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Imagine this: You are having a perfect day when, out of nowhere, your heart suddenly starts racing, your brain feels blank, and your mind wanders off to dark places. Confused, you try to make sense of where this sudden prickly feeling and the associated sense of doom is coming from, only to realize that you are due to start menstruating in a couple of days.

Do not worry; you are certainly not losing your grip. What you are experiencing is anxiety due to your hormones going into a frenzy, thanks to your upcoming period. Is it normal? Yes. Is it pleasant? Absolutely not.

Let’s discuss more about why you experience anxiety during period and how you can manage it in the best possible way.

The exact cause of PMS anxiety is yet to be understood, but experts believe it to be a combination of various psychological, lifestyle, and hormonal factors. Let’s look at these critical contributors one by one:

Hormonal Fluctuations

The menstrual cycle triggers a complex series of hormonal changes, especially in estrogen and progesterone levels. When your body is in the luteal phase, between ovulation and the beginning of menstruation, progesterone increases while estrogen fluctuates, affecting the neurotransmitters in the brain. These neurotransmitter changes, in turn, affect your mood, making you anxious and stressed. [1]

Neurotransmitter Imbalances

Serotonin, a natural neurotransmitter, helps regulate mood in daily life. Its low levels, secondary to hormonal changes during the menstrual cycle, can potentially make you anxious. GABA, another mood-regulating brain chemical, also fluctuates before and during menstruation, contributing more to your anxiety.

Psychological Factors

A previous history of depression or stress or even having a negative attitude toward menstruation can make you anxious before period.

Lifestyle Factors

Poor dietary habits, inadequate sleep, heightened stress levels, lack of exercise, and other lifestyle factors also contribute to PMS anxiety. These factors negatively impact your overall well-being, making it difficult for you to cope with hormonal changes and the consequent anxiety.

Premenstrual anxiety can have variable manifestations, and the severity can be different for different women. Some common symptoms include the following:

  • Restlessness: You find it hard to sit still or relax
  • Excessive worry: You take a lot of stress about personal relationships, current tasks, or future events.
  • Sleep disturbances: You find it hard to fall and maintain sleep.
  • Irritability: You become easily frustrated and annoyed.
  • Poor concentration: You need help to make decisions or focus on ongoing tasks.
  • Physical symptoms: You complain of fatigue, muscle tension, and headaches.

It is not uncommon for the symptoms mentioned above to overlap with those of other psychiatric conditions, such as major depressive disorder or generalized anxiety disorder. Hence, getting a proper diagnosis from a professional is essential.

If you have been struggling with anxiety close to your menstrual dates every month, consider checking if it is a symptom of a bigger problem. Experiencing severe premenstrual anxiety can often be a part of a medical condition, such as premenstrual exacerbation or premenstrual dysphoric disorder.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a type of mood disorder affecting up to 5 percent of menstruating women. The symptoms can become severe enough to interfere with daily living and may include one or more of the following: [2]

Feeling on the edge

  • Severe anger and irritability affecting relationships
  • Feeling anxious and tense
  • Despair, hopelessness, and sadness
  • Frequent crying and other mood swings
  • A feeling that you are out of control
  • Sleeping issues
  • Excessive food cravings, sometimes leading to binge eating
  • Poor focus/ trouble thinking
  • Low energy and fatigue
  • Physical symptoms, such as breast tenderness, muscle and joint pain, headaches, and bloating

PMDD is common in women with pre-existing mental health disorders or a positive family history. Evaluate if you have either of these and the symptoms mentioned above.

Premenstrual Exacerbation

PME and PMDD share a close relationship. It signifies an exacerbation of a pre-existing mental health issue, such as generalized anxiety disorder, during the luteal phase of your period. The difference between PME and PMDD is if you have the former, you will suffer from ongoing symptoms all month with their acute exacerbation before your period dates. PMDD, however, only happens a few days before the period and resolves shortly after.

The management of anxiety before or during period requires a multifaceted approach.

