A few weeks ago a friend G-chatted me in desperation. Normally easygoing, she sounded panicked. Unlike most women she knew, she suffered from only mild menstrual cramps. She barely even felt bloated. But every month, she said, she could feel a tsunami of hormones brewing inside her in the days leading up to her period.
Like Marvel’s Hulk transforming into an erratic monster, she, too, transformed—not into a caricature of a PMS bitch, but into an uber-sensitive, paranoid, depressive version of herself. These hormonal sneak attacks were wreaking havoc on her relationships, and yet she felt embarrassed to even acknowledge them, for fear of being seen as a walking stereotype. She wondered: Was there an antidote?
Surprisingly, premenstrual mood swings are something of a medical mystery. We know they’re caused by a combination of hormonal fluctuations, personal biology, and environment, but this delicate balance of factors can make treating them a process of trial and error for every woman. “This has been a topic of conversation for as long as people have been talking,” says Ira Jaffe, an OBGYN at NYU's Langone Medical Center. "If there was one approach that worked, we’d all be doing it. But no one has an exclusive hold on the best approach so far."
As I later reported back to my friend, there are proactive steps women can take to mitigate the effects of premenstrual mood swings, including diet and lifestyle changes. The first step, however, is acknowledging that these mood swings are real—and should not be a source of shame.
Over the past few decades, as more women have entered the workplace, discussing the psychological toll of menstruation has become something of a taboo. We still live in a world where women are discriminated against simply for having periods—who can forget Donald Trump telling Fox News’ Megyn Kelly that she had “blood coming out of her wherever”? So admitting that our periods can influence our state of mind can feel risky. But until we discuss this reality openly, we’ll never see progress. So let’s discuss, shall we?
Most women understand what a “period” is, but not everyone understands the complex hormonal and chemical changes that occur in the body before and after menstruation. The key to managing premenstrual mood swings, however, is understanding these changes.
So what do we know about our periods? We know that PMS happens once a month during the luteal phase of the menstrual cycle, which is the 14-day window before a woman gets her period. While not all women suffer from PMS, about 80% to 90% experience some form of physical or emotional changes before their period, and about 15% of those women experience multiple or severe symptoms—to the point at which PMS seriously impacts their life.
"We see a variety of things in PMS," says NYU’s Jaffe. "Increased irritability, short temper, difficulty focusing, easily moved to tears—things we could say are similar to clinical depression."
One reason for these changes may boil down to hormones—specifically, having too much or too little estrogen or progesterone in your body at a given time. At the very beginning of a woman’s cycle, right after menstruation, the body releases estrogen into the bloodstream, which causes the lining of the uterus to grow again. But then, about halfway through the month, estrogen tapers off and progesterone rises, which helps to stabilize that lining. This shift is key, since a spike in progesterone can lead to changes in mood that continue until menstruation begins. "Once we see menstrual flow and both hormones start to drop,” says Jaffe, “there is relief from the symptoms.”
But hormones are only part of the puzzle. Women also experience fluctuations in the release of neurotransmitters, including serotonin, dopamine, and GABA (gamma-aminobutyric acid). Also known as the “anti-anxiety” neurotransmitter, GABA plays a role in both relieving anxiety and elevating mood. Shifts in all of these neurotransmitters can affect our emotional state, says Elizabeth Bertone-Johnson, a professor of epidemiology at University of Massachusetts-Amherst who has studied PMS extensively.
And yet, while we know that fluctuations in hormones and neurotransmitters can alter a woman's mood, medicine offers no simple fix. This is because the multiple chemical interactions and chain reactions are different for every woman. If doctors could pinpoint one cause for a woman’s PMS mood swings—such as determining that her estrogen level was too high or low—they could treat them with medication, but that's simply not the case, explains Bertone-Johnson. Women can't just pop a pill to decrease estrogen levels or increase serotonin levels and feel like themselves again.
“We spend so much time trying to figure this out,” says Bertone-Johnson, who has been working to develop a “cure” for PMS for years. “Science suggests it's not just hormones and brain chemistry. It's a huge combination of a lot of different factors and varies from woman to woman.” This is one reason why women on hormonal birth control experience period-related psychological changes, too.
Along with hormonal fluctuations, a myriad of other factors contribute to the severity of PMS symptoms. These can include stress (which triggers the release of cortisol into the body), a woman’s environment, whether or not she has a support system, diet, whether she smokes, how much sleep she gets, and how often she exercises, combined with her own personal psychology and brain chemistry. With so many variables, what, if anything, can help curb the changes?
