Tame your “raging hormones”

Thirty years ago, hormones were all the rage — literally. In 1970, a prominent doctor and political adviser named Edgar Berman infuriated feminists when he made an outrageous statement: that women’s “raging hormonal influences” should preclude them from holding positions of power.

Today, most people, and thankfully doctors, know better. In general, our bodies regulate these natural hormonal fluxes with precision and finesse. But because our female brains are wired to be highly responsive to sex hormones, sometimes these vital hormones exert negative effects, dampening our moods, making us irritable, or sparking a case of the blues or, in rare cases, a serious mental disorder.

According to Deborah Sichel, M.D., a psychiatrist specializing in female mood disorders at the Hestia Institute in Wellesley, Mass., and the co-author of Women’s Moods (William Morrow, 1999), estrogen acts as a natural “upper” and mood stabilizer in the brain, while progesterone is more of a “downer.” The interplay between these mood-altering hormones and brain chemicals such as serotonin — which rises and falls with estrogen and must remain at certain levels to prevent depression and anxiety — helps to maintain our emotional balance. But kinks in this interaction appear to be at least partially responsible for the fact that women are twice as likely as men to develop depression and anxiety disorders, especially during times of major hormonal change. Here are four of those times:

1. Before your period

The week or so before the menstrual period is often characterized by symptoms of premenstrual syndrome (PMS). “Up to 85 percent of women experience at least one symptom of PMS,” says Joseph T. Martorano, M.D., a New York psychiatrist and author of Unmasking PMS (M. Evans & Co., 1993). These include a spectrum of moods — sadness, irritability, anxiety, confusion — that can range from mild to severe, along with physical symptoms that may include breast tenderness, abdominal bloating and headache. Between 3 and 7 percent of PMS sufferers have symptoms that are so incapacitating that they interfere with daily life. PMS usually lasts two to five days, but may plague some unlucky women for up to 21 days out of each 28-day cycle.

Unfortunately, there are no tests to confirm that you have PMS, and relatively few treatments for it are available. This dearth exists because doctors are not exactly sure what causes the syndrome. Currently, the most-discussed medical theory is that PMS sufferers are extra-responsive to hormonal fluctuations.

Over the course of the menstrual cycle, estrogen and progesterone levels increase and decrease predictably. At the start of each 28-day cycle (defined as the first day of your period), estrogen and progesterone levels are low. Then, on about day seven, estrogen starts to rise. It peaks around day 13 or 14 (just before ovulation takes place), and then suddenly drops and stays low for several days. Estrogen levels spike again between days 21 and 24 before taking a final slope downward. This latter fall in estrogen is accompanied by a surge in progesterone levels around days 19-27.

“Women with PMS have normal amounts of estrogen and progesterone, but it seems that their brains may be sensitive to changes in the levels of these hormones,” says Nada Stotland, M.D., professor of psychiatry and obstetrics and gynecology at Rush Medical College in Chicago. Martorano concurs, suggesting that progesterone might be to blame, while Sichel and others implicate estrogen or both hormones as the culprits.

2. During and after pregnancy

Pregnancy and the birth of a child are among the happiest times of a woman’s life — or so most people believe. But a new British study of 9,000 women suggests that 14 percent experience prenatal depression — although most cases escape detection by OB-GYNs or even by the women themselves. Instead, women suffer silently, too stigmatized to acknowledge that they are feeling low at a time when society says they should be ecstatic.

Hormones again appear to be a key precipitator since pregnancy is characterized by huge hormonal shifts as estrogen and progesterone levels rise dramatically, along with the stress hormone cortisol. These surges, which are necessary to support the developing fetus, may overwhelm a woman’s brain chemistry, potentially triggering swift, varying and irrational moods, Sichel says. In rare instances, hormone changes during pregnancy can even kick off serious mental illnesses, such as a major depression or postpartum psychosis.

After giving birth, when hormone levels suddenly plummet, up to 80 percent of women might experience several days of feeling down (the typical “baby blues”), characterized by crying, anxiety, irritability and difficulty sleeping. These symptoms usually begin three to four days after delivery and continue for about 12 days. In most cases, they resolve on their own.

