lives.
Some days you feel like a rock star. Some days you feel like a rock.
This has a lot to do with where you are in your monthly cycle.
Your mood is likely at its best during the first half of your menstrual cycle, called the follicular phase, where the ovary nurtures a developing egg. This is when estrogen levels climb and dominate progesterone levels. Estrogen helps you feel alluring, nurturing, and forgiving—all qualities that help you attract and entrance a mate, as your egg matures and becomes ready for ovulation. Because estrogen acts as a stress hormone, little difficulties slip away like water off a duck’s back. Who wouldn’t want to be with you? You’re so easy to be with!
The second half of the cycle, the luteal phase, is the two weeks between when the egg is released from the follicle and when your period starts. This is where mood complaints will occur, when progesterone dominates estrogen. Progesterone can make you feel sluggish and cranky, and it peaks at day twenty-one. Right before your period, estrogen levels drop hard and fast, and so does your goodwill toward others. If you get a little bitchy like clockwork every month, blame low estrogen and high progesterone. Welcome to PMS, premenstrual syndrome.
PMS is natural. Not fun, but normal. But in the “bible” that psychiatrists use to diagnose illness, the Diagnostic and Statistical Manual of Mental Disorders, premenstrual dysphoric disorder (PMDD), an extreme form of PMS, is listed as a pathological state, implying that it requires psychiatric treatment. Somewhere between 3 and 8 percent of women of reproductive age meet the criteria for PMDD. About 15 to 20 percent of women have horrendous PMS or none at all; the rest of us fall somewhere in between, and where we lie can shift from month to month and, more important, from menarche (the beginning of monthly periods in adolescence) to perimenopause, the two phases of our lives where PMS tends to worsen due to more erratic hormone fluctuations.
Crying at the drop of a hat, having a short fuse, feeling overwhelmed and underappreciated, craving chocolate, and not being able to get off the couch are all fair game during the days leading up to your period. Lower estrogen levels cause serotonin levels to drop precipitously a few days before menstruation, which may be the biological basis of many PMS symptoms. Low levels of serotonin are implicated in depression, panic disorder, and obsessive-compulsive disorder (OCD), so don’t be surprised if you feel a bit like a psych patient (or three) before your period starts. Less serotonin is like less insulation available to protect you from the outside world. You’re even more physically sensitive to pain than usual, and more emotionally sensitive to criticism. You’re less resilient in the face of stresses and feel sadder, hungrier, and more scared, tearful, and angsty. When you stack up PMS symptoms against those of a major depressive episode, there is a massive overlap. The big difference is that PMS goes away once your period starts. Major depression persists for weeks or months.
Typically PMS arises in the three or four days before your period starts, but a handful of my patients report their PMS symptoms starting a day or two after ovulation. They become terribly depressed, hopeless, and despairing. They get into fights more easily with family members and coworkers. They have trouble getting to sleep or staying asleep and feel bloated and crabby. A few of my patients assure me their PMS is mild, but pretty much everyone notices that “the period before their period” does bring some significant and noticeable changes in mood. Because it is perfectly normal to have mood fluctuations throughout your monthly cycles, you don’t necessarily need to medicate PMS away, but you do need to educate yourself about it. I also strongly recommend that you keep track of your cycle, jotting down when your period starts and when you ovulate. If you keep track of when certain mood symptoms occur, not only will it help you to plan your monthly calendar but it might help to keep certain family members, and maybe even coworkers, in the loop on what to expect.
Besides getting a good sense of when you’re fertile, keeping track of your cycle will give you a heads-up about when you’re going to be more emotionally sensitive and reactive. You can plan to take on more challenging assignments at the beginning of your cycle right after your period, when your resilience is higher. The peak estrogen levels seen toward the middle of your cycle mean improvement of verbal and fine motor skills, so plan your business presentations and sewing projects for that time of the month. You should definitely leave the tasks best suited to someone with OCD, like cleaning out your closets, for during the PMS part of your cycle. Also, your pain tolerance is at its lowest point during PMS. Not a great time to go to the dentist or get waxed. Schedule those appointments during the first half of your cycle.
Commonly my patients tell me that it’s easier for them to cry during the few days before their period. There is a phenomenon called rejection sensitivity that is often seen in clinically depressed patients. When your serotonin levels are bottomed out in depression, you’re more sensitive to everything, and it takes less of an insult or slight from someone for your feelings to be hurt. It’s no different in the days leading up to your period. Hurtful comments are going to hit you harder. Women cry more easily during PMS, and it’s not just the mean things that others say. There is an increased sensitivity to schmaltzy television commercials and corny country songs on the radio. If I get a lump in my throat when I see anything poignant on the streets of New York—a homeless schizophrenic rooting through the garbage, a businessman stopping to help tourists fumbling with a map—I know just where I am in my cycle.
Our emotional lives revolve around our own internal clockwork, and understanding that schedule requires attention. Keep track of when you’re horny, when you’re bitchy, when you’re flirty, and when you want to kick ass and take names. Becoming intimate with your rhythms will allow you to use natural fluctuations to your advantage, and establishing a baseline is the only way to accurately identify changes. This becomes especially important when starting or stopping a medication, especially those—such as oral contraceptives or SSRIs—that provide an unnatural stability. Their potential impact on mood, libido, and more is real, and you may find that that they’re taking more than they’re giving.
Learning from PMS
Being a crybaby is one thing, and maybe you could say that it is an endearing exacerbation of womanly empathy and vulnerability, but it hardly ends there. This increased sensitivity, especially to criticism, can cause explosive reactivity. My patients with PMS notice that they get snappy and easily irritated by things they would typically let slide the rest of the month. They become more unpredictable in their responses, and they can let loose with utterances or actions that are not in their repertoire the other three weeks of their cycle. This has to do with the frontal lobes inhibiting the emotional centers, which require solid doses of serotonin. Closer to PMS means lower serotonin levels, so for some of us, the closer we get to our periods, the more likely it is that the “bitch switch” is on. But it’s not that we’re getting upset over nothing.
We are getting upset over real things, it’s just that we usually hide our sadness and anger better. Thanks to high estrogen levels, we are usually more resilient. Breezy, even. We allow for others’ needs better and can remain detached more convincingly. Natural cycles of caring less and more correlate with our menses. A good way to think of estrogen is as the “whatever you want, honey” hormone. Estrogen creates a veil of accommodation. Designed to encourage grooming and attracting a mate, and then nurturing and nourishing our family members, estrogen is all about giving to others: keeping our kids happy and our mates satisfied. When estrogen levels drop before our periods, that veil is lifted. We are no longer alluring and fertile; we are no longer so invested in the potential
