Why is it that people around us can tell when it’s “that time of the month?” Do we look different, smell different, act different or what? If we took a poll and asked people the answer to that question most would respond: SHE ACTS DIFFERENTLY. Ever wondered why that is or what is actually happening during this time? No, your body has not been taken over by “Body Snatchers” and invaded by an alien. Most women admit they don’t feel like their usual selves and feel as though they are someone else. They don’t like what they are feeling, but still can’t seem to stop the behavior or outbursts. Why is that?
Let’s talk a little anatomy and physiology. Yeah, we had to learn it, but I’m going to give you the Cliff Notes. An average menstrual cycle is 21-30 days. Most fall in the average of 28 days with two phases: follicular and luteal. During the first or follicular part of the cycle, the follicle or egg starts to develop and the uterine lining grows anticipating implantation. The second phase or luteal phase is when the egg is released or ovulated. If the stars are in alignment, the egg and sperm meet and become one, traveling down the yellow brick road to the uterus where implantation occurs. 9 months later, you get a baby!
Both of these phases are controlled by a combination of Estrogen, Progesterone or Testosterone. Most problems with bleeding, mood, irregular cycles, infertility, no cycles, can be traced back to problems with the levels of your hormones. However, we commonly associate our moods to that time of the month. So what’s really going on here?
There is a condition we know as PMS (premenstrual syndrome) and PMDD or premenstrual dysphoric disorder. Most women are familiar with PMS. PMDD is a more serious form of PMS. Both are characterized by symptoms that usually occur 7 to 10 days before the start of the menstrual cycle and a few days when it starts. Women feel bloated, have mood changes, breast tenderness, fatigue, sleep changes such as insomnia and eating changes. You are not alone when you feel like you just got to have some chocolate or CARBS! Physical symptoms may also include joint or muscle pain, headache, weight gain due to fluid retention, acne and changes in bowel habits such as constipation or diarrhea.
Mood changes are common and no doubt is what puts folks on alert that your cycle is coming. The mood changes may be irritability, labile moods,
sadness, anxiety, depression, anger or any combination of these. These changes are occurring in most instances during the luteal phase when the predominant hormone is progesterone. Hence why some women will get relief with the use of progesterone supplements during this time.
Sadness, feeling down, overall dysphoria and even depressed moods can be related to hormones or low levels of serotonin. Serotonin is a neurotransmitter released in the brain. Low levels of serotonin may be associated with dysphoria, sadness or depression, so we can use supplements such as St. John’s Wort and SSRI’s. SSRIs or selective serotonin uptake inhibitors are a class of meds which make serotonin last longer.
Common medications in this class are Prozac, Zoloft, Effexor, Lexapro, Celexa, etc. A common one is Serafim or Prozac, dosed in smaller amounts than what is used for depression and has been very helpful with the control of mood swings and premenstrual emotions. There is help. SSRIs, progesterone creams and even birth control pills can regulate the imbalance. St John’s Wort, Chasteberry and essential oils all may be helpful, and exercise is always beneficial. For those who become totally debilitated by this time of the month, PMDD is the likely diagnosis and a combination of natural supplements, antidepressants, exercise and meditation may prove helpful.
Anxiety or anxiousness is normally felt by everyone at some point. However, when anxiety interferes with the ability to lead a normal life, it may become necessary to seek professional help. Anxiety may present as panic, phobias or fears, or social anxiety. Anxiety which is debilitating and paralyzing is a mental illness and requires further diagnosis. Anxiety associated with PMS or PMDD is short lived and not as overwhelming as it resolves itself after the menstrual cycle starts. Anxiety may present as feelings of fear, problems sleeping, cold or sweaty hands, shortness of breath, heart palpitations, dry mouth, inability to be still and calm, numbness or tingling in the hands or feet, nausea, muscle tension and dizziness. Triggers for anxiety may be caffeinated beverages such as energy drinks, coffee, tea, or chocolate.
So now you know there is no NEON sign flashing DANGER AHEAD! To know is to be forewarned. Speak with your healthcare provider for help and further recommendations.
Dr. Gloria Ivey-Crowe
Women Physicians of Northern Virginia