However, approximately 10 percent of new mothers who have never suffered from depression (excluding postpartum depression) before will have major or minor depressive symptoms — such as despondency, guilt, worry, bizarre or suicidal thoughts and an inability to cope — after giving birth. This type of mood disorder typically strikes immediately after the birth and may last for several months or even years if it remains undiagnosed or is left untreated. “Women who have had severe PMS, postpartum depression and major depression before are at particularly high risk,” reports Peter Schmidt, M.D., an investigator with the National Institute of Mental Health. Such women may have been suffering from undiagnosed depression throughout the duration of their pregnancies.

Another British study shows that women are at a greater risk for psychosis during the three months after they’ve given birth than at any other time of life. Sichel says that one in 1,000-3,000 women may experience hallucinations, delusions, agitation and confusion.

Frightening news stories, like that of Andrea Yates, the Houston-area mother who confessed to drowning her five young children last year, and who may also suffer from schizophrenia, suggest that in rare cases postpartum psychosis may even drive new mothers to violence against their children.

3. Stressful times

Like falling estrogen levels, stress can alter your brain chemistry and deplete serotonin. A body that’s under stress reacts by releasing hormones that will help it respond to a perceived physical or emotional challenge, says Sarah Berga, M.D., professor and director of the Division of Reproductive Endocrinology and Infertility at the University of Pittsburgh School of Medicine. The production of these stress hormones, such as cortisol, puts the body and brain on high alert, but it stops when the stress abates.

But what if stress doesn’t subside? In the familiar case of chronic, unrelieved stress, the body begins to react to minor triggers, such as the changes in estrogen and progesterone that occur premenstrually. The body then finds it increasingly difficult to discontinue the production of stress chemicals and to relax. This state of hyperalertness, or what Sichel calls “brain strain,” can eventually disrupt the brain’s functioning and lead to mood alterations, as well as physical symptoms such as headaches, stomach woes and fatigue.

“The impact of estrogen and progesterone fluctuations on your stress level depends on both the state of the brain when the fluctuations occur and the extent of the changes,” Berga says. If you are already stressed out when a hormonal surge or dip occurs, you are more likely to experience a mood effect. “A major change in your hormone levels, such as during pregnancy and after delivery, can serve as a stressor in and of itself, magnifying the effects of other stressors in your life,” she adds. “Likewise, other stresses in your life can magnify the effects of hormone changes.”

4. Medications

Among the medications that can trigger mood changes: oral contraceptives. Study results from the Kinsey Institute for Research in Sex, Gender and Reproduction published in the journal Contraception found that the birth control pill can have significant adverse effects on mood in 40 percent of women, increasing the likelihood of early discontinuation. Yet some women never make the connection between mood changes and oral contraceptives. “Women may not notice their negative mood because they have been on the pill for so long, they don’t know what their mood would be like if they were off hormones,” says Sichel.

On the other hand, oral contraceptives are widely prescribed for the treatment of PMS, even though few data support their effectiveness, according to the American College of Obstetricians and Gynecologists. Still, some medical experts, such as Sichel, believe women who are sensitive to the changing levels of hormones across their natural cycle are helped by stable doses of the pill.

More problematic is the injectable Depo-Provera, which with each quarterly treatment reduces estrogen levels to below normal and gives you a giant dose of progesterone, Berga says. The five-year contraceptive implant Norplant also can affect mood, although hormone levels tend to return to normal soon after the rods are surgically removed.

Likewise, fertility drugs (such as Pergonal, Clomid and Metrodin) that raise estrogen to 10 times the normal level to induce ovulation are notorious, she says, for causing mood swings, depression, irritability and hostility. (While estrogen is an “upper” when released naturally during the menstrual cycle, at high doses it has the opposite effect, Sichel says.)

Your best defense

The best defense against negative mood changes is to be aware that they can occur, and to be on the lookout for warning signs of an impending crash. “Learn about your body and its vulnerabilities,” Stotland advises. Determine if you are sensitive to estrogen and/or progesterone by keeping track of mood changes and checking to see if they relate to predictable hormonal fluctuations, such as those brought about by your menstrual cycle, or events, such as pregnancy or starting or stopping the pill.

