PMS & PMDD Anxiety

Women's Hormonal PMS Anxiety
by Dr. Daniel J. Heller

Anxiety can take many different forms: it can be simply feeling anxious and nervous; it can manifest as depression or irritability; or it can force us to compulsively fill our lives with activity—any activity—to allay feelings of anxiousness and nervousness. Anxiety manifests as worry about health, about family, and often worries about things over which we have no control whatsoever, but also as physical symptoms of insomnia, tension, heart palpitations, mysterious aches and pains, irritable bowel syndrome: in short, almost any symptom you can imagine. For many women anxiety arises over the fact that so many situations feel out of one's own control.

Hormonal anxiety, PMS anxiety, and menstrual anxiety are, of course, specific to women, and are often an exacerbation of a more formal anxiety problem such as generalized anxiety disorder or social anxiety disorder. Just as PMS and PMDD can make depression, migraines, and other conditions worse, they can also make anxiety and panic attacks worse.

As you'll read later in this article, the stress hormone cortisol is elevated before a woman's period. Although women's hormonal PMS anxiety doesn't mean that anxiety only occurs premenstrually—worries and anxieties may exist at a more manageable intensity at other times—they tend to really flare up before your period. PMS anxiety refers specifically to menstrual anxiety or hormonal anxiety that is a significant problem before the period.

Women's Anxiety

Are women more anxious than men? They are, and there are many possible reasons for this: the multitude of sometimes conflicting roles women are asked to fill in our culture (wife, mother, worker, caring friend); the way girls are raised, which often focuses on passive acceptance of problems rather than action-oriented problem-solving; women's greater sensitivity and responsiveness to others; and women's tendency to devote more time, energy, and attention to their own and others' emotions.

These social and cultural factors can interact with the monthly hormonal cycle to create PMS anxiety. One of these hormones, cortisol, that is ordinarily higher in men, increases to a level similar to that of men during the second half of the menstrual cycle. The cortisol-stress connection is well known and definitely plays a role in anxiety.

Balancing hormones and stress is key to the natural relief of anxiety—the holistic approach to anxiety focuses on balancing your whole life, body mind and spirit—rather than just using medication to treat only the symptoms.

PMS Anxiety: How Do You Know You Have It?

Anxiety and PMS anxiety can easily be misidentified: anxiousness is often experienced as irritability or tension, depression or feeling on edge, or feeling overwhelmed. Often anxiety will arise suddenly as a frightening panic attack, but even low-level anxiety can keep you from functioning at your best.

Many of the symptoms of PMS and PMDD are related to anxiety and the different ways that anxiety manifests:

• Irritability
• Insomnia
• Feeling overwhelmed
• Feeling out of control
• Feeling on edge
• Depression
• Tension
• Nervous Tension
• Stress

Overcoming Anxiety

We offer five anti-anxiety hints to overcome anxiety and anxiousness issues (and anyone can benefit from them):

• Control what you can control + "Don't sweat the small stuff": We all have a tendency to try to control events and people over whom we have minimal, if any, control. We also tend to get caught up in events that will probably seem unimportant in a few days or weeks. Both of these propensities create unnecessary grief for us: other people don't want to be controlled any more than we do, and if they do, it's likely to end up being a tremendous headache for us; and our precious time and energy is wasted when we spend it agonizing and worrying over things we can't impact. Of course, we should try our best, and fulfill our responsibilities, but a realistic attitude does help minimize unnecessary stress.
• Are you a square peg in a round hole? Many of my patients with anxiety feel out of place in their lives or are suffering in extremely difficult relationships, whether with family, a romantic partner, or at work. Because they feel so out of their element in their life, they feel like "a square peg in a round hole." One woman, whom I'll call Kate, came to see me for anxiety. She was working at a high-stress job, in a state and city where she knew few people, plus she had a lot of financial pressures, and medications hadn't helped her anxiety. What helped Kate feel better—in fact, it completely relieved her anxiety symptoms—was to go back home to visit her mother, and sleep in the bed she'd had as a child. Then, all her anxiety completely disappeared. In Kate's case, I believe that feeling that her life didn't suit her made her feel like a square peg in a round hole, and that her anxiety was not a hormonal, mood chemistry or psychological problem, but a situation that required hard choices about her life circumstances.
• Cut out caffeine: For people who don't suffer from anxiety, PMS, or PMDD, caffeine may have beneficial properties. For people with these concerns, caffeine is bad news. The stimulant effect of caffeine usually aggravates PMS, PMDD, and anxiety. You may have to brave a headache to break the caffeine habit, but it will be worth it.
• Practice relaxed breathing: Proper breathing can help control stress, anxiety, and panic. Most instructions about breathing, however, tell us that we ought to breathe more deeply. If you've ever had a panic attack, or seen someone have one, you'll know that one of the cardinal signs of an anxiety attack is hyperventilation—too much breathing.
  Anti-Anxiety Breathing
  A more useful description of healthy anti-anxiety breathing is relaxed, abdominal breathing. When you breathe slowly, with relaxation, into your tummy, you are breathing as nature intended, and in a way that fights anxiety. Deep breathing that inflates your chest, as if you were filling your lungs with air, is tense breathing that will make you anxious, though it's natural if you've been exercising. Practice calm, relaxed belly breathing for several minutes each day, and you'll notice you can begin to control anxiety and the restless thinking that goes with it.
  
• Balanced diet: We discuss our PMS Balance Diet so often because it is so important to natural PMS relief and to feeling your best. And yes, a proper diet can help with natural anxiety relief, particularly if you need the hypoglycemia version of our diet.

We know that anxiety from PMS, PMDD, or any cause is painful, and can have a huge impact on your ability to enjoy and participate fully in life and relationships. One thing you'll notice about all these natural anti-anxiety hints: they're things you can do on your own. As it says at the top of the page, we're all about education, empowerment, and natural relief. We hope you'll try applying some or all of these hints (and let us know how they work for you) and feel empowered to apply natural health in your own life.