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PMS, PMDD & anxiety - how to take care of your mental health around your period
Summary
Anxiety is one of the most common - and most misunderstood - symptoms of PMS and PMDD. Hormonal fluctuations in the luteal phase can heighten stress and fear responses, disrupt sleep and focus, and make daily life feel overwhelming. This article explores what causes PMS and PMDD-related anxiety, how it affects mood and wellbeing, and the wide range of treatment options available - from lifestyle changes and CBT to SSRIs, hormonal contraceptives, and emerging therapies.
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🌿 Key takeaways
PMS, PMDD and anxiety: what to know
- PMS anxiety is driven by hormonal fluctuations in the luteal phase - particularly changes in progesterone metabolites that affect the brain's GABA receptors
- People with PMDD show differences in grey matter structure in areas of the brain associated with negative emotion, including anxiety and depression
- Lifestyle changes - exercise, sleep, diet, yoga, nature - can meaningfully reduce anxiety severity alongside or instead of medical treatment
- SSRIs are the primary recommended treatment for PMDD and can be taken continuously or only during the luteal phase
- CBT, MBCT, reflexology, acupuncture, yoga, and CBD all have evidence for reducing PMS and PMDD-related anxiety - at varying levels of research strength
Overview of PMS and PMDD
Premenstrual syndrome (PMS) is a common condition that occurs in the second half of the menstrual cycle - the luteal phase, after ovulation and before a period. Around 75% of people who menstruate experience PMS. It is characterised by physical, psychological, and behavioural symptoms that typically disappear once a period begins - but can be severe enough to interfere with daily life, work, school, and relationships.
For around 3 to 8% of people, symptoms are severe enough to meet criteria for premenstrual dysphoric disorder (PMDD) - a type of depressive disorder. If your anxiety in the luteal phase is severe or disabling, it is worth exploring whether PMDD may be the cause.
What causes anxiety in PMS and PMDD?
The exact cause of anxiety and other mood changes in PMS and PMDD is not fully understood. There are several leading theories:
GABA receptor sensitivity
One leading theory is that PMS and PMDD are caused by individual sensitivity to oestrogen, progesterone, and their metabolites. When progesterone is broken down, a substance called allopregnanolone affects GABA receptors in the brain - receptors whose function is closely associated with emotions such as anxiety, stress, and fear. People with PMS and PMDD appear to have GABA receptors that respond differently to allopregnanolone compared to those who do not experience these conditions.
Hormonal fluctuations
A related theory suggests that anxiety and mood changes during the luteal phase are more broadly linked to fluctuating hormone levels in the luteal phase - and to individual sensitivity to those fluctuations, particularly in oestrogen and progesterone.
Brain structure differences
Research has found that people with PMDD show differences in grey matter structure in certain brain regions associated with negative emotions - including anxiety and depression. This supports the idea that PMDD is a neurobiological condition, not simply an emotional response to hormonal change.
🧠 In simple terms: PMS and PMDD anxiety is not "in your head" in the dismissive sense - it is driven by real, measurable neurobiological differences in how the brain responds to normal hormonal changes. The sensitivity is real. The anxiety is real. And it can be treated.
Effects of PMS anxiety
PMS anxiety can be hugely challenging to live with. It can make falling asleep harder, reduce concentration and productivity at work or school, and increase irritability and fatigue. Anxiety can also cause social withdrawal - which can in turn make anxiety worse, leaving people feeling isolated and lonely.
It can also contribute to tension in relationships, particularly where anxiety leads to communication difficulties or emotional withdrawal. Anxiety has also been found to exacerbate other PMS and PMDD symptoms, including headaches and cramps.
⚠️ If you need support now: If PMS or PMDD anxiety is significantly affecting your quality of life, speak to your GP. If you are experiencing suicidal thoughts, please reach out - Samaritans are available 24/7 on 116 123 (free, UK), or you can text SHOUT to 85258. If you are in immediate danger, call 999 or go to A&E.
Non-medical treatments for PMS anxiety
Many people find that general lifestyle modifications help reduce PMS and PMDD-related anxiety. These include regular exercise, balanced nutrition, adequate sleep, and active stress management. Yoga, meditation, and breathwork are particularly effective at reducing stress and anxiety levels. Spending time in nature has also been shown to have a calming effect on the mind, and talking to someone you trust can be hugely helpful.