And be sure to tell your OB-GYN if you have a history of PMS, depression, anxiety disorders or postpartum mood changes — or if anyone in your family has suffered from these problems, since there are genetic links. Finally, don’t be afraid to seek treatment. “These are all real biochemical disorders that can and should be treated,” Sichel says. “You don’t have to suffer in silence or in shame.”

Raging Hormones? Ways to Deal

In the last couple of posts we talked about the significant subset of women who suffer from debilitating emotional swings during the menopausal transition—and also about their loved ones who suffer right along with them.

It’s a Catch-22. You truly can’t control the hormonal storm that lashes you with sudden waves of uncontrollable rage, sadness, irritation, anxiety, and depression. Yet, you really can’t unleash these emotions on the people closest to you. People whom you love and have no wish to harm.

If you are caught in that cycle, there is work to be done, stat, to stabilize your emotions and allow you to get through this transition without further disruption to your life or hurt to your closest relationships.

I’m going to lay out your options, but you also need to have a conversation with your doctor, who will assess your risk factors and monitor your response to treatment.

Before you consider medications, you must lay a foundation of good health habits, if you haven’t already. I’ve mentioned this, oh, maybe a thousand times before, but that’s because it’s so important. Good health hygiene is even more critical now because some of those bad habits could be messing with your mood.

Exercise regularly. Just 30 minutes of moderate daily exercise improves circulation, relieves stress, improves sleep, makes your heart stronger, and more to the point, improves mood by releasing endorphins, which gives you a little euphoric lift.

You also have to eat moderately and healthfully. That means cutting down on sugar and caffeine, which causes mood and energy to peak and crash. In Great Britain, fish and veggie-eating folks had fewer depressive episodes than their junk-food-eating colleagues. In Spain, those who filled up on nasty trans-fats from pastries and fast food were 48 percent more likely to be depressed than those who ate good fat, such as olive oil. (And these folks weren’t even menopausal!) Magnesium is also linked to mood and sleep, so a magnesium supplement might be in order.

At the risk of being an absolute killjoy, you also have to stop smoking and cut back on alcohol, both of which affect mood. Alcohol, of course, is a depressant. I’m not talking about a glass of wine with dinner, but about regular and/or heavy drinking.

A further brick in that health foundation is to develop a strategy for relieving stress—meditation, yoga, mindfulness practice, or another religious practice that is meaningful to you. These are known to relieve stress, stabilize mood, relieve pain, including psychic pain, and generally make life more hopeful.

I am not for a minute saying that an honest self-improvement plan will be easy or immediate—in fact, it’s a lifelong endeavor. I’m also not saying that good health alone will adequately address your menopausal mood swings. But I can assure you that getting in shape, eating well, and implementing a spiritual practice will absolutely help, both now and later.

Now let’s address the medical options. Your healthcare provider will need to work with you to find the best treatment. So it’s time for a heart-to-heart with your doctor. Ask her about:

  • Hormone Therapy (HT). We’ve learned a lot about HT over the last decade. For many women, it’s hormone fluctuations that lead to disruptive symptoms. Using hormones systemically to counter that can be a good choice for some women. Reviewing your health status and risks can help determine whether you’re a good candidate for HT. It’s even possible that going on a birth control pill for the hormonal effect might bring relief.
  • Mood medications. This approach, using anti-anxiety, sleep aid, or antidepressant medications, works on your brain rather than your hormones, and many women find them effective during this menopausal transition. Antidepressants work because the brain has many estrogen receptors, and when you lack estrogen, the feel-good neurochemical, serotonin, tends to break down. So, the class of antidepressant that may give you relief is called a selective serotonin reuptake inhibitor (SSRI), such as Prozac, Zoloft, or Celexa. Antidepressants can dampen libido, which is the last thing you need right now, so work closely with your healthcare provider to find the right medication and the right dosage. And addressing lack of sleep or an excess of anxiety can break the cycle just enough for some breathing room for taking control in other ways.

