Premenstrual mood symptoms, such as anxiety, can be very severe in PMDD. Here are some tips on how to manage it.

Do you notice that you’re extra anxious right before your period? This is actually quite common.

During the menstrual cycle, the levels of estrogen and progesterone in your body fluctuate. These rapid changes in hormones can affect your brain chemistry and lead to anxiety, irritability, or mood swings.

While the severity of anxiety symptoms vary from person to person, some people who menstruate find that their symptoms interfere with their daily life.

Language matters

Sex and gender exists on a spectrum. We use “women” in this article to reflect the terms assigned at birth. But your gender identity may not align with the categories and associated risk factors listed below.

Your doctor may be able to help you better understand your presentation of premenstrual mood symptoms and how your specific circumstances will translate into diagnosis and treatment.

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If you experience an increase in anxiety symptoms before your period, you’re not alone. According to a survey of 238,000 women around the world, 64.18% reported experiencing anxiety or mood swings at this time.

What causes this? 2017 research shows that toward the end of the week before your period, the luteal phase, there’s a dramatic decline in circulating levels of estradiol. Estradiol is the form of estrogen produced by the ovaries.

This drop in estradiol leads to an increase in anxiety symptoms in women with anxiety disorders as well as those with premenstrual syndrome (PMS), or its more severe form, premenstrual dysphoric disorder (PMDD).


Premenstrual syndrome (PMS) refers to a group of physical and emotional symptoms that many menstruators experience in the days or weeks leading up to their period.

During your menstrual cycle, your hormone levels fluctuate, and the changing levels of estrogen and progesterone can affect your brain chemistry. These hormonal fluctuations can lead to increased anxiety.

PMS may cause the following symptoms:

  • mood symptoms, such as anxiety, sadness, irritability
  • cramps
  • fatigue
  • bloating
  • food cravings
  • tender or swollen breasts
  • constipation or diarrhea
  • headache
  • sensitivity to noise and light


Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that affects about 5% of women.

PMDD is characterized by a set of emotional and behavioral symptoms that are more severe and debilitating than those of PMS. These symptoms can include:

PMDD can significantly interfere with one’s ability to function in daily life, and may require medical treatment.

If you’re considering acting on suicidal thoughts, please seek professional support immediately.

Calling or texting a crisis helpline will connect you with a trained counselor 24/7, any day of the year, completely free of charge:

The symptoms of PMDD may involve:

  • Extreme mood swings: You may experience severe mood swings, including feeling irritable, anxious, or depressed. These mood changes can be intense and may interfere with your ability to function in daily life.
  • Fatigue: You may feel unusually tired or lacking in energy.
  • Changes in appetite or food cravings: You may experience changes in your appetite, including food cravings or binge eating.
  • Sleep disturbances: PMDD can disrupt sleep patterns, causing insomnia or oversleeping.
  • Physical symptoms: You may experience physical symptoms similar to those of PMS, such as bloating, breast tenderness, headaches, and joint or muscle pain.
  • Difficulty concentrating: PMDD can make it difficult to concentrate or focus on tasks, which can impact your ability to work or complete daily activities.
  • Feeling out of control: You may feel out of control, emotionally overwhelmed, or as though they are “going crazy.”

The most well-researched treatments for PMDD include:

  • ovulation suppression treatments: helps stabilize hormone fluctuations
  • antidepressant or anti-anxiety medications: both of which help correct neurotransmitter dysregulation

There are several effective treatment options for PMDD, which may include the following:

  • Antidepressant medications: This may include fluoxetine (Prozac), sertraline (Zoloft), or clomipramine (Anafranil), among others. Fluoxetine and Sertraline are the only psych meds approved by the U.S. Food and Drug Administration (FDA) for PMDD.
  • Birth control pills: PMDD is often treated with birth control pills that contain the hormones ethinyl estradiol and drospirenone (YAZ).
  • Gonadotropin Releasing Hormone (GnRH) Analogues: This medication works by reducing the production of certain hormones that can trigger PMDD symptoms. It’s typically given as a monthly injection or a daily nasal spray.
  • Anti-anxiety medications: This may include off-label medications like alprazolam (Xanax) or buspirone, among others.
  • Cognitive therapy: Cognitive therapy can help you identify and challenge any negative thought patterns that contribute to mood symptoms. This helps improve coping skills and reduces symptom severity.
  • Supplements: Supplements that may help PMDD include calcium, magnesium, chasteberry, and vitamins B6 and E.

Here are some practical tips that may help in dealing with anxiety before your period:

  • Practice relaxation techniques: Deep breathing, meditation, yoga, and progressive muscle relaxation can help reduce anxiety symptoms.
  • Exercise regularly: A 2020 systematic review suggests that exercise may improve PMS symptoms, as it produces anti-inflammatory chemicals, increases endorphin levels and helps regulate progesterone and estrogen synthesis.
  • Get enough sleep: Try to aim for 7-9 hours of sleep each night, and establish a relaxing bedtime routine to help you unwind and prepare for sleep.
  • Eat a balanced diet: Eating a balanced diet with plenty of fruits, vegetables, lean protein, and whole grains can help to stabilize your mood and energy levels.
  • Avoid caffeine, alcohol, and nicotine: These substances can contribute to anxiety and may worsen PMDD symptoms.
  • Keep a mood diary: Keeping track of your mood symptoms in a diary can help you to identify patterns and triggers that may be contributing to your anxiety.

Anxiety is a common symptom of both PMS and PMDD, and it can significantly affect your well-being and quality of life.

Treatment options may include lifestyle changes, medication, therapy, or a combination of these approaches.

If you’re experiencing anxiety before your period, it’s important to work closely with a healthcare or mental health professional to find the best treatment plan for your needs.

If you’d like, consider taking our PMDD quiz. This may help you further clarify the severity of your symptoms when speaking with a qualified professional.