Cara (not her real name) was 33. She ate a variety of whole foods, was active and seldom drank alcohol. She had a history of anxiety and depression and very stressful life events, including childhood trauma and abusive relationships.
When I saw Cara for her first appointment, she was in many ways in a very good place in her life. She had in the past year come out of an abusive relationship and knew she would never be in one again. She had begun seeing “a really good therapist” who was helping her unpack her childhood traumas. And she had a small group of true friends she could rely on.
Cara also had a good set of tools she had learned over the years for looking after her mental health. She enjoyed running her small business, though it could be stressful at times. She was “mostly happy being single” and was active in outdoor groups to grow her social circle.
She had been through intense stress in the last few years – being isolated in an abusive relationship, financial and work worries, a cervical cancer scare, and traumatic events with her abusive family that had led to her deciding to go no contact. While Cara felt she was now creating a good life for herself and had stronger boundaries and self esteem, the stress and trauma had understandably impacted her health.
“Every month, for about the past year, in the week or so before I get my period…..it’s like a big low comes in. Like those weather systems they talk about on the news. I get really, really down. I cry a LOT. My concentration is off. And for the past few months….I think about killing myself. It feels like the world is ending.
“And then as soon as my period arrives, it’s like the dark cloud lifts and I feel like myself again. I’ve found it hard to talk to anyone about it. But it’s scaring me. I don’t think anyone should be planning how you’re going to kill yourself once a month.”
For some women, these intense shifts in mood before their period begin at a younger age, and for some women they manifest after stressful events. Whenever in life they occur, what is the link between your period and sudden, intense low mood – even feeling suicidal?
Your hormones and your brain
Research has found the brain is a key target for the effects of progesterone and estrogens – sex hormones whose effects are not confined to reproductive function. The regions of the brain affected by ovarian hormones are involved in:
PMDD – now a recognized mental health problem
For some women, the mood changes that occur before their monthly period can be extreme and disturbing, as in Cara’s experience. It is a health condition known officially as Premenstrual Dysphoric Disorder (PMDD) and its characteristics include:
So what causes PMDD?
Research shows a decrease in estrogen – as happens in the luteal phase of your monthly cycle or after a pregnancy – is linked with depression and mood changes. And while progesterone rises during the luteal phase, it too drops significantly just before our period arrives (the late luteal phase). It seems to be the drop in levels of both hormones that brings on the symptoms of PMDD and leaves women feeling “like the world is ending”.
And more recently, research has suggested a link between increased sensitivity of receptors in the nervous system to progesterone metabolites, in women who experience intense mood changes before a period (PMDD). In other words, for some women, the hormonal shifts during the monthly cycle can hit much harder.
Additionally, if you have a history of anxiety disorder or trauma, this can increase your chance of developing PMDD. The link here is believed to be the changes in the function of the autonomic nervous system (a division of your nervous system) that occur for people affected by anxiety or trauma.
Getting back to good health
The good news is the symptoms of PMDD can be managed and reduced using nutrition and lifestyle changes. Because of the interplay between the nervous system and reproductive system, I focus on supporting these two body systems when helping clients manage PMDD holistically.
Cara’s personalized nutrition and lifestyle treatment plan focused initially on stress reduction to support her nervous health, with getting more sleep being a top priority (Cara acknowledged she had a tendency to stay up beyond midnight far too often). We increased nutrients needed for her nervous and reproductive systems in both food and supplement form, particularly activated B6 because of its proven record in reducing premenstrual depression and its necessity for making GABA, a soothing neurotransmitter that plays a role in sleep and calm mood.
To help establish a healthy hormone balance, Cara was advised to consistently follow a low-histamine way of eating for a few months, to avoid substances that would create more work for her liver (like alcohol) and to increase her consumption of organic seasonal vegetables, which she did like a champ. I also referred Cara to a naturopath so she could obtain a personalized blend of herbs to further support her hormonal health and nervous system health.
Two months into following the advice she had been given, Cara commented
“I got a little down just before my last period but it was nothing like it was. I know I have a way to go but I’m feeling better, steadily. I’m sleeping better and I now feel like I understand what was going on with my body and mind, rather than feeling so alone in it all.
“It’s scary to me, how this affected me. I was honestly at a point where, for several days a month, I was thinking about how I would kill myself, which method I would prefer. And when I thought about how my death would affect those I love, I just felt numb.
“I’m so glad I finally opened up and got help. The changes haven’t been difficult to make and have helped me get my health back on track fairly speedily. But I do wonder how many women don’t tell anyone, and don’t get any help with this. I wonder how many women we might have lost to this condition.”
If you'd like to have a chat about period problems or changes in your mental health, you can contact me using the form. I also welcome your comments on PMDD and period problems.