Medication isn’t a substitute for those common-sense efforts to improve your overall quality of life, but they can help you get through this bad patch.

This is a long journey, ladies, accompanied by a lot of turbulence and change. Life will be different—and very likely better—on the other side.

Traveling mercies.

Dr. Barb DePree

Author

Illustration by Anne Smith Right now, some 21 million American women are in perimenopause — the transitional period, lasting anywhere from 4 to 15 years, that leads up to menopause. And many women are grappling with symptoms that range from mildly annoying to virtually incapacitating. Think hot flashes, irregular periods, vaginal dryness, insomnia, forgetfulness and more. Unfortunately, doctors still don’t fully understand perimenopause. But they know much more than they did when our mothers and grandmothers went through it. Here, answers to common questions about what experts dub “the storm before the calm.”

Your ovaries are aging, but the pituitary gland in your brain, which governs reproduction, is determined to keep you fertile. Every month, your pituitary produces the follicle-stimulating hormone (FSH), which prods your ovaries to produce mature eggs. If an egg isn’t released on schedule, your pituitary churns out more FSH to correct the problem. This may or may not work — meaning you may or may not ovulate. In any case, your production of estrogen and progesterone becomes erratic. Some months you may skip your period altogether; other times you may experience heavy, unpredictable bleeding.

It could, indirectly. Estrogen nourishes the tissues of the vagina, urethra, bladder and pelvic floor. As perimenopause progresses — and droughtlike lows in estrogen occur more frequently — these tissues become thinner, less elastic and more easily irritated. The result: vaginal dryness and irritation, inflammation of the vulva (the outer genital area), painful intercourse and urinary incontinence.

Because of your erratic periods, you may assume you’re no longer fertile. That’s not true. The average woman has a 33 percent chance of becoming pregnant in a given month; after age 40, her chances plummet to 7 percent. However, if you don’t want to get pregnant, you still need to be diligent about birth control.

Sometimes when I get my period, I seem to hemorrhage. What’s going on?

Blame it on your fluctuating hormone levels — in this instance progesterone, which causes you to shed your uterine lining each month during your period. While the average menstrual flow totals a mere two ounces, it can escalate to 10 times that amount during perimenopause. Another reason you may bleed excessively: fibroids. These benign but very common tumors are often fueled by high estrogen levels.

Your brain is dependent upon estrogen to function properly, so when estrogen levels rise and fall unpredictably, moodiness, trouble concentrating and memory problems can occur. In addition, night sweats can disrupt sleep, making symptoms even worse.

Lots of doctors test FSH levels in a woman’s blood. Except for a midcycle spurt when you ovulate, FSH levels stay well below 15 when your ovaries are young; during perimenopause, they may start to rise; after menopause, they can skyrocket to 40 or above. Unfortunately, the FSH test isn’t reliable. Also, because some conditions — including thyroid disorders — can cause perimenopause-like complaints, your doctor may need to rule them out first.

How to Deal with Premenstrual Mood Swings

Track your symptoms

If you don’t already, start keeping track of your menstrual cycle and your emotions throughout its different stages. This will help you confirm that your mood swings are indeed linked to your cycle. Knowing there’s a reason you’re feeling extra moody can also help keep things in perspective and offer some validation.

Having a detailed log of your last few cycles is also handy if you want to bring up your symptoms with your doctor. There’s still some stigma around PMS. Having documentation of your symptoms might help you feel more confident about bringing them up. It can also help your doctor get a better idea of what’s going on.

You can track your cycle and symptoms using a period-tracking app on your phone. Look for one that allows you to add your own symptoms.

You can also print out a chart or make your own. Across the top, write the day of the month (1 through 31). List your symptoms down the left side of the page. Put an X in the box next to the symptoms you experience each day. Note whether each symptom is mild, moderate, or severe.

