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Menstruation, menopause, and mental health
Hormones can affect a woman's mood throughout her lifetime. Sometimes the impact on mood can affect a woman's quality of life. Many times the symptoms that result can be managed with medicine and/or therapy.
Premenstrual mood changes
Once a young woman starts menstruating, she may begin to experience emotional changes around the time of her period. 75 percent of women with regular period cycles report unpleasant physical or psychological symptoms before their periods. Premenstrual syndrome, or PMS, affects 30 to 80 percent of women. Psychological symptoms of PMS include:
- Sensitivity to rejection
- Sense of feeling overwhelmed
- Social withdrawal
Physical symptoms of PMS include:
- Fatigue (feeling tired)
- Sleep disturbance
- Increased appetite
- Abdominal bloating
- Breast tenderness
- Headaches (sometimes known as menstrual migraines)
- Muscle aches and joint pain
- Swelling of extremities
Premenstrual Dysphoric Disorder, or PMDD, is a more severe form of PMS. It affects 3 to 8 percent of women of reproductive age. Symptoms of PMDD include:
- Severe irritability
- Mood swings
The best way to confirm PMDD is to make a chart (PDF, 104 KB) of your symptoms (for example: cramps, headaches, or weight gain). A woman with PMDD should have symptom-free days between the start of her period and ovulation. Your doctor or a mental health professional can use a prospective scale (the Calendar of Premenstrual Experience and the Prospective Record of the Severity of Menstruation are two examples) to figure out if you have PMDD.
The causes of PMS and PMDD are not known, but research shows that they are based in the body and not just in the mind. Women who experience PMS and/or PMDD do not have higher levels of hormones compared to other women. Instead, women with PMS and/or PMDD may be extra sensitive to normal hormonal changes.
Lifestyle changes may help make the symptoms of PMS and PMDD better. Some doctors suggest that women:
- Eat lesser amounts of caffeine, sugar, and sodium
- Drink less alcohol
- Smoke less
- Get plenty of sleep
- Exercise more
- Try talk therapy
Medications or supplements prescribed by your doctor can also help PMS and PMDD. These may include:
- Calcium (1200 mg per day was shown to reduce PMS symptoms)
- Selective serotonin reuptake inhibitors (SSRIs)
- Hormonal treatments such as oral contraceptives
For all women, simple lifestyle changes in diet, exercise, and stress management are usually encouraged. These changes do not have risks and may help you.
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Menopause and mood changes
Women may experience a wide range of feelings, from anxiety and discomfort to release and relief, upon menopause. Most adapt to the changes and continue to live well and remain healthy through these transitions.
Some women, although not all, will experience significant depression before perimenopause. Perimenopause marks the time when your body begins the transition to menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last or how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years. Because of the intense hormone changes during perimenopause, women are more likely to have menopause-related depression before they reach actual menopause.
When women go through menopause, some may feel badly at the loss of their ability to bear children. However, some women look at menopause as a time to expand their work and social activities, and to dedicate more time to their spouse or partner. Having a positive attitude about this life change may help.
However, depression is not just in your mind. It can also be caused by hormonal factors. If you are feeling depressed and are going through menopause, be sure to discuss these feelings with your doctor or a health care professional. You can learn more about talking to your doctor in the menopause section of womenshealth.gov.
There are several treatment options for women who have depression during perimenopause.
- Menopausal hormone therapy – To help control the symptoms of menopause, some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. The use of MHT has been debated a great deal since the Women's Health Initiative (WHI) Hormone Study findings were released in 2002. Long-term use of MHT poses some serious risks. If you decide to try MHT, use the lowest dose that helps for the shortest time you need it.
- Antidepressants – Antidepressants may be an option for women who are unable or unwilling to take MHT.
- Talk therapy – Talk therapy may take place one-on-one with a mental health professional or in a group setting.
Once identified, depression almost always can be treated either by therapy, medicine called antidepressants, or both. Some people with milder forms of depression do well with therapy alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with combined treatment: therapy and antidepressants.
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More information on Menstruation, menopause, and mental health
Read more from womenshealth.gov
Menopause and Menopause Treatments Fact Sheet - This fact sheet answers frequently asked questions about menopause topics, including menopausal hormone therapy (MHT), coping with symptoms, and preventing diseases like osteoporosis and heart disease.
Menstruation and the Menstrual Cycle Fact Sheet - This fact sheet explains what menstruation is, what happens to a woman's body during a typical menstrual cycle (period), and what problems can interfere with a woman's period, as well as answers common questions such as when to see a health professional and how to use a tampon.
Premenstrual Syndrome (PMS) Fact Sheet - This fact sheet about premenstrual syndrome (PMS) explains how to tell if you have PMS, how common PMS is, and what treatment is available.
Explore other publications and websites
Age Page: Menopause - This fact sheet explains what menopause is, and the different symptoms and health concerns that come with the different stages. It gives recommendations for what women can do to stay healthy throughout menopause and answers common questions about hormone therapy and other important issues for menopausal women.
Emotional Aspects of Menopause (Copyright © The Cleveland Clinic) - This fact sheet describes some of the emotional changes of menopause. It also describes some of the medicines used to treat these changes.
Menopause (Copyright © Association of Reproductive Health Professionals) - This comprehensive website is a guide through the vast array of menopause and hormone therapy resources on the Web. It offers materials for doctors, the media, and the general public.
Menopause: Managing Your Body's Changes (Copyright © Hormone Foundation) - This publication offers helpful information on how the changes of menopause happen and what you can do to help yourself through many common menopause symptoms.
Perimenopause, Menopause, and Depression (Copyright © The Cleveland Clinic) - This fact sheet describes perimenopause and menopause and discusses your options for coping with depression during this period in your life.
Premenstrual Dysphoric Disorder (Copyright © Madison Institute of Health) - This website provides a place where visitors can learn about the likelihood of being affected by Premenstrual Dysphoric Disorder in a reassuring, confidential environment. Helpful treatment resources are also provided, as well as continuing education for clinicians.
Premenstrual Dysphoric Disorder (PMDD) (Copyright © American Academy of Family Physicians) - This publication provides general information on Premenstrual Dysphoric Disorder (PMDD) including diagnosis, causes, and treatment.
Premenstrual Syndrome - This publication provides information on premenstrual syndrome and premenstrual dysphoric disorder. It includes information on the causes and risks, symptoms, treatments, and possible complications.
The Menopause Years (Copyright ©American College of Obstetricians and Gynecologists) - This brochure describes the physical changes that may occur around menopause and what can be done to stay healthy during this time.
Women and Depression: Menopause (Copyright © University of Michigan Health System) - This publication explains why women may feel depressed during menopause. It also discusses treatment options and lifestyle changes that can improve the symptoms of depression.
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Content last updated March 29, 2010.
Resources last updated March 29, 2010.
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