Lifestyle and Dietary Tweaks

One of the critical areas to focus on is diet and lifestyle. Consider the following tips to adjust your lifestyle for better control of your PMS symptoms, such as anxiety:

  • Exercise regularly: Physical activity has been proven to be a powerful tool to keep anxiety under control. When you work out, your brain triggers the release of endorphins, tiny chemicals that act as natural mood lifters and anxiety busters. Engage in regular aerobic activities, such as swimming, running, and walking, to manage anxiety and boost overall mental health. Set the target of getting 30 minutes of exercise three to four times weekly. [3]
  • Eat a balanced diet: Eating a balanced diet with the right amounts of all macro- and micronutrients can help you ease anxiety before period. Ensure you eat enough complex carbohydrates, such as fruits, vegetables, and whole grains, to stabilize your blood sugar and elevate your mood. Flaxseed, walnuts, and salmon are good additions as they are rich in omega-3 fatty acids to support brain health. While you are adding healthy items to your daily menu, avoid sugar, alcohol, and caffeine as much as possible, as they can feed your PMS anxiety.
  • Stay well hydrated: Hydration is one of the most important aspects of good health. While you may not feel the importance of drinking water in your routine, a lack of hydration can mess with your physical and mental health, causing irritability, mood swings, and confusion, which may worsen your underlying anxiety. Aim to drink 6 to 8 glasses of water to maintain a good water level in the body.

Stress Reduction Techniques

Incorporating simple stress reduction techniques into your daily life, especially before your period, can help you cut down your anxiety levels. Below are some practices to engage in:

  • Go for meditation & mindfulness: Mindfulness practices, for example, meditation, have been proven to significantly reduce anxiety regardless of what’s triggering it. Practice progressive muscle relaxation, guided imagery, and deep breathing to calm your mind. Even if you engage in these practices for only a few minutes daily, the effects can be immense. [4]
  • Practice yoga: Yoga combines the benefits of meditation and breathing exercises to beat anxiety before and during periods. Focus on specific poses, such as forward bends, as they are highly stimulating and calm your mind.
  • Work on your sleeping schedule: Sleep is crucial to your emotional and mental well-being. Aim to get 6 to 8 hours of sleep every night to give your mind enough time to rejuvenate and equip itself to fight anxiety in a better way.

Cognitive and Behavioral Strategies

Consider the following cognitive and behavioral solutions for PMS anxiety management:

  • Enroll in CBT: Cognitive behavioral therapy, or CBT, is a proven treatment for anxiety and other similar psychiatric disorders. The technique involves identifying negative thought patterns and behaviors and challenging them under the supervision of a therapist. It also equips you with healthy coping strategies when you are particularly anxious before a period. [5]
  • Improve your time management: Plan and organize your tasks well ahead to avoid being overwhelmed. Living a structured life by prioritizing essential tasks and breaking them into more manageable steps can reduce your anxiety levels.
  • Start journaling: Fix a routine to pen down your feelings and thoughts in a personal journal to manage your anxiety. This free flow of emotions can also let you identify stress-related patterns and triggers that you can focus on as a part of management.

Herbal and Medical Solutions

In addition to making tweaks in your daily life, try the following medical and herbal solutions after consulting with a doctor:

  • Consider hormonal birth control: Hormonal birth control pills can control anxiety during period by regulating hormonal fluctuations. It is a prescription-only solution and may not be suitable for everyone.
  • Try antidepressants: Antidepressant medications, such as selective serotonin reuptake inhibitors, can manage severe PMS symptoms by stabilizing mood and reducing anxiety levels.
  • Use herbal supplements: Chasteberry, St. John’s Wort, evening primrose oil, and other herbal supplements are famous for controlling many PMS symptoms, such as anxiety. However, before you try any of these, talk to a doctor, especially if you already take any medication. Many of these supplements can cross-react with certain drugs and cause side effects.

