When my period comes around, I transform into a nervous, jittery version of myself. I worry I’m not working hard enough, I suck at writing, or I said something off-putting or offensive to my friends and family members. I’m not alone. While most people equate PMS with food cravings and cramps, evidence suggests 64% of those who menstruate feel extra anxious during That Time Of The Month. (As if bleeding for a week straight wasn’t frustrating enough.)
Joshua Klein, MD, FACOG, a reproductive endocrinologist and cofounder of Extend Fertility in New York City, tells SELF that this anxiety spike is a very common biological response to a whole host of physiological changes going down in your body, including the free fall of various sex hormones and neurotransmitters, research shows. “You’re not crazy, it’s a real thing,” he says. We asked three health experts for the best ways to cope with brutal anxiety spells before and during your period. Here’s what they said.
Take a look at your birth control.
The reason you feel so edgy as your flow nears? Plunging hormones, Dr. Klein says. “A week before your period arrives, progesterone and estrogen are falling, and that’s what provokes most premenstrual symptoms,” he notes. Basically, your brain has a ton of hormone receptors, and as hormone levels fluctuate during your cycle, they can affect the production of GABA, serotonin, and dopamine (a.k.a. the neurotransmitters responsible for keeping you relatively calm and stress-free).
One way to ensure your progesterone and estrogen don’t ebb and flow so drastically is to take a combination oral contraceptive (like drospirenone and ethinyl estradiol, YAZ is a common type), says Dr. Klein, meaning it contains both estrogen and progestin. Pairing these two hormones together in a pill helps prevent ovulation, thereby stabilizing hormone levels and mood swings, research shows.
Other hormonal birth control methods like the patch and the ring can also suppress ovulation by regulating both hormones that may be making you anxious. Nonhormonal birth control methods like the copper IUD, however, don’t have the same effect. Of course, some people find that their mood plummets because of the pill. Dr. Klein’s rec? Talk to your doctor to see which route might be most ideal, as most pills require a trial-and-error period to find the right type. Though it’s not birth control, you could bring up taking a serotonin reuptake inhibitor (SSRI) with a health pro too, as antidepressants are often first-line treatments for mood-related menstrual issues.
Nail down a regular de-stressing routine.
Alice Domar, PhD, a health psychologist, tells SELF that having a recurring relaxation practice has been linked to fewer symptoms of PMS—particularly psychological ones. She notes that it can help make you feel less irritable and reactive when you actually get your period. Of course, it’s important to land on a habit that specifically calms *you* down. If movement feels good, yoga, walking, and progressive muscle relaxation—which involves tensing, and then relaxing, various muscles—are solid places to start. If you need to completely turn off your brain to feel zen, meditation might be a good idea. (Here are seven simple mindfulness exercises you can easily fit into your day.)
Ideally, you want to do it for 10 to 15 minutes a day throughout the month. Ramping up during your period can provide brief relief, however, a repeated routine can have a cumulative, longer-lasting effect. Maybe you commit to a quick guided meditation every evening or a few yoga poses during your lunch break. If you stick with it, “you’ll probably notice you feel less anxious by your next period,” she says. (Here are a few relaxing exercises to start with.)
Try your best to get enough sleep.
Your period—and all the hormonal changes and cramps it can trigger—may also mess with your sleep. It’s a vicious cycle: Being deprived of rest makes you anxious, and that itself can keep you up at night, says Dr. Klein. And if there’s ever a time to prioritize your snooze, it’s the two to three days right before the bleeding starts, a.k.a. when those hormonal shifts are happening and your body needs all the downtime it can get. Aim for seven to eight hours per night (here’s a bedtime habit one sleep specialist swears by to help). If clocking those kinds of hours each night doesn’t feel possible—because, like me, your mind tends to run wild when your head hits the pillow—you can take a little afternoon nap, or even spend a few minutes in a dark, quiet room to recharge.
Move and nourish your body.
As Reese Witherspoon famously said in Legally Blond, “Exercise gives you endorphins. Endorphins make you happy.” That famous logic is actually pretty scientifically accurate and also applies to period anxiety, Dr. Domar says. “There’s a lot of data that shows that women who start some sort of regular exercise program, which can simply be walking, have fewer symptoms of PMS,” she explains. Why? That’s because, again, evidence suggests that endorphin levels drop right before your period, leading to anxiety and irritability.
If you’re thinking, Okay, the last thing I want to do when I have my period is work out, Dr. Domar says you don’t need to go super hard. Research shows that yoga, for example, can help alleviate some of the tough emotions that come with PMS. Her advice: Find an activity you can enjoy and try to do it for a half hour a few times a week. “You have to try different exercises until you find one you’re actually going to do,” says Dr. Domar. (Here are 13 exercise motivation tips to help you stick to a routine.)
While docs generally recommend eating tons of fruits, leafy veggies, and whole grains to offset period symptoms, there’s one nutrient especially that might be worth consuming: calcium. That’s because its natural levels can sometimes drop in your body during the premenstrual phase, and some studies have shown that a dip can exacerbate mood-related period symptoms. The American College of Obstetricians and Gynecologists (ACOG) recommends consuming 1,200 milligrams of calcium a day to help with any mood-related PMS symptoms like anxiety. Get your fill with dairy products like milk, cheese, or Greek yogurt, things like orange juice that’s been fortified with calcium, and a pack of almonds, or figs. You can also ask your doctor if calcium supplements might be a good idea—though it’s worth noting that scientists largely agree that the most effective way to get your nutrients is through real foods (and calcium supplements have been linked to heart attacks in some cases).
Know when it’s time to work with a therapist.
If period anxiety is affecting your quality of life or preventing you from keeping up with your daily tasks and responsibilities, you may be dealing with premenstrual dysphoric disorder (PMDD), which causes serious emotional symptoms one to two weeks before your period. Roughly one in 20 people who menstruate have it, but the condition is seriously underdiagnosed. “Most people with PMDD have no idea they have it,” Tory Eisenlohr-Moul, PhD, an associate professor of psychiatry at the University of Illinois at Chicago who specializes in hormone-related psychiatric disorders, tells SELF. “It's easy to blame your period and chalk it up to nothing.” PME (premenstrual exacerbation), PMDD’s cousin, so to speak, is another disorder with mood-related symptoms that peak in the premenstrual phase. To find out if this is you, Dr. Eisenlohr-Moul recommends keeping a log of your symptoms to help clue your provider into what’s going on. As we mentioned, if you do have PMDD or PME, SSRIs can be helpful, alongside other treatments, like cognitive behavioral therapy (CBT), which is a common type of talk therapy that helps you become more aware of any negative thinking patterns.
I’ve always kind of accepted that having my period means I’m going to, at some point, convince myself my life is unraveling. But it doesn’t have to feel like that—in fact, it shouldn’t. I’m definitely going to ask my therapist about my anxiety woes during my next session, and if my period is playing a role. But in the meantime? Well, you can find me snacking on string cheese as I listen to my guided meditation app in bed.
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