To track mood swings, make a note when you experience any of these symptoms:

  • sadness
  • sudden, unexplained changes in your mood
  • crying spells
  • irritability
  • poor sleep or too much sleep
  • trouble concentrating
  • lack of interest in your daily activities
  • tiredness
  • low energy

Hormonal birth control

Hormonal birth control methods, like the pill or patch, can help with bloating, tender breasts, and other physical PMS symptoms. For some people, they can also help with emotional symptoms, including mood swings.

But for others, hormonal birth control can make mood swings worse. If you go this route, you might have to try out different types of birth control before you find a method that works for you.

If you’re interested in the pill, opt for a continuous one that doesn’t have a week of placebo pills. Continuous birth control pills can eliminate your period, which sometimes helps eliminate PMS, too.

Natural remedies

A couple of vitamins may help relieve PMS-related mood swings.

A clinical trial found that a calcium supplement helped with PMS-related feelings of sadness, irritability, and anxiety.

Many foods are good sources of calcium, including:

  • milk
  • yogurt
  • cheese
  • leafy green vegetables
  • fortified orange juice and cereal

You can also take a daily supplement containing 1,200 milligrams of calcium, which you can find on Amazon. Don’t be discouraged if you don’t see results right away. It can take about three menstrual cycles to see any symptom improvement while taking calcium.

Vitamin B-6 might also help with PMS symptoms.

You can find it in the following foods:

  • fish
  • chicken and turkey
  • fruit
  • fortified cereals

Vitamin B-6 also comes in supplement form, which you can find on Amazon. Just don’t take more than 100 milligrams a day.

Lifestyle changes

Several lifestyle factors also seem to play a role in PMS symptoms:

  • Exercise. Try to be active for at least 30 minutes more days of the week than not. Even a daily walk through your neighborhood can help with feelings of sadness, irritability, and anxiety.
  • Nutrition. Try to resist the junk food cravings that can come with PMS. Large amounts of sugar, fat, and salt can all wreak havoc on your mood. You don’t have to cut them out completely, but try to balance out these foods with fruits, vegetables, and whole grains. This will help keep you full throughout the day and help avoid drops in blood sugar, which can make you irritable.
  • Sleep. Not getting enough sleep can kill your mood if you’re weeks away from your period. Try to get at least seven to eight hours of sleep a night, especially in the week or two leading up to your period. See how not getting enough sleep affects your mind and body.
  • Stress. Unmanaged stress can worsen mood swings. Use deep breathing exercises, meditation, or yoga to calm both your mind and body, especially when you feel PMS symptoms coming on.

Medication

If other treatment options aren’t helping, taking an antidepressant may help. Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressant used to treat PMS-related mood swings.

SSRIs block the absorption of serotonin. This increases the amount of serotonin in your brain. Examples of SSRIs include:

  • citalopram (Celexa)
  • fluoxetine (Prozac and Sarafem)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Other antidepressants that work on serotonin might also help treat PMS mood swings. These include:

  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)

Work with your doctor to come up with a dosage plan. They might suggest you only take an antidepressant during the two weeks before your symptoms tend to start. In other cases, they might recommend taking them every day.

Mood Swings: PMS and Your Emotional Health

The most common emotional PMS symptoms are:

  • Irritability
  • Anger
  • Depression
  • Crying
  • Oversensitivity
  • Feeling nervous and anxious
  • Alternating sadness and rage

Getting to the Root of PMS Mood Swings

Although researchers don’t know exactly why PMS strikes, these emotional disturbances are thought to be connected to the rise and fall of hormones, specifically estrogen, throughout the menstrual cycle. Estrogen levels begin to rise slowly just after a women’s period ends, and it peak two weeks later. “Then estrogen levels drop like a rock and begin rising slowly before dropping again just before menstruation starts,” explains Livoti. These hormonal peaks and valleys are thought to cause mood swings and other menstrual symptoms.

“Stressful situations, such as a divorce or job loss, don’t cause PMS, but they can make it worse,” adds Livoti. Some research suggests that female hormones interact with brain chemicals in a way that can affect mood in those with PMS. “Reduced levels of estrogen during the luteal phase of the cycle could possibly cause a drop in serotonin, although more research needs to be done to confirm this link,” says Livoti. Lower serotonin levels are associated with depression, irritability, and carbohydrate cravings, all of which can be PMS symptoms.

