Why Does My Anxiety Flare Up A Few Days Before My Period? A Psychologist Answers

Doctor of Clinical Psychology By Perpetua Neo, DClinPsy
Doctor of Clinical Psychology
Perpetua Neo, DClinPsy, is a psychologist and executive coach who received her clinical psychology doctorate from University College London. She has been featured in Elle, Forbes, Business Insider, and elsewhere.
Woman experiencing period anxiety

This year has been one of the most challenging years in modern history, one that has taken a toll on our mental and physical health. To help you through it, we launched Experts On Call, a new series in which top-tier health and well-being experts answer your questions—however big or small—to help you find solutions, put together a game plan, and make each day a little bit easier. Don't forget, you can ask questions anytime, and we'll do our best to find the right expert to point you in the right direction. Without further ado, here's another edition of the series with a question from reader Emily.

I’ve noticed that my anxiety is higher in the days leading up to, or the first few days of my period. Is this normal? What steps do you recommend to help balance my anxiety throughout the month?

—Emily

Experiencing anxiety in the days leading up to menstruation is normal for many people. The extent to which someone feels the effects will vary, though. Here are a few possible reasons for having pre-period anxiety and some tips for managing it:

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Why anxiety might flare up before a period:

1. Natural hormonal changes. 

In general, the human body undergoes a lot of hormonal changes throughout the menstrual cycle. To prepare for pregnancy, the body will increase hormone production. If an egg is not implanted, those hormone levels drop again. 

As these hormones fluctuate, the neurotransmitters in the brain and the gut will change as well. These neurotransmitters (namely serotonin and dopamine) help regulate mood, so it's not abnormal to experience anxiety or irregular emotions during this time of the month. 

2. You're anticipating the changes.

Some people might also get anxious over the anticipation of their period and the changes that it brings. Periods can be physically uncomfortable, inconvenient, or painful, so it's natural to worry (or dread) what's coming. 

If a person is fixated on losing weight or building muscle, the fear of becoming bloated or puffy during their period can be stressful. These changes are biological, though, and part of the normal human cycle. It's important to accept them and normalize them so they don't harm our mental fitness. The bloat and pain won't last forever, but recognizing that they may happen every month is an important part of setting realistic expectations. 

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3. You may have an underlying condition. 

A small percentage of women (about 3 to 8%) experience premenstrual dysphoric disorder (PMDD). This condition occurs about one to two weeks before menstruation and is characterized by a significant increase in mood disturbances. 

Though PMDD symptoms feel like full-blown anxiety or depression, they tend to disappear after the period ends. Symptoms of PMDD could include intense mood swings, trouble focusing, extreme tiredness and fatigue, extreme appetite changes, physical pain, irritability, and trouble sleeping. 

Those who are predisposed to anxiety disorders, such as generalized anxiety disorder, panic disorder, claustrophobia, agoraphobia, or social anxiety, may experience premenstrual exacerbation (PME). The two are similar and can be hard to distinguish, but anyone who already has a history of mood disorders is more likely to fall into the PME category. 

How to manage period and pre-period anxiety. 

If your period symptoms are interfering with your quality of life, it's important to seek help from a physician and/or mental health professional. If the symptoms are relatively mild, though, there are a few ways to help manage this anxiety both before and during menstruation:

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1. Understand the natural cycle. 

Doing research on the hormonal changes that are happening in your body, or speaking to people who experience similar symptoms, can help make sense of and normalize what's happening to you during your period.

Recognizing that these changes will not last forever and can be managed, both physically and mentally, helps give a sense of control over the situation. 

2. Acknowledge your anxiety without judgment. 

When negative thoughts come into our heads, many people try to repress them. When that happens, instead of making them go away, those feelings will grow and come back with a vengeance. To keep this from happening, speak your feelings out loud or write them down. 

Don't judge your thoughts; just name them so they no longer have power over you. Then, work on getting out of your head and back into your body. One way I recommend grounding yourself is by shuffling your feet on the floor until you feel contact between the soles of your feet and the surface you're standing on. 

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3. Practice deep belly breathing. 

Deep breathing exercises help activate the parasympathetic nervous system (aka the rest-and-digest function of the brain.) Follow these steps to reduce anxiety through the breath:

  1. Breathe in through your nose, filling your belly so that it expands outward.
  2. Breathe out, expelling all the air. 
  3. Repeat at least 3 times.

When practicing this breathwork, the mind can't focus on anything (including anxious thoughts) except for the natural process of breathing in and breathing out. 

4. Show yourself compassion. 

People with anxious personalities tend to live in more punitive mindsets and constantly judge themselves. Research suggests that showing compassion to ourselves is important not only for our sanity and well-being but also for performance—particularly for people with type-A personalities. 

A few ways to show compassion to yourself is by making tea, going for a walk, or taking a magnesium supplement (magnesium tends to diminish when we're anxious and may interfere with quality sleep.) 

5. Stop looking out for anxious symptoms. 

If anxiety is going to occur, it's important to have the tools to help manage it. However, looking out for symptoms of anxiety or panic to prepare may only create the problem. Try not to plan for the worst—worrying doesn't solve problems; problem-solving does.

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