Tracking your symptoms consistently is also valuable - both to understand your patterns and to build evidence if you later want to discuss a diagnosis with a healthcare professional.
📅 Track with Evelyn: The Evelyn Premenstrual Health Tracker - a free, printable daily log for tracking mood, anxiety, and physical symptoms across your cycle, designed to take to a GP appointment.
Medical treatments for PMS anxiety
Your GP can offer several medical treatment options for PMS and PMDD-related anxiety. Which they recommend will depend on the severity of your symptoms, your preferences, and your health history.
Combined oral contraceptives (COCs)
COCs are comprised of synthetic hormones that act like oestrogen and progesterone in the body. By controlling or suppressing the hormonal fluctuations of the cycle, they can reduce PMS and PMDD-related anxiety and other symptoms. They are most effective when taken continuously rather than cyclically - but not all pills can be taken this way, so check with your GP.
Newer-generation COCs - containing drospirenone - are more commonly prescribed as older formulations can reintroduce PMS-like symptoms due to their progesterone type. COCs can be used alone or combined with talking therapies. They are not appropriate if you are trying to conceive.
SSRIs
SSRIs are the primary recommended treatment for PMDD and can be effective in reducing PMS and PMDD-related anxiety. They can be taken continuously or only during the luteal phase - your GP will advise. Most healthcare professionals suggest a three-month trial to assess effectiveness. Side effects can include nausea, drowsiness, fatigue, reduced libido, and sweating. If you are planning to become pregnant, discuss your options with your doctor before starting SSRIs.
Emerging treatments
Because one possible driver of PMS and PMDD-related anxiety is the action of the progesterone metabolite allopregnanolone on GABA receptors, scientists are exploring novel drug therapies that target this pathway. Early evidence is promising, but more research is needed before these are available as standard treatments.
CBT and talking therapies for PMS anxiety
Cognitive Behavioural Therapy (CBT)
CBT is a type of talking therapy that can help with a wide range of mental health issues, including PMS and PMDD-related anxiety. One of its key advantages over medication is that the effects can be longer-lasting and are maintained after therapy ends. CBT is available in individual, couple-based, or group formats, and can be offered in person or online. It works by helping you identify unhelpful thought patterns and replace them with more constructive ones. Studies show CBT reduces PMS and PMDD-related anxiety and depression and improves coping ability - though research suggests it is generally more effective for psychological symptoms than physical ones.
Mindfulness-Based Cognitive Therapy (MBCT)
MBCT combines traditional CBT with mindfulness strategies. It involves learning relaxation techniques and promoting non-judgmental awareness of current emotions. Existing studies show it can reduce PMDD anxiety and improve quality of life. Further research is ongoing.
Alternative treatments for PMS anxiety
Reflexology
Reflexology originates from traditional Chinese medicine and involves stimulating specific reflex points on the hands, feet, and ears. Studies have found that it can reduce mood-related PMS and PMDD symptoms including anxiety, with longer sessions (around 60 minutes) associated with more positive effects.
Acupuncture
Acupuncture involves stimulating specific pressure points with fine needles. Existing research has found it can reduce mood-related PMS and PMDD symptoms including anxiety, though larger studies are still needed.
Yoga
Yoga promotes relaxation, body awareness, and physical health. It is thought to work by stimulating the sympathetic nervous system and regulating the release of stress hormones. Research has shown it can reduce PMS and PMDD-related anxiety, anger, irritability, and low mood, and has also been shown to improve quality of life for people with PMS and PMDD.
CBD
Researchers have begun exploring the potential of cannabidiol (CBD) to reduce PMS and PMDD-related anxiety. CBD is derived from the cannabis plant but has no psychoactive properties. It stimulates receptors that affect multiple systems in the body, including those linked to anxiety and mood. Early research suggests CBD may help reduce PMS anxiety, irritability, and stress when taken consistently over time. Research is still in early stages. Consult a healthcare professional before starting CBD if you are trying to conceive, pregnant, or breastfeeding.
⚠️ Before starting supplements: There are many supplements and vitamins reported to ease PMS symptoms. Evidence varies, and healthcare advice should always be sought before starting something new - particularly if you are already taking medication.
Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.
