don’t disappear when the period ends. Signs you have PMS can be both emotional and physical.

Emotional symptoms of PMS:

• angry outbursts
• anxiety
• changes in libido
• confusion
• crying spells
• depression
• increased nap taking
• insomnia
• irritability
• poor concentration
• social withdrawal

Physical symptoms of PMS:

• abdominal pain
• aches and pains
• bloating and weight gain
• breast tenderness
• fatigue
• gastrointestinal symptoms
• headache
• skin problems
• swelling of the hands or feet
• thirst and appetite changes, including food cravings

Do I have PMS or a mental health concern?

If you want to get more information from your doctor about why you feel so low before your period, it’s helpful if you bring a little info with you. Buy the cute notebook you’ve been eyeballing and start tracking your symptoms, and logging the dates your period begins and ends.

“If you are concerned about how your cycle and mental health are affecting you, it is important that you track — on a daily calendar for three months — the intensity of your top three symptoms. For example: irritability, social withdrawal, and depressed mood,” says Dr. Louann Brizendine, neuropsychiatrist, founder of the University of California San Francisco Women’s Mood and Hormone Clinic, and expert on The Body Agency’s Body Board. “Ask yourself whether your anxiety or depression gets worse the week before your period starts to help determine whether you’re dealing with a mental health condition, or a complication like PMS or PMDD. If your symptoms are there all month long but then get worse the week before your period every month, then you likely have premenstrual exacerbation of a mental health condition and both need to be treated.”

Recording your symptoms may also help doctors catch any that clearly indicate PMS is the problem. “Some defining symptoms of PMS that would confirm that’s what you're experiencing are increased irritability, crying easily, moodiness, snapping at others, bouts of anger, anxiety, depression, and withdrawing socially,” says Brizendine.

Questions to ask yourself

• Do I have any PMS-specific symptoms that don’t overlap with anxiety or depression?
• What are my top three symptoms?
• Do I only feel those symptoms in the week leading up to my period? Or, are they present all month long, and just get more intense during the week before my cycle starts?
• Month to month, are there any patterns to when I experience symptoms, or how severe they are?

Should you call your therapist or your OB-GYN?

If you’re not sure where to start, you’re not alone. You could search your area for a psychiatrist or other mental health provider with special training in women’s reproductive health, which is Brizendine’s recommendation. De Four Jones says it’s also important to talk to your OB-GYN about your concerns.

If you suspect you’re dealing with PMS, you should make an appointment with your OB-GYN to investigate. If you’re leaning toward something like anxiety and depression being the problem, you might opt to start with a therapist. It’s important to communicate with both providers at some point, just to ensure you’re covering all your bases, and so your doctors can work collaboratively, De Four Jones says.

“Sometimes things are not as black and white. We would like to think, ‘Is it mental or is it hormonal?’ Sometimes it's both, and don't think less of yourself if it is. It's a fine-woven fabric,” she says.

When you see your doctor, they’ll ask you a bunch of questions about your symptoms and how much they impact your daily life (like do they make it hard to leave the house for work or fun?), De Four Jones says. They might recommend some natural remedies, she says, like taking specific vitamins and supplements, or discuss using medications to alleviate your symptoms.

“If somebody has depression and anxiety, antidepressants can help with treating the PMS in those patients. There's anti-anxiety drugs that can be used the same way for some people. With respect to the hormones, there are different birth control pills or even placing somebody on a device like a Mirena IUD, Nexplanon, or the Depo shot. What that does is it shuts down their period from occurring and therefore they’re not ovulating, and that then helps with decreasing the hormonal imbalance, lessening those physical symptoms as well as those emotional symptoms.”

There are some natural approaches to treating PMS symptoms, De Four Jones says. Some of her patients have reported that taking over-the-counter calcium supplements improved their physical and mood-related symptoms, and that magnesium has helped reduce their water retention and breast tenderness. For her part, De Four Jones encourages patients to try relaxation techniques, like mindfulness and yoga, to support their mental health during rough days.

Trying to figure out whether you’re dealing with PMS or a mental health condition can be overwhelming — all these systems in your body are so interconnected. Just know you don’t have to crack the code on your own; your providers want to help you find relief, and you can start taking control just by tracking your symptoms while you wait for your appointment date.

Experts:

Monique De Four Jones, M.D., MBA, OB-GYN and associate chief of Labor and Delivery at Long Island Jewish Medical Center, and associate professor of Obstetrics and Gynecology at the Zucker School of Medicine

Dr. Louann Brizendine, neuropsychiatrist, founder of the University of California San Francisco Women’s Mood and Hormone Clinic, and expert on The Body Agency’s Body Board