It’s common to experience increased anxiety from PMS, or Premenstrual Syndrome. Although many different physical and emotional symptoms are possible with PMS, according to one study, over half of menstruating women experience some sort of mood disturbance before or during their period, like worsened anxiety or more sadness or irritability. (1)

Anxiety with PMS can arise as early as 10 days before your period starts. (2) Unless you track your cycle, you may not always connect anxiety from PMS to your menstrual cycle—especially when it happens a week or more before bleeding starts. But while anxiety and menstruation are in fact linked, thankfully there are many skills that can help our bodies and brains feel safe and in control.

Let's get proactive and use the soothing techniques below to be kinder to ourselves in managing anxiety in PMS.

Is worse anxiety from PMS normal?

Increased anxiety in PMS is one way your body responds to the hormonal fluctuations of your menstrual cycle—a normal biological process. Hormone levels drop during the luteal phase of your cycle (i.e. the week or so leading up to your period), which makes it harder to regulate emotions.

That said, no amount of anxiety from PMS is “normal” in the sense that it’s “supposed to” happen to you. Just because PMS anxiety is common doesn’t mean it’s inevitable, or something you have to put up with every month.

Your period is like a barometer for your health, and difficult PMS symptoms like anxiety can be a sign that your cycle needs more support. De Lune created Steady Mood as a natural way to relieve common PMS symptoms like mood issues, brain fog, fatigue, bloating, and digestive problems. Supplementing with the vitamins, minerals, and herbs your hormonal cycle needs to thrive can help make periods a lot easier, both physically and emotionally.

Note that if anxious or intrusive thoughts interfere with your daily activities—whether caused by your cycle or some other reason—talk to a healthcare provider. More information about distinguishing PMS from PMDD (an extreme form of PMS) is below.

 

Tips to help with anxiety from PMS

The tips below are simple, but may need some time to actually stick. Don’t get discouraged! Some strategies might be helpful at first, then stop working as well over time. If you notice your coping skills aren’t helping you anymore, it’s okay to try something new.

Like with any skill, practice makes perfect, and the learning process can feel messy and vulnerable. It’s important to remember that even though practicing new coping skills can be challenging, facing anxiety without any strategies, or staying stuck in coping strategies that are no longer serving you can be even more challenging.

Trying out the following techniques is a great start to relieving anxiety from PMS, especially in combination with support from a licensed counselor who can help guide you through the process.

1. Know your worth

The first step in healing your relationship with anxiety is to understand that feeling any uncomfortable emotion is not a moral failing. It does not change your inherent value or worth as a person, and it does not mean that you aren’t capable.

2. Know your goal

Some people only notice anxiety during PMS, whereas others struggle with its impacts all cycle long. Regardless of how salient anxiety is in our lives, the goal isn’t necessarily to get rid of anxiety completely, as that may not be possible.

Instead, the hope is to find healthy and helpful ways to manage our symptoms by noticing how we feel and subsequently react to potential triggers such as people, places, and events that create the feeling of anxiety within our bodies.

3. Track your mood

Mood tracking is like checking in with a friend to see how they’re *really* doing. It can help us get to know ourselves in a deeper and more curious way as we observe how we feel based on what’s happening around us—or in the case of hormonal anxiety, inside us.

You can track your mood three times a day (I encourage clients to use breakfast, lunch, and dinnertimes as reminders), or as often as every couple hours if you’d like. You can use a spreadsheet, your phone notes, or pen and paper. Your practice can be as simple as you need it to be, and it’s easy. Here’s how:

• Reflect on the last few hours. How have you been feeling in your mind and/or body?
• Note which emotions you’re feeling, and what else is happening during that time.
• How intense does each emotion feel on a scale of 1-10? (1 being the lowest intensity, 10 the highest)

4. Find your patterns

Making a habit of mood tracking can give you a jumpstart in regulating anxiety in PMS. I encourage clients to track their mood as consistently as possible for at least three months. A few cycles of data can reveal patterns in your emotions or behaviors before your period.

Noticing your patterns can help you prepare for the hardest days of your cycle with strategies tailored to you and your specific issues. For an even deeper look at your patterns, you can track your mood and track your menstrual cycle at the same time, and enjoy the special benefits of cycle tracking.

5. Use the best science

Cognitive Behavioral Therapy (CBT) is the form of therapy most widely used by licensed counselors to help clients overcome virtually all types of mental health symptoms.

