Managing Hormonal Changes in PMS, PMDD and Menopause

Estrogen-Related Depressive Disorders: Managing Hormonal Changes in PMS, PMDD, and Menopause

Could your depression be hormonal? PMS, PMDD, menopause, and perimenopause often trigger mood shifts and physical symptoms. Many women experience emotional ups and downs without realizing that hormones may be the root cause. By tracking patterns in your mood and body, you may uncover a connection to these age-related hormonal changes. Identifying and managing hormonal changes in PMS, PMDD, peri and postmenopause can offer meaningful relief.

Consider these estrogen-related depressive disorders:

• Premenstrual Syndrome (PMS) (20s to early 40s)

• Premenstrual Dysphoric Disorder (PMDD) (usually mid-20s to mid-30s)

• Postpartum Depression (during childbearing years, after childbirth)

• Perimenopause (mid to late 40s to early 50s)

• Menopause and Post menopause (51 years and older)

  The above ages vary by person.

  The above are often recognized as cyclic changes or changes related to age.

  
  

  

  Mood Swings

PMS and PMDD

Most of us know what premenstrual syndrome (PMS) is: a few days before a period, some people develop moodiness, sadness, headaches, anxiety, fatigue, restlessness, sleep or appetite changes, aches and pains, acne, temporary bloating or weight gain, and a whole mix of other symptoms. This cluster of physical and emotional changes is PMS.

Premenstrual Dysphoric Disorder (PMDD) is a more severe, debilitating form of premenstrual symptoms. PMDD is not caused by poor coping — it reflects a heightened biological sensitivity to the normal hormonal shifts of the menstrual cycle. People with PMDD may experience intense anxiety, crying spells, anger or irritability, exhaustion, low self-esteem, hopelessness, and a loss of interest or pleasure in things they usually enjoy. For some, these symptoms can include thoughts of suicide.

The pattern is striking: Symptoms build in the days before a period, and then, a few days after bleeding begins, they often disappear as suddenly as they arrived.

Perimenopausal and Postmenopausal Depression.

Older people sometimes develop depression around menopause because of the fluctuations of estrogen and progesterone at that time. During the perimenopausal and postmenopausal years, estrogen and progesterone levels go down and stay down. This causes a decrease in serotonin levels, which, in turn, can cause depression. This is more inclined to happen to those who have a history of depression.

These disruptive symptoms can make daily life feel unmanageable, but understanding their hormonal root is the first step in managing hormonal changes in PMS, PMDD & menopause. With the right guidance and support, many people find meaningful relief and regain emotional balance.

A Note About Postpartum Depression

During postpartum depression, similar changes can occur when estrogen levels drop following the birth of a baby. In this case, a new mom might develop crying spells, feelings of hopelessness, difficulty bonding with the baby, withdrawal, and other signs of depression. The new mother may experience significant changes in behavior. All new mothers should be evaluated for this by their healthcare providers at any check-up appointment. In fact, it can occur at any time up to six weeks after the delivery of a baby. 

Because of biological sensitivity to hormonal shifts, a change in lifestyle (especially sleeping and the stress of being a new mom), neurochemical vulnerability (changes in serotonin, dopamine or other neurotransmitters), those with prior mental health problems like depression, anxiety, bipolar and others may be more prone to postpartum depression.

On the other end of the spectrum, research shows that after childbirth, many new mothers experience a surge of positive emotions after childbirth. Hormonal changes in the brain undergo major changes (1). A new mother tends to have increased energy, increased feelings of reward, a more positive mood, and a new sense of purpose that grows from the experience of childbirth: bonding, caregiving, and emotional nurturing. They focus on creating a positive, rewarding environment for the child. Subsequently, focus shifts outward from themselves toward their babies.

If you feel that you or someone you know may have postpartum depression (or other unusual behaviors after delivery), please call the National Hotline for Depression After Delivery at 1-800-944-4773.

​​​Approaches to PMS, PMDD, Postpartum Depression, Perimenopausal and Postmenopausal Depression

General Approaches

• Lifestyle modifications (sleep, healthy diet, regular exercise, and reducing exposure to stress)

• Seek support from a friend or family member, or a support group, to provide support (this is important)

• Cognitive behavioral therapy or talk therapy

• Keep a diary of symptoms to identify trends and patterns

• Acupuncture (especially in those with PMDD)

• Relaxation exercises: Yoga, meditation, progressive muscle relaxation, guided imagery, and others

• Inform a healthcare provider about any concerning symptoms

• Listen to good music - this is known to increase endorphins ("happy" hormones)

