Anxiety Before a Period: Why It Happens & How to Manage

What Causes Anxiety Before a Period?

Hormonal changes play a significant role in causing anxiety before a period. Estrogen and progesterone levels fluctuate throughout the menstrual cycle, disrupting mood and anxiety levels. During the premenstrual phase, a decrease in estrogen and an increase in progesterone can lead to heightened anxiety symptoms. These hormonal shifts influence neurotransmitters like serotonin, impacting mood regulation and contributing to anxiety in women before their period.

One study found that the COVID-19 pandemic affected women’s menstrual cycles and anxiety levels. They found that when women felt more stressed, their anxiety increased, and their menstrual symptoms got worse. They also noticed that women’s periods became shorter, and they used fewer pads during the day. This shows stress can worsen premenstrual symptoms and change how long periods last.¹

Is PMS Anxiety Normal?

Experiencing anxiety symptoms before your period is common for many people; however, it is not normal. This phenomenon is often referred to as premenstrual syndrome (PMS) anxiety. Hormonal fluctuations, particularly changes in estrogen and progesterone levels, can contribute to increased anxiety during the premenstrual phase. While PMS anxiety is common, it’s important to monitor its severity and impact on daily functioning.

Severe PMS symptoms, known as dysphoric symptoms, may require treatment. Some dysphoric PMS symptoms include depression, anxiety, irritability, difficulty concentrating, increased appetite, and reduced pleasure in activities. Statistics show that between 3% and 9% of women seek treatment for dysphoric PMS, indicating that while it affects a significant number of women, it’s not a normal part of the menstrual cycle for everyone.²

Risk Factors of Having Anxiety Before a Period

Several factors can increase the risk of experiencing anxiety before a period. Hormonal fluctuations, such as imbalances in estrogen and progesterone levels, play a significant role. Additionally, lifestyle factors like inadequate sleep, poor nutrition, and high stress levels can exacerbate premenstrual anxiety.

Research also suggests anxiety is genetic. One study showed that genes are responsible for around 26% of the risk for lifetime anxiety disorders and 31% for current anxiety symptoms. Scientists also found new genetic markers linked to anxiety.³ Anxiety also shares genetic ties with depression and insomnia, which can also impact premenstrual anxiety.

Can Anxiety Before a Period Be a Sign of Something Else?

While anxiety before a period is a common occurrence for many individuals, severe symptoms may indicate underlying conditions such as premenstrual dysphoric disorder (PMDD) or premenstrual exacerbation (PME) of an existing anxiety disorder. Some existing disorders that can be impacted by the menstrual cycle include generalized anxiety disorder, mood disorders, panic disorder, and post-traumatic stress disorder.

Severe anxiety before a period can be a sign of:

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe and debilitating form of premenstrual syndrome (PMS) that affects 3-8% of women.⁴ Unlike typical premenstrual anxiety, PMDD symptoms are far more intense and can significantly disrupt daily functioning. Individuals with PMDD may experience severe mood swings, intense irritability, extreme fatigue, and heightened anxiety, among other symptoms.

These symptoms typically occur in the week or two before menstruation and improve shortly after the onset of the menstrual period. Unlike typical PMS, PMDD symptoms can significantly impair a person’s ability to function at work, school, or in their relationships, highlighting the need for professional diagnosis and management.

Premenstrual Exacerbation

Premenstrual exacerbation (PME) refers to the worsening of existing mental health disorders during the premenstrual phase of the menstrual cycle. Approximately 60% of women with a mental health diagnosis report an increase in their symptoms as a result of menstruation.⁵ Individuals with PME may experience heightened anxiety, panic attacks, or other symptoms related to their underlying anxiety disorder, exacerbated by hormonal fluctuations before menstruation.

Hormonal Imbalance Disorders

Hormonal imbalance disorders, such as thyroid disorders and polycystic ovary syndrome (PCOS), can manifest symptoms similar to premenstrual anxiety. Thyroid disorders, such as hypothyroidism or hyperthyroidism, can disrupt hormone levels and affect mood regulation, leading to symptoms like anxiety, irritability, and mood swings.

Similarly, PCOS, a hormonal disorder common among women of reproductive age, can cause hormonal imbalances, leading to symptoms like anxiety, depression, and mood disturbances, which may exacerbate during the premenstrual phase. Proper diagnosis and management of these hormonal imbalance disorders are crucial in addressing symptoms of anxiety and improving overall well-being.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry or anxiety about various aspects of life, including health, work, relationships, and everyday situations. Individuals with GAD may experience heightened anxiety symptoms that persist beyond the premenstrual phase, indicating a separate underlying anxiety disorder. While premenstrual anxiety is common, the presence of ongoing anxiety symptoms that significantly interfere with daily functioning may warrant further evaluation.

