Some menstrual mood changes may be more than PMS. Here’s how to tell the difference and get support.

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Premenstrual syndrome (PMS) can have some pretty uncomfortable symptoms.

Leading up to your period, you might experience not only physical symptoms such as cramping and bloating, but also worsening changes in your mood, including feelings of sadness and increased emotional sensitivity.

But can your period cause depression?

It depends.

PMS symptoms can include hormonal changes that trigger depression-like symptoms, but these symptoms aren’t usually severe enough to qualify as clinical depression. They will typically fade once your period starts.

However, there’s another menstrual mood disorder that can cause depression symptoms, and still another that can amplify any other condition you may have.

Yes, period depression is real. Two menstrual mood disorders can cause it:

  • premenstrual dysphoric disorder (PMDD)
  • premenstrual exacerbation (PME)

In fact, up to 5% of folks who get periods develop depression or anxiety that’s linked to the weeks leading up to their period, and a few days into it.

This is called premenstrual dysphoric disorder (PMDD). It has more severe symptoms than PMS.

PMDD symptoms include both PMS and depression symptoms.

Symptoms of depression

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) explains the criteria for depression as having five or more symptoms that persist most of the day, nearly every day, for 2 weeks.

Symptoms could include any combination of at least five of the following:

  • despair
  • mental and physical fatigue
  • hopeless or helpless feelings
  • eating too much or too little
  • sleeping too much or too little
  • issues with concentration, decision making, or focus
  • sudden aimlessness or disinterest in favorites
  • guilt and worthless feelings
  • thoughts of suicide or dying

PME intensifies a variety of medical or mental health issues. So, if you’re already living with depression, PME will worsen depression symptoms any time leading up to, during, or after your period.

When it feels like depression, but isn’t

If you’re experiencing depression symptoms that come and go, have fewer than five symptoms from the list above, or your symptoms are only present for a few days and not 2 full weeks, you might be experiencing depression-like PMS symptoms but not PMDD or PME.

Another possible cause of menstrual depression symptoms may have something to do with your hormonal birth control.

Though researchers aren’t sure exactly what causes PMDD or PME, fluctuations in hormones may be one reason. This may also help explain why birth control can also affect your mood.

DisorderPeople affected (per year)Depressed episode?Duration of depressive symptomsSymptoms before periodSymptoms during periodSymptoms after periodWorsening of other chronic illness
PMSup to 90%sporadic before periodyes
PMDD3%–8%1–2 weeks (continues into period)yespossibly
PME40% of those screened for PMDDpossibly1–2 weeks (continues into period)possiblypossiblypossiblyyes


PMS typically occurs about 1 to 2 weeks before your period. About 90% of folks with a menstrual cycle experience symptoms of PMS.

PMS hormonal fluctuations can cause a variety of both physical and emotional symptoms. They can include:

Symptoms can be mild or moderate. When symptoms are severe,two menstruation-related mood disorders could be at play.


If you find that symptoms of existing chronic illnesses intensify during PMS, or what feels like randomly throughout your entire cycle, you may have PME.

As the name suggests, premenstrual exacerbation worsens symptoms of existing conditions, such as:

  • asthma
  • bipolar disorder
  • depression
  • epilepsy
  • general anxiety disorder
  • panic disorder

PME is very similar to PMDD. The major difference is that PME heightens existing depression, while PMDD causes depression-like symptoms not related to major depressive disorders.

Still, they are so similar that about 40% of all PMDD cases could actually be a misdiagnosed case of PME.


PMDD is more severe than PMS and marked by:

  • symptoms causing severe physical or mental distress to the point that it disrupts daily life
  • extreme mood shifts
  • symptoms often fading a couple of days after the period starts

Diagnosis of PMDD is defined by experiencing a combination of five or more depression symptoms and PMS symptoms in the week before your period, instead of the full 2 weeks for clinical depression.

In most cases, symptoms will go away or lessen around the start of your period.

For a doctor to diagnose PMDD, they must rule out depression symptoms resulting from an underlying clinical depression or anxiety disorder.

You might want to talk with a healthcare professional if you feel like PMS symptoms are intensifying, mirroring depression symptoms, and interfering with your quality of life.

Your doctor may recommend over-the-counter or prescription pain meds to manage physical pain.

A mental health professional might prescribe antidepressants for PMDD. If you have PME, a mental health professional may adjust your antidepressant dosage if you’re treating other mental health conditions that PME intensifies.

In the meantime, you can try some best practices at home.

Self-help tips for menstrual depression

Remember, you’re not alone. Many people experience menstrual depression and can successfully manage it.