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PMS & PMDD Stress Can Make You Feel Out of Control & Overwhelmed
by Dr. Daniel J. Heller
"I feel on top of the world." "Everything's under control." "I'm in the driver's seat." These expressions come to mind when things are going well and you're managing the stresses in your life. But when life starts to get the best of you, and stress builds up, then you're more likely to think "I feel out of control," or "I feel overwhelmed."
In fact, we hear about this from our patients, who ask us, literally, "why do I feel overwhelmed and out of control before my period?" A woman named Nita asked us this very question, which inspired us to write a more in-depth article to discuss PMS stress, and feeling out of control and overwhelmed.
PMS and PMDD can make it difficult, if not impossible, to manage stress. Feeling overwhelmed and out of control are real premenstrual symptoms, recognized by researchers as part of PMS and PMDD—though all too often, doctors don't acknowledge this relationship. These feelings result from a particularly toxic combination: out of control stress, out of balance hormones and mood chemistry, combined with the fluctuation of premenstrual hormones. The PMS stress that creates these feelings can also be a result of PTSD—post-traumatic stress disorder.
You probably already knew that the problem of managing stress, and of finding ways to calm down, is worse before your period. But you may not have realized how many of the emotional symptoms of PMS and PMDD can be traced back to out of control stress. Tension, anxiety, irritability, depression, mood swings, and anger, not to mention physical symptoms like irritable bowel syndrome, and cognitive symptoms like difficulty concentrating, can all be caused by the way your body and mind become overwhelmed by out of control premenstrual stress.
In fact, the emotional and other symptoms of PMS and PMDD can be thought to start with stress, anxiety, and tension, which then result in depression, irritability, anger, loss of interest in normally fun or important activities, withdrawal from social situations, and difficulties in relationships. Given this, it's not surprising that PTSD would also be related to these issues. You know what this can do to your life: PMS and PMDD make it feel as if nothing is going right, and that life is just too much to manage, which then impacts your work, your relationships. Then, home, school, and family can all feel overwhelming. Or it can simply feel like your own personal emotions and moods are the source of feeling overwhelmed and out of control.
Is there any scientific evidence for this PMS-stress connection? There's plenty: women who perceive more stress in their lives have more PMS, PMDD, and more PMS symptoms. This isn't just a coincidence: women with PMDD have altered levels of hormones and stress hormones compared to women without PMDD. What's more, women with PMS seem to be more sensitive to stress.
This PMS-stress connection was confirmed in women over 40. Women over 40 with PMS have experienced more negative life events; have more difficulty with anger; and have more concerns about self- and social control, than women without PMS. They also have greater stress sensitivity and higher levels of stress hormones (in this case, norepinephrine.)
Women who have more anxiety and irritability as part of PMDD have an even greater degree of hormone imbalance. The researchers who discovered this believe that the crucial hormone for the relationship between mood and PMS and PMDD may be allopregnanolone, a type of progesterone, that effects the brain as well as the rest of a woman's body.
However, your reproductive hormones, estrogen and progesterone, and allopregnanolone do more than just regulate your reproductive system and your menstrual cycle—they clearly effect your brain and your mood, with estrogen favoring a stress pattern, and progesterone favoring a relaxation pattern. This is consistent with an idea that is common among holistic health practitioners, that PMS and PMDD result at least in part from an estrogen dominance pattern.
Are all women equally susceptible to stress, PMS, and PMDD? Apparently not: women with PMDD report increased life stress, and they are also more likely to have a history of sexual abuse. This type of chronic or severe stress is believed to create an altered stress response pattern that touches all aspects of life. Of course, any survivor of sexual abuse could develop PTSD as a result. In fact, one study found that PTSD was eight times more common—and a history of trauma was two times more common—in women with PMDD and women with premenstrual symptoms.
Traumatic events in general appear to greatly increase a woman's chances of developing PMDD. One study found that women with a history of unspecified trauma were four times more likely to have PMDD. Women with a history of anxiety disorder were two and a half times more likely to have PMDD, and women who reported more daily hassles were 60% more likely to have PMDD. All of these women were also more likely to have severe PMS. Trauma, anxiety, hassles, PTSD: these are all tremendously burdensome stressors that could make anyone feel out of control and overwhelmed. In women, they make it much more likely that PMS and PMDD will become a problem.
To be fair, not all studies find that stress predicts symptoms or symptom severity of PMS so of course there are other factors at work. It's important to see stress as part of the multifactorial cause and effect of hormone imbalance, PMS, and PMDD, which means diet, nutrition, herbal medicines, lifestyle, and other factors play a role as well.
You can lighten your stress burden with a few simple, healthy lifestyle changes. In addition to the brief list above, we share more details on ways to better manage your stress, and relieve those feelings of being overwhelmed or out of control around your period, in our PMS anxiety article; our article on PMS irritability; and our discussion of PMS & PMDD mood swings.
Here are a few of our favorite ways to get a handle on stress:
