Carrie’s journey through perimenopause was plagued with insomnia; her mood was also affected. “I didn’t know how to deal with menopause at all. I had a lot of emotional issues at the time. I feel like I wasn’t myself. I was very stressed. I was anxious. My body didn’t feel right. I was a mess. I didn’t know what was happening to me.”
PMS during perimenopause can be more severe and less predictable. PMS describes a constellation of symptoms that include depressed mood, anxiety, irritability, and mood swings as well as other physical symptoms. It occurs before the menstrual period, at which point symptoms typically go away for a period of time.
The exact cause of PMS is unknown, but relates to the impact of rapidly changing ovarian hormone levels impacting brain neurotransmitters including, specifically, serotonin. “Perimenopausal PMS” has not been specifically studied, but is likely to respond to all of the therapies that work for regular PMS.
If you’ve ever used deep breathing to overcome anxiety or used a good workout to conquer anger, you may already know that the body has a chemical way of overcoming these powerful emotions. Both exercise and relaxation can help ease the emotional static of PMS. They are actually our top picks for getting out of a “blue mood.”
Exercise, PMS, and mood
Virtually every study on exercise shows that it improves PMS. In addition, women with PMS who stop exercising tend to notice their PMS gets much worse. While the PMS and exercise studies are not randomized controlled trials, the overall health benefits of exercise combined with evidence for an improvement in PMS symptoms make it a first-line therapy for PMS.
A number of studies have shown that regular exercise can help lift depression. In fourteen controlled studies, aerobic exercise worked just as well as psychotherapy in treating mild to moderate depression. Besides relieving depression, exercise lessens anxiety and negative attitudes, and serves to boost self-esteem and life satisfaction.
The relaxation response
Stress has been correlated with increased severity of PMS symptoms. While at the Mind/Body Medical Institute, Harvard psychologist Alice Domar, PhD, attempted to test this hypothesis. Collaborating with her colleague Irene Goodale, Ph.D., she designed a study to determine whether utilizing the RR to decrease the body’s response to stress would result in reduced severity of PMS.
In her five-month study of 46 women with diagnosed severe PMS, the women were randomly assigned to three groups. In the first group, women charted their symptoms twice a day. In the second group, the women read leisure materials twice a day. Women in the third group listened to audiotapes to elicit the RR twice a day. At the end of five months, the women who practiced relaxation showed a 58 percent improvement in all PMS symptoms, compared to 27 percent improvement in the reading group and 17 percent improvement in the charting group.
Prescription therapies to address PMS and mood concerns
Selective serotonin reuptake inhibitors (SSRIs) constitute the primary pharmacologic therapy for PMS. Two of these antidepressants (Sarafem and Zoloft) are currently approved for premenstrual dysphoric disorder (a severe form of PMS).
Interestingly, these medications work very quickly – within a matter of days. Furthermore, women with PMS can take the medication only during the premenstrual time period and still get relief. (This is unlike the pattern seen in depressed patients who take these medications daily.) However, figuring out just when that premenstrual time period is can be difficult during perimenopause when cycles become irregular.
Can estrogen improve your mood? Some evidence suggests that estrogen has a positive effect on areas of the brain involved in the regulation of mood and behavior. And, in fact, estrogen has been shown to improve adverse mood symptoms, in particular, depressed mood in women during the perimenopause. This evidence is based on a few small studies.
These suppress hormone activity and induce a menopausal state. Because perimenopausal “PMS” improves after menstrual periods stop totally, a GnRH agonist, like Lupron, can be used to induce artificial menopause. This therapy is now used less often than SSRIs.
There are also some natural herbal supplements, like Menozac, which can help you relieve PMS/menopause symptoms, balance your hormone levels and improve overall health during and after menopause without the unwanted side effects. Alternative medicines work for the majority of people and are a great way to ease menopausal symptoms naturally.