• Spend time in nature - even brief outdoor moments can calm the nervous system

• Get morning sunlight to support mood and sleep rhythms

• Engage in creative activities (art, writing, crafting, dancing)

• Establish a predictable daily routine to stabilize mood

• Limit alcohol and caffeine, which can worsen mood swings and sleep

• Try warm baths or heat therapy to relax the body and mind

• Practice slow, mindful breathing to reduce stress

• Use aromatherapy (see below)) to support relaxation

• Watch or listen to something that makes you laugh or smile

• Reduce overstimulation (news, social media, multitasking)

Over-the-Counter Medicines

There are plenty of over-the-counter medicines for physical symptoms of PMS and minor PMDD, but none for mood or emotional symptoms. Examples of those that may help with cramps, headaches, back pain, and general physical discomfort.

• NSAIDS (common: Ibuprofen/Aleve) - For physical discomfort of PMS and PMDD

• Aspirin, acetaminophen, caffeine combinations (common Pamprin) - Primarily for physical discomfort in PMS and PMDD

Considered Herbal and Natural Support

Some herbal and nutrient options have been studied for PMS—and a few for PMDD and menopause. None are cures, and most work best alongside lifestyle changes and, when needed, prescription treatment. Evidence is strongest for chasteberry, saffron, certain vitamins/minerals (like magnesium, B6, calcium), omega‑3s, and ginger. Others are more traditional or early‑stage options. Always check with a clinician, especially if you take other medications or have complex health conditions.

• Ashwagandha - May help mood or stress related to any of the above hormonal-related issues

• Gingko Biloba - May help with certain menopause‑related cognitive symptoms, but evidence for PMS is limited, and it is not a treatment for PMDD or hormone‑related mood symptoms

• Chamomile - May help with hormone-related mood problems, especially general anxiety and/or sleep issues

• Sage - Especially noted for menopause related hot flashes*

• Lavender May help with PMS‑related anxiety, irritability, or sleep problems, but it has not been proven to treat PMS as a whole.

• St Johns Wort - May help depression related to any of the above estrogen-related problems. Note: There are lots of potential interactions

• Multivitamins and Minerals - especially Vit E (physical symptoms related to PMS), magnesium, B6, and calcium may help PMS

• Omega 3 - May help with mood and pain in PMS, PMDD, and menopause support

  Ginger - Especially for PMS - especially for physical symptoms - and possibly helps PMDD

• Curcumin - Especially mentioned for PMS and possibly menopausal symptoms

• NAC - Possibly supportive of physical symptoms of PMS and mood; questionable for PMDD and menopause

• Saffron- May help with mood and hormone-related conditions

• Primrose Oil - Possibly helpful in PMS and menopause           

• MACA - Possibly helps with menopause

• Chasteberry - PMS, limited evidence for PMDD, and menopause)​​​

• ​Royal Jelly is also cited for menopause and possibly for PMS, both with limited evidence

• Fermented Soy - Perimenopause, menopause

• Black cohosh - Perimenopausal symptoms, like hot flashes, some physical and possibly mood

• ​Valerian - May help with PMS and PMDD -related tension, sleep, and anxiety, but overall evidence is limited. May help sleep problems related to menopause (again, limited)

• Garden of Life Dr. Formulated PMS Support - has some recommended individual ingredients for PMS: Primrose, Ginger, Saffron, vitamins, and minerals. (Available over the counter in some pharmacies)

​Prescriptive Treatment 

• Hormone Replacement Therapy (HRT) - (for perimenopausal and postmenopausal symptoms). There are several forms of this, including estrogen/progesterone patches, creams, oral medications, intravaginal cream, gels, injections, and others. They are used to replace the lost hormones, which, in turn, may stabilize mood. Some of these may be contraindicated in certain cancers and can cause blood clotting problems, particularly in smokers.

• Oral contraceptives (esp. monophasic) (PMS, PMDD). These help to stabilize estrogen and progesterone levels. This, in turn, can help with physical discomfort and mood problems that accompany menstruation. These may be contraindicated in those with some underlying health conditions.

• Antidepressants like SSRIs (serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are the first-line medications for those with significant PMS, PMDD, postpartum (occasionally), menopausal, and postmenopausal depressive symptoms.

Zurzuvae is a new medication recently approved by the FDA that claims to more rapidly treat postpartum depression. It works with the neurotransmission of GABA (a "calming neurotransmitter in the brain). There are some contraindications to and warnings regarding this medication (not to mention the fact that it is new and I am always skeptical of very new drugs: They may be great, but only time and trials will tell). 

If you have PMS or PMDD, are depressed during or after menopause, or have postpartum depression, try lifestyle changes. If those do not work or if you are severely depressed, please see a healthcare provider ASAP. Things can be done, and there is help out there!