CBT was the first form of psychotherapy tested with the strictest criteria for scientific evidence, and most consider it the current gold standard. (3)

I always encourage people to connect with a licensed provider before diving into consistent CBT work, but there are techniques from CBT that we can use on our own! This next tip is one example. 

6. Put your thoughts on trial

Anxiety can be magnified by irrational thoughts. For example, thoughts like “something bad will happen” or “I will make a mistake” might lack evidence, but still have an impact on how you feel.

By examining the evidence and challenging these thoughts, you can reduce anxiety. (4) Here’s how:

• Choose a thought that has contributed to your anxiety. Gather evidence in support of your thought (verifiable facts only), and against your thought.
• Compare the evidence and determine whether your thought is accurate or not.
• Examine the thoughts that fuel your anxiety by asking questions like: “Is my thought based on facts or feelings?” “How would my best friend see this situation?” “How likely is it that my fear will come true?” “What’s most likely to happen?” “If my fear comes true, will it still matter in a week? A month? A year?”

 

7. Show self-compassion

Being nice to yourself and showing yourself some grace—a simple idea that can be the hardest to utilize—is imperative for reducing anxiety in PMS.

Self-compassion is a state of mind; it’s allowing yourself to just *be*, and finding value in that alone. It takes time, consistent practice, and a willingness to be vulnerable with yourself as you retrain your brain to let go of the “shoulds” you’re holding onto. I find that these “shoulds” are best explored through a combination of open ended questions and statements, like the examples below.

8. Normalize your period’s needs

One way we can practice self-compassion is to fully acknowledge that our bodies are cyclical, and therefore have different needs at different points throughout the month.

How do you feel knowing that having a menstrual cycle may mean caring for yourself differently during your period than during ovulation? Are you willing to give your body more support when it asks for it?

If your standard is consistency—feeling the same way every day of the month—it may be uncomfortable to normalize needing extra help, more time to rest, or different ways to express your emotions during your period. However, consistency may not be realistic for those of us with a menstrual cycle, and holding ourselves to unrealistic standards can actually set us up for even more anxiety from PMS.

9. Explore sitting with discomfort

Anxiety from PMS tells us that we’re in danger, even if nothing around us is actually putting us at risk. Once you recognize that the anxiety itself is the only real threat, ask yourself if you’re capable of sitting with that discomfort for a while, knowing that PMS is temporary and doesn’t define who you are as a person.

Each phase of the menstrual cycle can present a slightly different version of ourselves, and some phases won’t be the “best” version. While it’s important to take responsibility for how we treat others (and ourselves) during PMS, it’s also important to be “okay” with not always being “okay”.

10. Talk to a provider if you suspect PMDD

If your anxiety during your period feels out of control, or if you’re struggling with PMS anxiety that’s much more intense than what’s typical for you, it’s possible there’s a larger, more serious issue at play…

PMS vs PMDD

Premenstrual Dysphoric Disorder, or PMDD, is a medical condition that presents as a more extreme version of PMS, in which emotional symptoms like depression, irritability, or anxiety are very severe. (5)

If you think you may be among the ~5% of menstruating women who have PMDD (6), track your PMS symptoms in as much detail as you can for at least two menstrual cycles. Note how your symptoms disrupt your relationships or interfere with your responsibilities at work, school, home, or life in general.

Then contact a trusted medical provider to discuss your experiences. Don’t forget to bring your mood tracker to your appointment, practice self-compassion, and challenge your anxious thoughts with evidence!

Alisha Miller, MS, LCMHC, NCC, is a Licensed Clinical Mental Health Counselor in North Carolina. She believes that all humans deserve access to thoughtful, evidence-based ethical care that caters to each persons’ specific needs and goals. Alisha finds joy in working with her clients through relational and personal boundaries, self-compassion, and trauma-informed bodywork. Alisha has worked in the university setting, private practice settings, and non-profit agencies utilizing an integrative, client centered approach. She diligently works with clients in areas that encompass her clinical certifications in Internal Family Systems Theory, Acceptance and Commitment Therapies, and Cognitive Behavioral Therapies.

This information is for educational purposes only. It is not a substitute for professional medical advice, and is not intended to diagnose, treat, cure, or prevent any condition.

References

1. https://femaleforwardtogether.com/state-of-the-cycle/

2. https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome

3. David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4.

4. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY, US: Guilford Press.

5. https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd

6. Pearlstein, T., & Steiner, M. (2008). Premenstrual dysphoric disorder: burden of illness and treatment update. Journal of psychiatry & neuroscience : JPN, 33(4), 291–301.