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  • Q&A with Australian Health Practitioners

    Why am I so depressed before I get my period?

    Related Topic
    Women's Health
    During the past 6-12 months my pre-menstrual symptoms have gradually been getting much worse.

    My cycle is regular, 28-32 days, and my PMS symptoms usually begin two weeks before I menstruate.

    A very troubling symptom is severely painful breasts, less troubling is acne. But the most troubling symptom for me is depression, in the two weeks before my period I could cry at anything, I am so anxious and afraid of everything to the point I am too scared to answer my phone, I can't talk to people, I barely want to leave the house, I think nothing but negative thoughts; the worst thing is that I am self-employed and I basically can't work for two weeks in the month. Then the day I get my period I am normal, just like flicking a switch!

    I really need to be able to do something to fix this, my GP says it's just normal but I don't think she understands how bad it is for me.
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    Thanks

    Dr David Moore

    Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician

    David received a solid foundation to training in tertiary obstetric units and has developed skills in the management of complex and high-risk pregnancies and deliveries. … View Profile

    Hello there,

    Let's be clear - this is NOT simple PMS.

    The symptoms you describe are concerning for premenstrual dysphoric disorder (PMDD), a significant condition that affects around 3% of women.

    The underlying cause of PMDD is poorly understood, but it is related to the cyclical hormone changes that occur with your ovarian cycle (although your ovarian cycle mirrors your menstrual cycle, stopping periods through hysterectomy is NOT effective as you still retain your ovaries).

    Its diagnosis hinges on physical symptoms (e.g. sore breasts) and mood symptoms (generally depression) that ONLY occur in the two weeks before a period, and completely resolve after the period (usually in first few days of bleeding) - this is what distinguishes PMDD from underlying depression or anxiety disorders. Sometimes keeping a diary of your cycle (Day 1 being the first day of your period) recording your mood (e.g. 1-10) and other symptoms, may aid your doctor to make the diagnosis.

    I'm sorry that you have been told that it is “normal”. What you are feeling is serious, and I congratulate you for looking into things further.

    PMDD can deteriorate and become a significant health issue. I encourage you to seek another opinion, either from another GP (especially one with an interest in Women's Health), or by asking for a referral to a gynaecologist or psychiatrist (who would most likely liaise with a gynaecologist regarding treatment).

    The good news is, there are effective treatments. Simple things, like regular exercise and relaxation techniques may help (and are safe to try) but, if your response is limited, medication (not life-long) is usually required.

    Medications may include the contraceptive pill - this is because the Pill changes your ovarian cycle and keeps the hormone levels lower than the natural state. The most effective treatment, however, may be a low dose of a particular type of antidepressant called an SSRI. Please note: I am not saying you have depression and need “happy pills”; SSRIs have various actions and, in very low doses, have been proven to be effective for PMDD.

    Obviously I can't make specific comments in your case without a thorough consultation, but please be aware that:

    • what you are feeling is real
    • it is serious
    • it can be treated
    And please continue seeking professional help.

    Best wishes,
    David.

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  • Dr Rosie Worsley

    Endocrinologist

    I have been a doctor for 15 years and for most of the last decade I have focused on women's hormones. I completed specialist training … View Profile

    Completely agree with Dr Moore, your symptoms sound very much like PMDD. Women with PMDD have often had some sort of premenstrual symptoms since they were teenagers, but for some women it seems to start later on. It classically worsens as women enter their 40s and get closer to menopause. 

    If you have had depression in the past, it is also possible that you are having premenstrual exacerbations of underlying depression. That is, that your hormones are triggering off depression in the same way that a lot of women with migraine find that their hormones trigger a migraine before their period.

    It can also be the case that women have depression (or another mental health condition) AND PMDD. 

    Either way, their are some very effective treatments to help manage symptoms. SSRIs probably have the most benefit, and work much more quickly in PMDD than in depression (it maybe that SSRIs prevent the conversion of progesterone to allopregnanolone in the brain, with allopregnanolone thought to be the hormone responsible for many of the symptoms). The pill helps some women, but many women with PMDD find the pill makes them worse. Hormone therapy can also be helpful. When these approaches don't work, medical menopause is sometimes needed.

    Accessing treatment can be a challenge as PMDD is still an underappreciated phenomenon. There are some good patient support groups on line where you can find information about health professionals in your area who treat PMDD.

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