​​​Testosterone Changes in Males

So, what about men and testosterone? Let's not forget them and their moods!

Around the ages of 30 to 40, a man’s testosterone levels typically begin to decline gradually. Over time, this can lead to physical and emotional changes. A male may notice loss of muscle mass, erectile dysfunction, reduced sex drive, irritability, anxiety, decreased memory or focus, and increased fatigue, among other symptoms.

Some studies suggest that lower testosterone may contribute to mood changes such as depression, but studies are inconsistent and not conclusive. Mood changes in midlife can be related to many factors—hormonal shifts, physical health, stress, lifestyle, and social changes—so low testosterone is only one possible contributor.

Numerous resources show that lifestyle factors can also influence testosterone levels. Obesity, low physical activity, certain medications, chronic stress, poor sleep, alcohol or drug misuse, and smoking can all contribute to lower testosterone.

General Approaches to Increasing Testosterone

Because many lifestyle factors can contribute to low testosterone, the best first step is often to focus on healthy habits.

• Healthy diet

Eating a balanced diet that supports overall metabolic health can help maintain healthy testosterone levels. Foods rich in protein, healthy fats, leafy greens, and minerals—such as lean meats, eggs, salmon, oysters, avocados, garlic, onions, bananas, and leafy greens—are commonly recommended.

• Regular exercise

Both aerobic activity and strength training can support testosterone levels, especially in men who are overweight or inactive.

• Adequate sleep

Poor or insufficient sleep can significantly lower testosterone. Prioritizing consistent, restorative sleep is important.

• Avoid smoking and limit alcohol

Smoking and heavy alcohol use can negatively affect hormone levels.

• Maintain a healthy weight

Weight loss can meaningfully improve testosterone levels in men with obesity.

• Review your medications

Some prescription medications can lower testosterone, including spironolactone, opioids, glucocorticoids, ketoconazole, certain chemotherapy drugs, and occasionally beta blockers or statins. If you’re concerned that a medication may be affecting your hormone levels, don’t stop it on your own—talk with your healthcare provider. There are often alternatives.

Over-the-Counter (OTC) Medications

Most over‑the‑counter “testosterone boosters” are actually supplement blends. They typically contain one or more of the ingredients listed in the section below on herbal and alternative remedies (especially DHEA, along with herbs, vitamins, and minerals). These products are marketed for testosterone support, but their effects vary and are not the same as prescription testosterone therapy.

Considered Herbal and Alternative Remedies

• Zinc

• Grape seed extract - No direct correlation (animal studies only) - used for general wellness and circulation support.

• Omega-3 - Great source for overall health - questionable reliability

• Quercetin - Quercetin does not reliably increase testosterone in humans. Most of the “testosterone‑boosting” claims come from animal studies or cell studies

• Ashwagandha - This is one of the few herbal supplements with some human evidence suggesting it may modestly increase testosterone, but this effect is typically seen only in chronically stressed, sedentary, or infertile men. Because ashwagandha can lower cortisol levels, this stress‑reducing effect may partly explain the small increases in testosterone observed in studies. Overall, the changes are minimal and not comparable to medical treatment (2).

• Panax Ginseng - Panax ginseng has some human evidence suggesting it may support sexual function; it only slightly increases testosterone levels — the effect is small, inconsistent, and not strong enough to treat low testosterone (3)

• DHEA (Dehydroepiandrosterone) - DHEA can slightly increase testosterone levels in certain populations: Older men (esp. over 50), and in women (4), among others.

• Fenugreek - Some studies show this may help increase testosterone levels modestly in some men. (5)

• Magnesium - Helps maintain adequate testosterone.

• Vitamin D may increase testosterone in vitamin D-deficient men, but it will not increase testosterone in those with normal vitamin D levels.

  
  

Those who feel their testosterone may be low—especially if there’s been a sudden, noticeable change in mood or other symptoms without a major lifestyle shift—should consult a healthcare provider. A clinician can rule out other medical issues that can cause similar symptoms, such as high cholesterol, high blood pressure, diabetes, or other underlying conditions, and can also check testosterone levels.

If levels are low, testosterone replacement therapy may be prescribed. People can also order tests to do at home (tests online) or through labs like Quest or LabCorp - Where you would go to have your labs drawn.

Note: High testosterone levels can cause real harm. Excess testosterone has been linked to an enlarged prostate, possible cardiovascular issues (the evidence is mixed), acne, irritability or aggressive behavior, low sperm count, high blood pressure, liver strain, increased body hair, weight gain, testicular shrinkage, and sometimes swelling in the extremities. You don’t want to be that guy.