Yes, Your Period Can Make Your Depression Worse. Here’s Why—And How To Cope
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Lotus Kay started to feel depressed when she was 12 years old. But when she got her first period about a year later, a peculiar pattern emerged: Her depression symptoms would get worse the week before and during the first few days of her period, and then return to baseline—but never fully go away—for the remainder of her cycle. “It’s like clockwork,” Kay, who’s now 23 and lives in New York, tells SELF.
You may think this is an ordinary case of PMS, or even its more severe cousin premenstrual dysphoric disorder (PMDD), but Kay was actually dealing with an entirely different—but just as serious disorder—called premenstrual exacerbation, or PME.
“People with periods have been socialized to suffer in silence and assume that everything is PMS, but we’re probably conflating many different syndromes,” says Rubiahna Vaughn, MD, MPH, a reproductive psychiatrist with the Montefiore Health System in New York. “It can get really confusing about what is and isn’t normal,” she tells SELF. “But a lot of people have PME.” And that’s definitely not normal.
If you’re wondering, Why the hell haven’t I ever heard of this before?, you’ve come to the right place. Here’s everything to know about PME and what you can do to make life with depression (and a vagina) a little more bearable.
What is PME?
PME is when symptoms of any chronic mental or physical condition, including anxiety, alcoholism, or schizophrenia become more severe the first few days before and during your period, according to the International Association for Premenstrual Disorders (IAPMD).
If you have PME of depression (as some doctors call it), you’ll notice that feelings of guilt, worthlessness, sadness, or, in some cases, suicidality, ramp up during this time in your cycle, but then go back to their “normal” level after you finish bleeding for the month. It’s like “symptoms are turning up in volume and then turning back down,” Jaclyn Ross, PhD, a clinical psychologist who runs the Chicago Premenstrual Disorders Clinic, tells SELF. That’s different from PMDD, she adds, which is when you have such severe anxiety, depression, or other mood changes that you almost can’t function a week or two before your period, but the rest of the time you feel pretty okay.
Lotus Kay.jpg
Kay knows the struggle firsthand. On top of depression, she has fibromyalgia, irritable bowel syndrome, and OCD, all of which worsen around the time she bids her uterine lining farewell. She also has autism, which some research suggests can make people more sensitive to the natural hormonal ebbs and flows that happen during menstruation.
It’s unclear how many people actually have PME, but in a 2004 study of 900 people ages 13 to 54 who had periods—which experts we spoke to say is the largest and most representative on the topic to date—found that about 60% of those with depression felt worse right around the time they bled. But you’ve likely never heard of PME before because it’s not a diagnosable condition, at least not yet. Experts are working hard to get it added to the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a move that could not only lead to the development of specific treatments for the disorder, but also give people struggling with it the assurance they want and need.
Experts don’t know exactly why some people with depression feel worse around the start of their period, but studies suggest their brains are unusually sensitive to normal hormone fluctuations—namely drops in estrogen and progesterone in that phase of the menstrual cycle, Tory Eisenlohr-Moul, PhD, director of the CLEAR Lab at the University of Illinois at Chicago, which studies how the menstrual cycle affects mental health, tells SELF.
“The majority of people who seek care for quote-unquote PMDD have chronic symptoms as well, and that speaks to the need to update this diagnosis to be more inclusive of those who experience worsened depression,” Dr. Eisenlohr-Moul says. “To have a diagnosis for PME at all would be a major step forward.”
How to feel a little better if your period makes your depression worse
If you have depression and a period, you may be vulnerable to PME, regardless of how severe your symptoms are. Here’s what you can do to feel a bit better and navigate the tricky conversations you might need to have with your health care provider about treatments.
1. Track your symptoms over several period cycles.
When Kay realized that something funky was going on, she committed to noting how she felt every day in a health diary. And experts say you should do the same. Documenting your symptoms for at least two months in a journal or app is the first step in knowing whether your period really is making your depression worse, Dr. Ross says.
Pay attention to when you feel more hopeless, less motivated to do things you love, or irrational when it comes to your interactions with others. Also log other factors: Are you eating more? Are you oversleeping? “These notes can give you concrete things to discuss with your medical provider,” says Dr. Ross, who’s also a clinical research scientist.
2. Be prepared to advocate for yourself.
You may hope your health care provider knows everything they need to help you, but the reality is they may not, especially when it comes to menstrual disorders, which are notoriously understudied. Kay, for example, has yet to find a doctor or therapist who knows what PME is; she learned about the disorder only after reading about it online. “Doctors just focus on whether my period is painful or not; they’re not very interested in what happens before it comes or after. And too often they’ll separate physical and mental health, but they’re so connected,” Kay says. “Not everything is all in our head.”
If you find that your go-to health professionals have no idea what you’re talking about or are trying to convince you that you’re just PMS’ing, stand your ground, Dr. Eisenlohr-Moul says: “If your doctor is still resistant, find anyone else. It could be a primary care provider, a gynecologist, a psychiatrist. It really doesn’t matter,” she continues. “What you’re looking for is somebody who is going to be receptive and listen.” The IAPMD offers a directory of providers who know about PME and other menstrual disorders if you need some help.
3. Continue or start to manage your depression.
If you’ve already found a treatment or two that makes you feel a little better (like a daily SSRI), stick with it, experts say, because as of now, there aren’t any options that are specifically approved to treat PME of depression. In other words, getting help for your underlying condition, whatever it is, will likely buffer the impact your period will have on it. So if you aren’t already tending to your depression, it may be time to start.
It’s not clear if eating certain foods or exercising more could make a difference, but “if it’s helpful for other types of depression, then it’s likely to be helpful for this one,” Dr. Vaughn says. This means that therapy could be another good option, she adds. Unfortunately, treatments specific to PMDD like birth control pills haven’t been found to be helpful for those with PME.
“Working with a psychiatrist will help you problem solve and set yourself up for success,” Dr. Vaughn says. “But if you’re consistently feeling hopeless, not wanting to get out of bed, or having thoughts that life isn’t worth living, you absolutely need to see a professional immediately.”
4. Plan ways to cope ahead of time.
Once you have a better picture of how your symptoms shift across your menstrual cycle, you can take steps to avoid problems in the future. Think about what you can do to make things easier during those times you’re feeling most vulnerable. For example, you could meal prep Sunday night so you don’t start your morning pissed off because you’re short on time, or you could make plans to get dinner with your best friend during the first couple days of your period to offset loneliness and despair.
On that note, it’s a good idea to seek out things that make you feel good or at least better. “If you normally love drawing and that enhances your mood, but you hate drawing just before your period, then find a different strategy,” Dr. Ross says. “Tailor your coping to be more effective based on what’s going on with your thinking, your emotions, and your behaviors at these different times in your cycle.”
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Originally Appeared on SELF
