You don't have to live with the emotional turmoil that PMS mood swings can bring. Instead, find relief through certain lifestyle changes and medications.

1. Mood Swings: PMS and Your
Emotional Health
 By Jan Sheehan |Medically reviewed by Pat F. Bass III, MD, MPH
You don't have to live with the emotional turmoil that PMS mood
swings can bring. Instead, find relief through certain lifestyle
changes and medications.
Premenstrual syndrome (PMS) affects a high percentage of
women of childbearing age, with many women feeling mood
changes in the days before menstruation. And while menstrual
symptoms like irritability, anger, and mood swings are a monthly
bother for most women, severe PMS can be emotionally
debilitating for some. Fortunately, treating PMS with medication
and lifestyle changes can help women control mood changes
and other emotional difficulties.
A Roller Coaster of Emotions
PMS can cause wild, uncontrollable mood swings in some
women, who may go from crying spells to angry outbursts and
anxiety attacks, then back to a stable emotional state — all in
one day.
“You’ll know these emotional ups and downs are due to PMS if
they start consistently a week to two weeks before your period
and stop a day or two after menstruation starts,” says New York
City gynecologist and fellow of the American College of
Obstetricians and Gynecologists, Carol Livoti, MD.PMS
symptoms, including mood swings, occur during the last (luteal)
phase of the menstrual cycle, which starts after ovulation —
typically day 14 to 28 of a woman’s monthly cycle. Once
menstruation starts, mood swings usually disappear.
The most common emotional PMS symptoms are:

2.  Irritability
 Anger
 Depression
 Crying
 Oversensitivity
 Feeling nervous and anxious
 Alternating sadness and rage
Getting to the Root of PMS Mood Swings
Although researchers don’t know exactly why PMS strikes,
these emotional disturbances are thought to be connected to the
rise and fall of hormones, specifically estrogen, throughout the
menstrual cycle. Estrogen levels begin to rise slowly just after a
women’s period ends, and it peak two weeks later. “Then
estrogen levels drop like a rock and begin rising slowly before
dropping again just before menstruation starts,” explains Livoti.
These hormonal peaks and valleys are thought to cause mood
swings and other menstrual symptoms.
“Stressful situations, such as a divorce or job loss, don’t cause
PMS, but they can make it worse,” adds Livoti. Some research
suggests that female hormones interact with brain chemicals in
a way that can affect mood in those with PMS. “Reduced levels
of estrogen during the luteal phase of the cycle could possibly
cause a drop in serotonin, although more research needs to be
done to confirm this link,” says Livoti. Lower serotonin levels are
associated with depression, irritability, and carbohydrate
cravings, all of which can be PMS symptoms.
Severe PMS: Beyond Run-Of-The-Mill Mood Swings
Between 3 and 8 percent of menstruating women have an even
more severe condition called premenstrual dysphoric disorder
(PMDD). These women become seriously depressed a week or
two before their periods. “With PMDD, major depression and
extreme irritation are the foremost symptoms,” says Livoti. “PMS

3. is milder and usually involves physical menstrual symptoms, as
well as emotional ones.”
Women with a family history of depression or who have
previously experienced postpartum depression are at increased
risk for PMDD, which is included on the American Psychiatric
Association’s list of mental illnesses (the Diagnostic and
Statistical Manual of Mental Disorders). To be diagnosed with
PMDD, a woman must have at least five of the following
symptoms around the time of her period:
 Deep sadness or despair, with possible suicidal thoughts
 Lasting irritability and anger, which may include frequent
outbursts at loved ones
 Feelings of tension or anxiety
 Panic attacks
 Mood swings
 Crying
 Disinterest in daily activities and relationships
 Trouble thinking or focusing
 Feeling out of control or overwhelmed
 Fatigue
 Low energy
 Food cravings or binge eating
These symptoms will disappear shortly after menstruation starts.
“If they last all month, that’s not PMDD,” says Livoti. Instead,
another mental or physical illness may be the cause.
Treating PMS Symptoms, From Mild to Severe
For many women, lifestyle changes can be a successful part of
PMS treatment. For women with severe PMS, medication may
be needed. The following PMS treatment options can help
stabilize mood swings and improve a woman’s emotional health
in the weeks before menstruation:

4.  Exercise. Physical activity can lift moods and improve
depression. It’s believed that endorphins — feel-good brain
chemicals that are released during exercise — may help counteract
some of the hormone changes that may trigger severe PMS.
“Exercising can also boost energy and help with cramps and
bloating, which may help you feel better,” says Livoti. Aerobic
exercise such as walking, running, bicycling, or swimming is
recommended.
 Small, frequent meals. Eating small meals throughout the day
rather than two or three big meals may also help ease PMS
symptoms. A large meal, particularly one high in carbohydrates,
can cause blood sugar swings, which could worsen PMS. “Low
blood sugar may contribute to crying spells and irritability that are
often seen in women with severe PMS,” says Livoti. Try to eat six
small meals a day to keep your blood sugar levels steady.
 Calcium supplements. In a 2009 double-blind clinical trial of
college women with PMS, those who supplemented their diet with
500 milligrams of calcium twice daily had significantly less
depression and fatigue than those who didn’t. In fact, “a number of
studies have shown that getting plenty of calcium can help ease
mood changes related to severe PMS, although we don’t know
exactly why,” says Livoti.
 Avoid caffeine, alcohol, and sweets. Staying away from coffee
and other caffeinated drinks for two weeks before your period may
make a difference in your mood because caffeine can increase
anxiety, nervousness, and insomnia. Cutting down on alcohol may
also be helpful because alcohol acts as a depressant. And steering
clear of candy, soda, and other sugary foods, especially in the
week before your period, may help ease severe PMS symptoms by
preventing mood swings associated with blood sugar fluctuations.
 Stress management. Stress can make severe PMS symptoms
worse, so finding ways to give stress the slip can help treat PMS.
Try relaxation techniques such as meditation, deep breathing, and
yoga. Individual or group therapy has also been found to be an
effective PMS treatment for women with severe mood swings and
debilitating emotional changes.

5. Antidepressants called selective serotonin reuptake inhibitors
(SSRIs) that change serotonin levels in the brain have been shown
to be helpful for women with severe PMS and PMDD. In fact, the
U.S. Food and Drug Administration has approved three of these
medicines — Zoloft (sertraline), Prozac or Sarafem (fluoxetine), and
Paxil CR (paroxetine) — for the treatment of PMDD.
Talk to your doctor about which of these approaches might work
best for any moderate or severe emotional PMS symptoms you’re
experiencing.