Premenstrual Emotional Changes: Dr. Jekyll or Ms. Hyde

There are numerous bodily and emotional changes that can occur during the week prior to the onset of menses (period) and resolve within the first few days of menses. Bodily symptoms can be numerous including bloating, fatigue, water retention, and breast tenderness.  Emotional changes include anger, increased tension, irritability, sadness, and anxiety.

Several different organizations, including the American Psychiatric Association (APS), have defined these symptoms, when only occurring during and specifically confined to the week prior to the beginning of a period, as the Premenstrual Syndrome (PMS). Different studies estimate that up to 50% of women experience various symptoms of this syndrome. When the emotional changes are severe and are extremely disruptive, the APS has defined this as The Premenstrual Dysphoric Disorder (PMDD).  It is estimated that three to ten percent of women are afflicted with PMDD.

It is extremely important to understand that these disorders are real and there are clear cut hormonal and neurological changes that account for them. Changes in estrogen and progesterone levels directly account for the bodily changes and directly affect brain chemicals like Monoamine Oxidase, Norepinephrine, Dopamine, and Serotonin, which are neurotransmitters that affect mood.

Studies show that increasing exercise, especially aerobic, and changing diet by increasing calcium and soy have proven to be beneficial for PMS and PMDD.

Serotonin, one of the major neurotransmitters for mood, is reduced when estrogen drops during the week prior to menses. The fact that this drop intricately affects mood is evidenced by numerous double blind studies.  These studies show that specific anti-depressants which increase serotonin are extremely affective in combating the symptoms of PMS and PMDD.

One must keep in mind that PMS and PMDD are specific disorders confined to a specific time period.   It is; therefore, extremely important to diligently record symptoms and their time relationship to menses. Symptoms which persist outside this window of time (one week prior to menses) should be evaluated with appropriate psychological testing, blood testing, physical examination, and personal history to be treated accordingly.  Always realize that these symptoms can be exacerbated during the premenstrual week.