Panic Disorder

Panic disorder can significantly impact someone’s anxiety before their period, exacerbating symptoms and making the premenstrual phase even more challenging to navigate. Individuals with panic disorder experience recurrent and unexpected panic attacks, which are sudden and intense episodes of fear or discomfort. These panic attacks can be triggered by various factors, including hormonal fluctuations associated with the menstrual cycle and the anticipation of premenstrual symptoms.

Mood Disorder

Mood disorders, such as depression and bipolar disorder, can significantly impact someone’s anxiety before their period, potentially exacerbating premenstrual symptoms and increasing overall distress. These disorders involve disruptions in mood regulation, which can interact with hormonal fluctuations during the menstrual cycle to intensify anxiety symptoms.

In individuals with depression, premenstrual hormonal changes may exacerbate existing feelings of sadness, hopelessness, and worthlessness, leading to heightened anxiety levels.  Similarly, those with bipolar disorder may experience fluctuations in mood during the premenstrual phase, including periods of elevated mood (mania or hypomania) in addition to depressive episodes.

PTSD

Post-Traumatic Stress Disorder (PTSD) following a traumatic birth or sexual assault can significantly impact someone’s anxiety before their period, highlighting the emotional distress and increasing premenstrual symptoms. Traumatic birth experiences, such as complications during delivery, emergency procedures, hemorrhage, or perceived loss of control, can leave lasting psychological scars, leading to symptoms characteristic of PTSD.

During the premenstrual phase, hormonal fluctuations can act as triggers, intensifying PTSD symptoms in individuals who have experienced a traumatic birth or sexual assault. The anticipation of menstruation may evoke memories or reminders of the traumatic event, increasing feelings of anxiety, hypervigilance, and distress. Additionally, the physical discomfort and hormonal changes associated with menstruation can further exacerbate emotional sensitivity and trigger PTSD symptoms.

How to Manage Anxiety Before a Period

Managing premenstrual anxiety involves using techniques like deep breathing, mindfulness, and relaxation exercises to calm the mind and body. Regular exercise, a healthy diet, and enough sleep can also help. Seeking support from loved ones or mental health professionals is important for finding coping strategies and personalized guidance to manage premenstrual anxiety effectively.

Here are 7 ways to manage anxiety before a period:

1. Try Relaxation Techniques & Mindfulness

Relaxation techniques, including grounding exercises, meditation, and mindfulness, are highly effective in managing anxiety before a period. Grounding techniques for anxiety involve focusing on sensory experiences to anchor yourself in the present moment. Meditation for anxiety encourages a calm and centered state of mind, increasing relaxation and reducing the impact of stress. Mindfulness in managing anxiety encourages non-judgmental awareness of thoughts and emotions, empowering individuals to observe and respond to anxiety triggers with greater ease.

To incorporate these practices into daily routines, consider setting aside dedicated time each day for relaxation exercises. Start with short sessions and gradually increase duration as you become more comfortable. Experiment with different techniques to find what resonates best with you. Additionally, integrate mindfulness into everyday activities such as eating, walking, or commuting by focusing on your senses and surroundings.

2. Incorporate Daily Exercise

Daily exercise reduces anxiety symptoms by promoting the release of endorphins, which are natural mood lifters, and decreasing levels of stress hormones like cortisol. Regular physical activity also helps improve sleep quality, boost self-esteem, and provide a healthy outlet for stress and tension.

During the premenstrual phase, low-impact exercises such as yoga, swimming, or walking can be particularly beneficial as they help to alleviate physical discomfort and promote relaxation. Incorporating activities that focus on breathwork and gentle movements can further enhance the calming effects of exercise, making it an effective strategy for managing anxiety before your period.

3. Make Changes to Diet

Making changes to your diet can play a significant role in managing premenstrual anxiety. Opting for a balanced diet rich in whole foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats can provide essential nutrients that support mood regulation and reduce anxiety symptoms. Incorporating foods high in omega-3 fatty acids, such as salmon, flaxseeds, and walnuts, can help reduce inflammation and promote brain health, potentially alleviating anxiety.

Additionally, consuming complex carbohydrates like whole grains and legumes can help stabilize blood sugar levels and enhance serotonin production, contributing to a more stable mood. Limiting intake of caffeine, alcohol, and processed foods, which can exacerbate anxiety symptoms, is also advisable. By making mindful dietary choices, you can better manage premenstrual anxiety and support overall mental well-being.

4. Improve Sleep Hygiene

Good sleep hygiene is essential for managing premenstrual anxiety, as adequate sleep plays a crucial role in regulating mood and reducing stress. Establishing a consistent sleep schedule, avoiding stimulants like caffeine and electronic devices before bedtime, and creating a comfortable sleep environment can promote better sleep quality.

Practicing relaxation techniques such as deep breathing or gentle stretching before bed can also help calm the mind and prepare the body for sleep. Prioritizing sleep hygiene habits can contribute to more restful nights and reduce the impact of premenstrual anxiety on overall well-being.

