PMS and the brain: is it all in our heads?

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Ladies.  We all know it, we all dread it, and we’ve all 100% been in the grips of our loathed monthly funk, otherwise known as premenstrual syndrome (PMS). While most people (both women and men) live in fear of those three little letters, there’s a common belief that it’s actually all in our heads.

This debate resurfaced after a review was published concluding that there was no clear evidence of the existence of a “specific pre-menstrual negative mood syndrome” in the general population. Apparently, women are using their period as a biological license to be angry, moody and irrational for a number of days every month.

Now I’m happy to agree that PMS is all in our heads, but that doesn’t make it a myth or a made-up phenomenon. There is a whole lot of evidence out there demonstrating the powerful influence our reproductive hormones have on our brains. As we know, brain chemistry underpins our emotions, our thoughts, our mood, and our behaviour. In the days leading up to menstruation, our levels of oestrogen, progesterone and testosterone jump on a roller-coaster ride that can wreak all kinds of havoc in the brain, the mind and the body.

What is PMS?

PMS refers to the wide range of physical and emotional symptoms that women experience in the lead-up to their period. Most women suffer from one or two symptoms of PMS, but the number and intensity of these symptoms varies a great deal from one woman to the next, and also from one cycle to the next.

Some common symptoms of PMS include:

• Irritability
• Anxiety
• Lower coping ability
• Wanting to be alone
• Difficulty concentrating
• Mood swings
• Fluid retention
• Bloating around the abdomen
• Sore boobs
• Skin breakouts
• Headaches and/or migraines
• Tiredness, lethargy and insomnia
• Food cravings

Hormones and mood

Recently, a lot has been discovered about the widespread effects our reproductive hormones have on brain function, structure and circuitry. These hormones (oestrogen, progesterone and testosterone) are produced in response to signals and other precursor hormones that are triggered by the pituitary gland; an area of the brain that controls our growth, development and the functioning of the endocrine (hormone) system.

Oestrogen has actually been shown to be a ‘protective’ agent in the brain, through its impact on dopamine and serotonin; two brain chemicals that regulate our mood. This helps explain why some women report feeling mentally and emotionally worse in the low-oestrogen phase of their cycle, which you guessed it, is the few days leading up to your period.

A drop in levels of progesterone can also elicit lowered moods, as well as cravings for carbs and sugary foods, which many women experience. Women treated with bioidentical progesterone at this time of the month show reductions in food cravings, and more stable moods.

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One study recruited women who consistently experienced steady moods and little to no symptoms of PMS to investigate their brain function in the lead-up to their periods. They found that these women actually experienced a boost in activity in the medial orbitofrontal cortex; a part of the brain underpinning emotional control. It was thought that a boost in this area of the brain might help regulate emotions while hormones surge, while for others; this boost in emotional control might not be present.

PMS and cognitive function

Brain fog, difficulty concentrating, and distraction levels high? Poorer cognitive function is another symptom of PMS experienced by many women. This is also a symptom that often extends past the PMS phase, thanks to our old friend abdominal cramps.

A recent study demonstrated the negative effects of period pain on the ability to perform a range of complex tasks. Women suffering from period pain had greater difficulty with tasks requiring higher levels of attentional control, as well as slower completion times and lower accuracy.

One study compared women during different phases of their menstrual cycle, and found that those in the mid-luteal phase (the week leading up to your period) were more reactive to negative stimuli, compared to women in other phases of their cycle. It was suggested that increased negative reactivity might explain the lower stress tolerance that many women experience during PMS.

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It's only temporary! 

Different phases of the menstrual cycle affect a woman’s brain in a number of ways. Unfortunately, those few pesky days leading up to your period are where we do it the toughest; thanks to the widespread effects our hormones have on our brain circuitry, and therefore our mood, emotions, cognition and behaviour.

So if you find yourself in those dreaded few days where you’re crying over a jellybean, and realise that Aunt Flo’s visit is fast approaching, remember there’s a lot going in that brain of yours that is very much out of your control. Be kind to yourself, listen to your body, go for a walk, or eat the pretzel (but try not to kill anyone), because your brain’s doing the best it can to deal with the onslaught of hormonal fluctuation. 

And to the men out there (thanks for sticking with me here), just remember it’s only temporary. In a few days your wife/girlfriend/sister/mother/friend will be back to her normal self, and that brain of hers will be firing at its best again. In the meantime, try to avoid telling her it’s all in her head – you’ll probably live to regret it, regardless of how right you are.

For some women, PMS can bring on extreme mood disturbance called PMDD (Pre-menstrual dysphoric disorder). Consult your doctor if you feel your symptoms are more serious.