Self-Care and Relaxation

Remember to take time for self-care while setting healthy menus and exercising in the gym. PMS anxiety or not, self-care is essential, particularly for your mental health. Follow the tips below to pay attention to yourself and relax your mind.

  • Do something you enjoy: Fix some time to do anything you truly enjoy. It can be anything, such as taking a hot shower, reading your favorite book, watching a TV show, or even adopting a new hobby. The aim is to boost your happiness levels and keep anxiety under control.
  • Aromatherapy: Use the calming benefits of essential oils, such as chamomile, bergamot, and lavender, to relax your mind and body and ease anxiety during period. Add a few drops of your favorite essential oil into a diffuser or a hot bath, sit back, and relax.
  • Acupuncture and massage: Both massage and acupuncture can reduce anxiety and stress levels by relaxing the nerves. Ensure to include them in your self-care plan if you regularly feel anxious before period. [6]

Counseling and Professional Help

While self-management is essential when it comes to keeping anxiety during periods under control, the role of counseling and professional treatment cannot be undermined. If you believe you need extra support on top of what you are already doing in daily life, do not hesitate to follow the tips mentioned below:

  • Join a support group: Find a local group that supports people with PMS anxiety. Such groups serve as a platform to meet other people fighting similar issues so that you can mutually support each other. You can find these groups in person or online.
  • Go for professional counseling: Find a local therapist or counselor to get additional support and guidance about managing anxiety during period. Therapy provides you with a safe space to reflect on your emotions and feelings while creating a personalized plan to manage high anxiety levels.
  • Communicate with loved ones: Therapy is not the only way to release your emotions and stress. Share your feelings and experiences with trusted family members and friends to alleviate the anxiety burden. This open communication mentally relieves you and fosters support and understanding.

Premenstrual anxiety is a common issue, with thousands of women facing it every month. While the condition is manageable with self-care tips and lifestyle management, do not hesitate to seek medical help if it interrupts your daily life.

Not sure if it is the right time to speak to a doctor about your anxiety? Following are some signs to look out for.

  • Severe symptoms: If your PMS anxiety is causing severe or overwhelming symptoms, talk to a doctor.
  • Impact on life: If your PMS anxiety is interfering with your academics, relationships, or work, consider getting help.
  • Regular mood swings: Experiencing severe mood swings, mainly when they include depression or thoughts of self-harm, is a solid indication to contact a medical professional for help.
  • No improvement: If you have strictly followed all self-help strategies but fail to notice any improvements in symptoms, seek advice from a medical professional about what else to do.

A healthcare professional will conduct a thorough history-taking session and a physical evaluation. Once they establish a diagnosis, you can seek appropriate treatment options to start working on healing.

As common as it sounds, PMS anxiety or anxiety before or during your period can be pretty debilitating. Fortunately, it remains manageable mainly with simple yet effective remedies and treatments. Understanding the causes and symptoms of this issue is the first step in keeping the problem under control.

So exercise every day, watch what you eat, and do not hesitate to seek medical help whenever you feel necessary. Help is available at every step!

[1] Gudipally PR, Sharma GK. Premenstrual syndrome.

[2] Mishra S, Elliott H, Marwaha R. Premenstrual dysphoric disorder.

[3] Aganoff JA, Boyle GJ. Aerobic exercise, mood states and menstrual cycle symptoms. Journal of psychosomatic research. 1994 Apr 1;38(3):183-92.

[4] Lustyk MK, Gerrish WG, Douglas H, Bowen S, Marlatt GA. Relationships among premenstrual symptom reports, menstrual attitudes, and mindfulness. Mindfulness. 2011 Mar;2:37-48.

[5] IZADI MM, DAVOUDI I, MEHRABIZADEH M. Effect of group cognitive-behavioral therapy on health-related quality of life in females with premenstrual syndrome.

[6] Armour M, Ee CC, Hao J, Wilson TM, Yao SS, Smith CA. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database of Systematic Reviews. 2018(8).

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