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Managing Hormonal Changes in PMS, PMDD and Menopause

  • Victoria Wermers, RN,MSN,FNP, PMHNP
  • Nov 11, 2024
  • 6 min read

Updated: Jul 29


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:

  • 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 Postmenopause (51 years and older)

    The above ages are variable: they may vary from person to person.

    These are often recognized as cyclic changes or changes related to age.


    Mood Swings
    Mood Swings

PMS and PMDD

Most of us know what premenstrual syndrome (PMS) is: A few days before a period, some females develop moodiness, depression, headaches, anxiety, fatigue, restlessness, sleep and appetite problems, aches and pains, acne, transient weight gain, mood changes, and a whole host of other problems. This is PMS. Premenstrual dysphoric disorder (PMDD) is another, more severe, form of PMS, which can be debilitating. When a person is unable to cope with their PMS symptoms, PMDD can develop. Those with PMDD develop extremes of anxiety, crying, anger, and irritability, fatigue, low self-esteem, hopelessness, typically a lack of energy and enjoyment in things they normally take pleasure in, among other things. Sometimes, this depression intensifies to the point of suicidal ideation (a drive to commit suicide). A few days after the period starts, BOOM, as suddenly as it appeared, it's gone.


How do people get this way? It's all about the hormones. The underpinnings of PMDD are complicated, but many researchers cite changes in the neurotransmitters glutamate, GABA, dopamine, and serotonin as a cause. During the menstrual cycle, predictable changes in the hormones estrogen and progesterone levels occur. Just before a period, estrogen and progesterone levels in a person's body begin to drop. These typically go back to normal when the period ends. When these hormones drop, there is a corresponding decrease in serotonin (a "happy" neurotransmitter), which can profoundly affect the mood. There are sometimes environmental or hereditary components that may contribute to this response (basically, if it happened to your mom, it may happen to you).



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. New mothers should all be evaluated for this by their healthcare providers when they have any check-up appointments. In fact, it can occur at any time up to six weeks after the delivery of a baby. 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 decreased exposure to stress)

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

  • Cognitive behavioral therapy, talk therapy

  • Keep a diary of symptoms

  • Acupuncture (especially in PMDD)

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

  • Inform a healthcare provider

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


Over-the-Counter Medicines

There are plenty of over-the-counter medicines for physical symptoms of PMS and minor PMDD:

  • 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


​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

And what about men and testosterone? Let's not forget them and their moods.

​Around the ages of 30 to 40, a man's testosterone usually starts to decrease. Physical changes take place over time: A person may start losing muscle mass, experience erectile dysfunction, a diminished sex drive, irritability, anxiety, decreased memory or focus, and perhaps more fatigue, among other changes. Some studies indicate that lower testosterone can also cause mood problems like depression, but those studies remain inconsistent and inconclusive. this kind of mood change can be due to low testosterone, but by the same token, might be due to other physical and social changes as one moves on in life. 

Lifestyle can also contribute to low testosterone. Things like obesity, lack of activity, some medications, stress, lack of sleep, alcohol and drug abuse, and even smoking can affect your testosterone levels.


General Approaches to Increasing Testosterone

Since so many lifestyle factors can cause low testosterone, the best initial approach might be to make some lifestyle changes.

  • Healthy diet: More protein (lean beef, chicken, eggs), leafy greens, bananas, honey, salmon, oysters, garlic, onions, avocado, and others.

  • Exercise (more aerobic and weight lifting)

  • Adequate sleep

  • Don't smoke or drink alcohol

  • Loose weight

  • Review your medications: 

    Occasionally, prescription medications can lower your testosterone levels: Some of these include blood pressure medications (esp. spironolactone, beta blockers), cholesterol medications, chemotherapy, antifungal medications (ketoconazole), and opioids. If you feel that your medication may be causing low testosterone, don't just come off the medicine - speak to your healthcare provider first. There are usually substitutes.

​

Over-the-Counter Medications

Most over-the-counter "testosterone boosters" contain one or more of the remedies mentioned in the section just below "Considered Herbal and Alternative Remedies" (especially DHEA).

​

Considered Herbal and Alternative Remedies


​Those who feel like their testosterone is low, particularly if a profound, sudden shift in mood and other symptoms has taken place (in the absence of a major lifestyle change) should consult with a healthcare provider who can rule out other problems (like high cholesterol, high blood pressure, diabetes and other diseases that can cause the symptoms above). and check testosterone levels. If low, testosterone replacement therapy can be prescribed (People can also order hormone tests online or order through labs like Quest or LabCorp and go in to have them drawn). 

​

Note: Be aware that high testosterone levels can do a lot of harm: Too much testosterone can cause an enlarged prostate, may contribute to heart problems (controversial), acne, aggressive behavior, low sperm count, high blood pressure, liver problems, excessive body hair, weight gain, testicular shrinkage and sometimes swelling of the extremities. You don't want to be that guy.





 
 

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