Severe PMS: Beyond Run-Of-The-Mill Mood Swings

Between 3 and 8 percent of menstruating women have an even more severe condition called premenstrual dysphoric disorder (PMDD). These women become seriously depressed a week or two before their periods. “With PMDD, major depression and extreme irritation are the foremost symptoms,” says Livoti. “PMS is milder and usually involves physical menstrual symptoms, as well as emotional ones.”

Women with a family history of depression or who have previously experienced postpartum depression are at increased risk for PMDD, which is included on the American Psychiatric Association’s list of mental illnesses (the Diagnostic and Statistical Manual of Mental Disorders). To be diagnosed with PMDD, a woman must have at least five of the following symptoms around the time of her period:

  • Deep sadness or despair, with possible suicidal thoughts
  • Lasting irritability and anger, which may include frequent outbursts at loved ones
  • Feelings of tension or anxiety
  • Panic attacks
  • Mood swings
  • Crying
  • Disinterest in daily activities and relationships
  • Trouble thinking or focusing
  • Feeling out of control or overwhelmed
  • Fatigue
  • Low energy
  • Food cravings or binge eating

These symptoms will disappear shortly after menstruation starts. “If they last all month, that’s not PMDD,” says Livoti. Instead, another mental or physical illness may be the cause.

Treating PMS Symptoms, From Mild to Severe

For many women, lifestyle changes can be a successful part of PMS treatment. For women with severe PMS, medication may be needed. The following PMS treatment options can help stabilize mood swings and improve a woman’s emotional health in the weeks before menstruation:

  • Exercise. Physical activity can lift moods and improve depression. It’s believed that endorphins — feel-good brain chemicals that are released during exercise — may help counteract some of the hormone changes that may trigger severe PMS. “Exercising can also boost energy and help with cramps and bloating, which may help you feel better,” says Livoti. Aerobic exercise such as walking, running, bicycling, or swimming is recommended.
  • Small, frequent meals. Eating small meals throughout the day rather than two or three big meals may also help ease PMS symptoms. A large meal, particularly one high in carbohydrates, can cause blood sugar swings, which could worsen PMS. “Low blood sugar may contribute to crying spells and irritability that are often seen in women with severe PMS,” says Livoti. Try to eat six small meals a day to keep your blood sugar levels steady.
  • Calcium supplements. In a 2009 double-blind clinical trial of college women with PMS, those who supplemented their diet with 500 milligrams of calcium twice daily had significantly less depression and fatigue than those who didn’t. In fact, “a number of studies have shown that getting plenty of calcium can help ease mood changes related to severe PMS, although we don’t know exactly why,” says Livoti.
  • Avoid caffeine, alcohol, and sweets. Staying away from coffee and other caffeinated drinks for two weeks before your period may make a difference in your mood because caffeine can increase anxiety, nervousness, and insomnia. Cutting down on alcohol may also be helpful because alcohol acts as a depressant. And steering clear of candy, soda, and other sugary foods, especially in the week before your period, may help ease severe PMS symptoms by preventing mood swings associated with blood sugar fluctuations.
  • Stress management. Stress can make severePMS symptoms worse, so finding ways to give stress the slip can help treatPMS. Try relaxation techniques such as meditation, deep breathing, and yoga. Individual or group therapy has also been found to be an effectivePMS treatment for women with severe mood swings and debilitating emotional changes.

    Antidepressants called selective serotonin reuptake inhibitors (SSRIs) that change serotonin levels in the brain have been shown to be helpful for women with severe PMS and PMDD. In fact, the U.S. Food and Drug Administration has approved three of these medicines — Zoloft (sertraline), Prozac or Sarafem (fluoxetine), and Paxil CR (paroxetine) — for the treatment of PMDD.

    Talk to your doctor about which of these approaches might work best for any moderate or severe emotional PMS symptoms you’re experiencing.

