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For Women, the Timing of Symptoms Can be Important


Many women experience changes affecting mood, behavior and quality of life associated with menstrual cycle fluctuations. Those changes can range from very mild to severe and limiting.


Premenstrual dysphoric disorder (PMDD) affects an estimated 2 to 6 percent of women of reproductive age. PMDD is associated with significant symptoms of depressed mood, irritability and mood swings, in the week prior to menstruation. Symptoms can also include feelings of hopelessness, anxiety or tension, changes in appetite, trouble sleeping or sleeping too much, or difficulty concentrating. These symptoms are severe enough to disrupt daily life and cause problems in relationships, at work or in social function. The symptoms start to improve within a few days of the start of menstruation. A less severe but more common form of the condition is referred to as premenstrual syndrome.

Women can also experience worsening of existing physical and mental conditions in the week prior to their menstrual cycle, referred to premenstrual exacerbation of a mental or medical disorder.

Conditions including migraines, asthma, allergies, and seizure disorders can worsen in the week prior to menstruation. Mental health conditions, such as depression and bipolar disorder, anxiety disorders and eating disorders, can also worsen before menstruation.

An estimated 40 percent of women who seek treatment for PMDD actually have an underlying mood disorder that is exacerbated prior to menstruation, and not PMDD.

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“Women are twice as likely as men to experience a mood disorder, and they experience considerably higher levels of disability due to depression, anxiety, and somatic complaints. Some of what they experience may be due to reproductive hormonal variations during the course of the menstrual cycle,” Laura G. Leahy, Dr.N.P., A.P.R.N., a family psychiatric advanced practice nurse at APNSolutions, wrote in a recent column in APA’s Psychiatric News PsychoPharm. Identifying and understanding the influence of these fluctuations can be important in diagnosing mental health conditions and getting the right treatment.

Daily tracking moods and symptoms can helpful in identifying the relationship between cycles and mood changes and even anticipating days of worsening, according to the Center for Women’s Health at Massachusetts General Hospital.

Leahy suggests a number of helpful strategies for women with PMDD and for women with premenstrual exacerbations, such as calcium and magnesium supplements, exercise, herbal formulations, cognitive-behavioral strategies, and light therapy. Leahy also suggests medication changes could help, such as changes in the dose of oral contraceptives or, for those on medication for an existing mental health condition, altering the dose of medication for a short time before menstruation.

The Center for Women’s Mental Health also suggests several lifestyle changes that may help, such as decreasing use of caffeine, sugar and alcohol, getting aerobic exercise and getting enough sleep.

Many women may not be aware of the influence of the cycle on their mental health and doctors often don’t ask. Leahy suggests that for women with psychiatric illness, it’s important to thoroughly explore abrupt symptom changes and their timing in relation to their cycles.

References and Resources


AnxietyBipolar DisordersDepressionPatients and FamiliesHoarding DisorderOCDEating DisordersAddictionPTSD


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