While we can’t expect a miracle cure anytime soon, we can make lifestyle changes to help ward off premenstrual mood swings. Perhaps more than anything, we can change how we eat.
You may know that balancing blood sugar is key to overall health. When our blood sugar veers too high or too low, we feel dizzy, irritable, anxious, tired, and generally crappy. In the long run, imbalanced blood sugar can lead to more serious conditions like diabetes and hypoglycemia.
Along with the other chemical changes, in the days leading up to our period our blood sugar levels can fluctuate, too. This is why diet can have a huge influence on the severity of premenstrual symptoms, says Robyn Srigley, a “PMS coach” and holistic nutritionist who helps women manage period-related pain and balance their moods through diet and lifestyle changes. "The first thing every woman has to do is balance her blood sugar and make sure to eat nutrient-dense food,” she explains. “Most meals should be comprised of lean protein, fat, and fiber."
One trick for balancing blood sugar is adding a teaspoon of cinnamon to a smoothie. "Ovaries are very sensitive to insulin," Srigley says. "By adding a teaspoon of ground cinnamon, you can increase your insulin sensitivity and utilize that blood sugar for energy." Some research suggests that, during the luteal phase, progesterone may lower insulin sensitivity—which isn’t a good thing. Being more sensitive to insulin means you don’t have to pump out as much of it to keep blood glucose levels in the normal range. So by raising your insulin sensitivity, you can better balance your blood sugar. This can help prevent that hangry feeling of “I have to eat or I'll rip someone's face off.”
Insulin is not the only hormone affected by diet. Food can also play a role in balancing estrogen and progesterone levels. For example, in order to balance estrogen, Srigley tells her clients to eat cruciferous vegetables such as broccoli, brussels sprouts, and kale. "They're full of fiber which helps to bind to excess estrogen and then you excrete it when you poop," she says.
Another tip for combating irritability, lethargy, and anxiety is increasing protein levels. The hormone progesterone can increase our appetites—and research suggests that eating more protein-rich foods counteracts this effect. This works because progesterone selectively metabolizes protein—meaning it both craves protein and quickly gobbles it up. In fact, when progesterone spikes our bodies can burn protein 10% more efficiently, which is why eating more of it keeps us feeling satiated.
Vitamins may also play a role in combatting mood swings. In her research, Bertone-Johnson found that women who consume more vitamin D and calcium through the foods they eat experience fewer symptoms. In fact, upping these vitamins decreases PMS risk by 30% to 40%, she says. Another key nutrient to preventing PMS, according to her research? Vitamin B. Higher levels of certain B vitamins, such as thiamine and riboflavin, were also associated with a lower risk of PMS. So start chowing down on foods such as salmon, red meat, spinach, bell peppers, broccoli, and lentils.
Eating sweets, however—a common PMS cliche—is the wrong way to feel better. "As much as you can, avoid sugar," says Srigley. Refined sugars lead to a quick sugar high, which also means a quick sugar low. The exception? Dark chocolate with no dairy in small quantities.
We now know that the environment inside our body can contribute to premenstrual mood swings, but so can the environment outside of it. Namely: Stress. "Anything you can do to reduce stress at this time—reading, walking outdoors, yoga, whatever it may be—seems to help,” says Srigley, the PMS coach.
When we feel stressed our bodies release cortisol, and an overabundance of cortisol can increase inflammation, lower our immune function, overwork our adrenal system, and put us at greater risk for depression and mental illness. So it’s no surprise that too much cortisol may also exacerbate PMS systems.
In her research, Bertone-Johnson has found that women who were experiencing PMS displayed higher levels of internal inflammation—and we know that more stress leads to inflammation, and more inflammation can lead to PMS. "Stress throws a lot of things out of whack," she says, "and we've seen that stress affects both reproductive function and hormones."
One way to combat premenstrual mood swings is to surround yourself with a supportive social network. Studies have shown that women who have a support system to lean on experience fewer symptoms of PMS, in part because of the ways this support can reduce stress. And if you don't have a good system in place, therapy can help, too.
The most important thing to remember however, says Jaffe, is that it's okay to ask for help if premenstrual mood swings are getting in the way of your life and your happiness:
“Needing help is not a sign of weakness.”
Taryn Hillin is Fusion's love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.