Many women experience emotional changes that make them feel low during the days before their periods. In some women, these changes may be mild and transient, disappearing with the onset of a period. In other women, emotional symptoms may be severe enough to interfere with normal activities. Common symptoms are depression, anxiety, irritability and aggression, resulting in what is sometimes called the “PMS blues”.

When emotional or physical symptoms of PMS are severe, this condition is called premenstrual dysphoric disorder, or PMDD. PMDD occurs in two to ten percent of all women of reproductive age in the United States. Women with PMDD may have feelings of hopelessness and guilt and a sense of being overwhelmed. Many women with PMDD report feeling very tense and become suddenly sad or are overly sensitive to other people. These symptoms may cause them to withdraw from normal social interaction and can seriously interfere with normal activities and relationships at home and at work.

Many of the emotional symptoms of PMS experienced by women are thought to stem from the brain’s reduced ability to utilize a chemical called serotonin during the premenstrual phase. Serotonin has a mood-enhancing effect. Therefore, the mainstay of treating more severe emotional symptoms is a group of drugs called selective serotonin reuptake inhibitors, or SSRIs. These drugs act by improving the brain’s ability to utilize serotonin, thereby stabilizing a woman’s mood.

Some emotional symptoms are worsened by the effect of physical symptoms of PMS. A woman may experience pain and tiredness and not feel up to sticking to her normal exercise routine. Exercise releases natural mood-elevating and pain-relieving compounds called endorphins; less exercise means lower endorphin levels. Weight gain, bloating, and insomnia may worsen anxiety during PMS. Therefore, management of these physical symptoms through exercise, diet, and medication can help reduce emotional symptoms.