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Key points
- PMS is a normal syndrome experienced by up to 90 percent of menstruating people.
- PMS can be overwhelming, but knowing what’s happening can set you on the road to healing.
We all know the ugly: ugly crying, ugly rage, ugly self-talk. And that’s not even the bad: Up to 90 percent of women experience premenstrual syndrome (PMS) sometime in their reproductive lives, and it tends to worsen as we age, peaking in peri-menopause. But there’s good news, too, and plenty of it; knowledge is power, and there are many things you can do—and be aware of—that decrease PMS and give you more control.
The most prevalent symptoms women experience with PMS are not cramps or bloating, breast tenderness, fatigue, or headaches. Nope, the most prominent symptom of PMS is irritability. If you find yourself snapping at the popcorn purveyor at the movie or the person next to you at the laundromat (the audacity of bringing that detergent and smelling up the place), you’re not alone. There’s good reason The Red Tent—about biblical women in a menstrual hut—became a New York Times bestseller. The idea of ditching work, kids, and/or spouses before or during menses definitely has its appeal.
Women commit more crimes—including violent crimes—before menses. If you feel like (proverbially) wringing someone’s neck at this time of the month, you’re in good company. Women are less satisfied with their primary relationships during PMS. And physically, symptoms like sleep problems involving over-sleeping (hypersomnia) or insomnia can exaggerate emotional symptoms.
Besides irritability and anger, feeling generally down or depressed, anxious, overwhelmed, more sensitive to rejection, or isolating are, guess what? Common PMS symptoms. It’s not just you.
What you can do
The most important tool we have to combat PMS is knowing when it’s about to happen. You can’t snap your fingers and make it disappear, but if you’re crying at TikTok or snapping at the cat, you can at least remind yourself it’s PMS, it’s not what you would think or feel at other times, and it will definitely pass.
- Charting your cycle. There is no tool as helpful as charting to tell you when PMS is about to flare. Charting offers you time to put strategies (see below) into gear. Flo, Clue, Period Tracker, and many more are great apps to track your emotional symptoms, as well as the iPhone Health app. Old school, a hard copy chart like the Daily Record of Severity of Problems (DRSP) works especially well. After just two cycles, you will probably be amazed at how graphically your symptoms increase and decrease across your cycle. The importance of charting can’t be overstated, and it offers an empowering healing tool.
- Lifestyle measures. All the things we know about health, like exercising, eating and sleeping well, and relaxation (yoga, meditation, mindfulness), are all effective in decreasing PMS. It is important to make time in your calendar for good self-care when you anticipate PMS.
- Vitamins, minerals, herbs, etc. Supplements get mixed reviews in research, partly because adequate studies have not been done and individual results vary. What works for you may not work for your best friend. Trying one thing at a time is essential (so you know what is or isn’t helping). Giving each supplement a couple of months’ trial is also important because supplements work more slowly than medications.
- Calcium, magnesium, vitamin B6, and omega fatty acids have been used to manage PMS and may be helpful for you via supplements or food.
- Chasteberry (vitex agnus-castus) is a time-honored herb used for PMS and other menstrual issues. St. John’s Wort, Gingko, and black cohosh have also been used with PMS, but with mixed results.
- Light therapy. Although not an herb or supplement, light therapy—the bright white light used for seasonal affective disorder—is helpful for PMS. Light therapy is most effective used every morning during the second half of your cycle; you simply prop it next to your make-up mirror, computer, or breakfast for 10-15 minutes, 12-18 inches away from your face. You don’t need to stare at the light; it simply needs to shine on you.
Medications
- SSRIs—selective serotonin reuptake inhibitors are the gold standard for treating PMS. They are also used to treat PMS’s more severe sisters, premenstrual exacerbation or PME, the worsening of anxiety or mood disorders around menses—and premenstrual dysphoric disorder, or PMDD, a more severe, emotionally symptomatic PMS. SSRIs are effective in treating the mood, irritability, and anxiety symptoms that make PMS so, well, irritating. They can be taken every day for two weeks before your period, all month long, with a dosage increase premenstrually, as found to be most helpful to you.
- Benzodiazepines: Before SSRIs existed, benzodiazepines, or the Xanax, Ativan, and Valium class of drugs, were standard care for PMS. They’re not perfect; we know they can be addictive. They also depress the nervous system, which means they help anxiety and irritability but can worsen mood. Still, they provide a great adjunct for occasional use and are also helpful in treating sleep disturbances accompanying PMS.
- Other medications used for PMS include drugs that suppress ovulation, like birth control pills (OCPs), and more. However, women with more symptomatic PMS often find OCPs exacerbate mood or anxiety symptoms and are not helpful.
Although we know a lot about PMS and women’s reproductive mental health, there is still a lot we don’t know. If you’re struggling, know you are not alone and can find a clinician who specializes in menstrual mood and anxiety disorders. You can start with your primary care provider or OB-GYN and go from there. Keep asking until you find the answers and strategies you need. This is all about you.
