Why Anxiety Gets Worse Before Your Period

By Alanna Nunez

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You’re at home or work just chilling when suddenly a voice in the back of your head whispers, “Hey, remember that time you got awkwardly close to Jen’s face at the holiday party and spit on her while you talked? Haha, that was so weird, wasn’t it? Why are you so weird?”

Yup, good old anxiety has a way of rearing its ugly head at the most inconvenient times – a big date, a work presentation, a party with friends. Frustratingly, it can even amp up right before and during your period. It’s not convenient but, unfortunately,  it’s true. Like most PMS-related symptoms, anxiety around the time of your period  has to do with how your hormones fluctuate throughout your cycle. The good news is, you don’t have to live with this forever – with a few simple tweaks, you’ll be feeling better in no time. 

menstruation 101: guide to your cycle

Before we dive in, here’s a quick refresher on what your hormones are doing before, during, and after your period: Day 1 of your cycle is the first day of your period. For most, this will last anywhere from three to seven days. During this time, estrogen and progesterone levels plummet down to next to nothing, which is partly what’s responsible for the bloating, diarrhea, and cramps many people experience. 

Next comes the follicular phase, though technically it overlaps a little with your period. This phase typically ends around day 14 of your cycle, which is when ovulation occurs. Lastly, we’ve got the luteal phase. That’s where PMS symptoms, including anxiety, really kick into high gear. Why? During the luteal phase your body’s production of progesterone goes into overdrive in preparation for potential pregnancy. That increased progesterone helps thicken your uterus. At the same time, your body sends an egg traveling merrily down your fallopian tubes where it’s fertilized – or not, in which case, your body has to rid itself of that thickened lining, and the whole cycle starts all over again with your period. 

Still with me? Good. For the purposes of this story, the two parts we care about are the luteal phase – that week right before your period begins – and the actual period itself. If you’re not pregnant, that’s when your estrogen and progesterone levels start free-falling, which some experts theorize could play a major role in worsening anxiety. 

let’s talk about hormones

Another possible culprit: cortisol. Sometimes called the stress hormone, cortisol levels rise right before your period starts, Iram Kazimi, M.D., at the University of Texas Health Science Center at Houston, told Vice in 2019. “It's possible that women suffering from this type of PMS anxiety have lower levels of anxiety throughout the month that are simply exacerbated by cortisol, rather than PMS,” she said. 

Prostaglandins may also play a role, Sharyn Lewin, M.D., FACS, FACOG, a board-certified gynecologic oncologist tells us. Thanks to the uterine contractions these hormones trigger, they play a key role in menstrual cramps, but it’s also possible they contribute to an upswing in mood swings.

Luckily, you are not doomed to watch the anxiety meter on your mental dashboard tick up every day in the week before your period. There are a few simple steps you can take to mitigate this annoying problem. 

get some shut-eye

To start, Dr. Lewin recommends practicing good sleep hygiene leading up to your period, since a lack of sleep can definitely worsen existing anxiety and contribute to new anxiety. This means no scrolling mindlessly through Twitter before bed (sorry!). She also recommends limiting your evening caffeine intake and reading a calming book, meditating, listening to soft music, or doing a restorative yoga routine to help you unwind before bed. 

say no to booze

You might also want to go easy on the alcohol, because it’s notorious for disrupting sleep, “and any kind of poor quality sleep or dehydration can make [anxiety] symptoms worse,” Dr. Lewin notes. 

get sweaty

“Exercise is also important, all the time, but especially before your period and during your period, because it releases a lot of endorphins that help with stress, anxiety, and pain relief,” she adds. Loading up on green veggies and lean meat may also help, Dr. Lewin notes. Lastly, she recommends acupuncture, which research has shown may be effective for certain kinds of anxiety disorders (that said, if you suffer from panic attacks or obsessive-compulsive disorder, acupuncture may not be right for you). 

Your anxiety shouldn’t negatively interfere with your day-to-day life or activities, Dr. Lewin cautions. If your symptoms are so debilitating that your life grinds to a halt – you can’t focus on work, you’re in so much pain you have to cancel plans with friends or family, for example – the week before your period, it’s possible you may have premenstrual dysphoric disorder (PMDD), a severe form of PMS that’s often accompanied by insomnia, anxiety, depression, severe cramps, a lack of energy, and muscle aches. If that sounds like you, talk to your doctor – lifestyle changes may help, but many women find relief from birth control pills or taking antidepressants in the second half of their cycle

Most importantly: You’re not alone if you suffer from premenstrual anxiety.  “It’s actually quite common, and there is a lot of help available,” Dr. Lewin says.

Do you get anxious right before or during your period? Share your anxiety hacks in the comments!

Alanna Nuñez is a writer and editor living in Brooklyn. She’s written for Cosmopolitan, Shape, Well + Good, Women’s Health, and more, and is currently trying (and failing, most days) to write her first novel.