5. Begin Therapy

Beginning therapy by finding a therapist who specializes in perinatal mental health and anxiety can be a valuable step in managing premenstrual anxiety. A therapist with expertise in anxiety disorders and women’s health can provide tailored treatment strategies, such as cognitive-behavioral therapy (CBT), to help individuals identify and challenge negative thought patterns and develop effective coping skills.

Additionally, therapy offers a safe and supportive space for exploring underlying factors contributing to premenstrual anxiety and developing personalized strategies for managing symptoms effectively. Seeking therapy can empower individuals to better understand and navigate their anxiety before their period, leading to improved overall well-being.

Effective treatment options for anxiety include:

• Cognitive behavioral therapy (CBT): CBT for anxiety helps individuals identify and challenge negative thought patterns and behaviors contributing to anxiety. It also teaches practical coping strategies to manage premenstrual symptoms effectively.
• Exposure therapy: Exposure therapy for anxiety  gradually exposing individuals to feared situations or stimuli in a controlled and safe environment. Through repeated exposure, individuals learn to confront and tolerate their fears, leading to reduced anxiety and increased confidence in managing anxiety-provoking situations.
• Acceptance and commitment therapy (ACT): ACT for anxiety focuses on accepting uncomfortable thoughts and feelings while committing to actions aligned with personal values. It can help individuals develop psychological flexibility and resilience in managing premenstrual anxiety
• Medications: Medications for anxiety typically include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as benzodiazepines. SSRIs and SNRIs work by increasing the levels of neurotransmitters like serotonin and norepinephrine in the brain, which helps regulate mood and reduce anxiety symptoms over time. Benzodiazepines, on the other hand, work quickly to calm the nervous system by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA), leading to relaxation and reduced anxiety. However, benzodiazepines are typically prescribed for short-term use due to their potential for tolerance, dependence, and withdrawal symptoms.
• Mindfulness-Based Stress Reduction (MBSR): MBSR involves mindfulness meditation, yoga, and mindfulness techniques to cultivate present-moment awareness and reduce stress and anxiety related to premenstrual symptoms.
• Interpersonal Therapy (IPT): IPT focuses on improving interpersonal relationships and communication skills, which can be particularly beneficial for addressing relationship-related stressors that contribute to premenstrual anxiety.

6. Consider Medication

Considering medication for managing anxiety before a period can be an option for some individuals, particularly if symptoms are severe or significantly impacting daily functioning. Medications such as antidepressants or anxiolytics may help alleviate premenstrual anxiety symptoms by regulating neurotransmitter levels in the brain. However, it’s crucial to consult with a healthcare provider to discuss medication’s potential benefits, risks, and adverse effects and develop a personalized treatment plan tailored to individual needs and preferences.

7. Track your cycle

Tracking your menstrual cycle can help manage anxiety before your period by providing insight into patterns and anticipating premenstrual symptoms. By keeping track of your cycle, you can identify when you’re approaching the premenstrual phase and prepare accordingly. This proactive approach allows you to implement coping strategies, such as practicing relaxation techniques or seeking additional support, before anxiety symptoms escalate.

Additionally, tracking your cycle enables you to recognize any changes or trends in anxiety levels across different menstrual cycles, empowering you to better manage and address premenstrual anxiety over time. Overall, cycle tracking fosters a sense of control and predictability, reducing uncertainty and anxiety associated with the menstrual cycle.

Is There a Way to Prevent Anxiety Before a Period?

While it may not be possible to prevent anxiety before a period completely, adopting certain lifestyle adjustments and coping strategies can help manage symptoms effectively. Maintaining a balanced diet, exercising regularly, practicing stress management techniques such as mindfulness or deep breathing, and ensuring adequate sleep can reduce premenstrual anxiety.

Additionally, some individuals may benefit from the use of supplements or medications prescribed by a healthcare provider to regulate hormonal fluctuations or manage anxiety symptoms. By incorporating these preventive measures into your routine, you can minimize the impact of premenstrual anxiety and enhance overall well-being.

Should I See a Doctor About Anxiety Before a Period?

If premenstrual anxiety significantly interferes with your daily life or persists despite trying self-help strategies, it’s advisable to seek medical advice. Symptoms such as intense anxiety, panic attacks, severe mood swings, or difficulty functioning may indicate an underlying condition like premenstrual dysphoric disorder (PMDD) or generalized anxiety disorder (GAD). During a consultation, a healthcare provider will conduct a thorough evaluation, which may include discussing your symptoms, medical history, and menstrual cycle patterns.

How to Find Professional Support

Finding professional support for anxiety can begin by asking for recommendations from your primary care physician, friends, or family members. Online therapist directories or therapy platforms for anxiety offer convenient ways to search for licensed therapists specializing in anxiety treatment and women’s health. These platforms provide options for scheduling appointments, communicating with therapists, and accessing therapy sessions from your home. For medication management, online psychiatrist options can be viable, allowing individuals to receive prescriptions and ongoing monitoring of medication effectiveness through virtual consultations.