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A few weeks ago a friend G-chatted me in desperation. Normally easygoing, she sounded panicked. Unlike most women she knew, she suffered from only mild menstrual cramps. She barely even felt bloated. But every month, she said, she could feel a tsunami of hormones brewing inside her in the days leading up to her period.

Like Marvel’s Hulk transforming into an erratic monster, she, too, transformed—not into a caricature of a PMS bitch, but into an uber-sensitive, paranoid, depressive version of herself. These hormonal sneak attacks were wreaking havoc on her relationships, and yet she felt embarrassed to even acknowledge them, for fear of being seen as a walking stereotype. She wondered: Was there an antidote?

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Surprisingly, premenstrual mood swings are something of a medical mystery. We know they’re caused by a combination of hormonal fluctuations, personal biology, and environment, but this delicate balance of factors can make treating them a process of trial and error for every woman. “This has been a topic of conversation for as long as people have been talking,” says Ira Jaffe, an OBGYN at NYU’s Langone Medical Center. “If there was one approach that worked, we’d all be doing it. But no one has an exclusive hold on the best approach so far.”

As I later reported back to my friend, there are proactive steps women can take to mitigate the effects of premenstrual mood swings, including diet and lifestyle changes. The first step, however, is acknowledging that these mood swings are real—and should not be a source of shame.

Over the past few decades, as more women have entered the workplace, discussing the psychological toll of menstruation has become something of a taboo. We still live in a world where women are discriminated against simply for having periods—who can forget Donald Trump telling Fox News’ Megyn Kelly that she had “blood coming out of her wherever”? So admitting that our periods can influence our state of mind can feel risky. But until we discuss this reality openly, we’ll never see progress. So let’s discuss, shall we?

What causes PMS mood swings?

Most women understand what a “period” is, but not everyone understands the complex hormonal and chemical changes that occur in the body before and after menstruation. The key to managing premenstrual mood swings, however, is understanding these changes.

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So what do we know about our periods? We know that PMS happens once a month during the luteal phase of the menstrual cycle, which is the 14-day window before a woman gets her period. While not all women suffer from PMS, about 80% to 90% experience some form of physical or emotional changes before their period, and about 15% of those women experience multiple or severe symptoms—to the point at which PMS seriously impacts their life.

“We see a variety of things in PMS,” says NYU’s Jaffe. “Increased irritability, short temper, difficulty focusing, easily moved to tears—things we could say are similar to clinical depression.”

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One reason for these changes may boil down to hormones—specifically, having too much or too little estrogen or progesterone in your body at a given time. At the very beginning of a woman’s cycle, right after menstruation, the body releases estrogen into the bloodstream, which causes the lining of the uterus to grow again. But then, about halfway through the month, estrogen tapers off and progesterone rises, which helps to stabilize that lining. This shift is key, since a spike in progesterone can lead to changes in mood that continue until menstruation begins. “Once we see menstrual flow and both hormones start to drop,” says Jaffe, “there is relief from the symptoms.”

But hormones are only part of the puzzle. Women also experience fluctuations in the release of neurotransmitters, including serotonin, dopamine, and GABA (gamma-aminobutyric acid). Also known as the “anti-anxiety” neurotransmitter, GABA plays a role in both relieving anxiety and elevating mood. Shifts in all of these neurotransmitters can affect our emotional state, says Elizabeth Bertone-Johnson, a professor of epidemiology at University of Massachusetts-Amherst who has studied PMS extensively.

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And yet, while we know that fluctuations in hormones and neurotransmitters can alter a woman’s mood, medicine offers no simple fix. This is because the multiple chemical interactions and chain reactions are different for every woman. If doctors could pinpoint one cause for a woman’s PMS mood swings—such as determining that her estrogen level was too high or low—they could treat them with medication, but that’s simply not the case, explains Bertone-Johnson. Women can’t just pop a pill to decrease estrogen levels or increase serotonin levels and feel like themselves again.

“We spend so much time trying to figure this out,” says Bertone-Johnson, who has been working to develop a “cure” for PMS for years. “Science suggests it’s not just hormones and brain chemistry. It’s a huge combination of a lot of different factors and varies from woman to woman.” This is one reason why women on hormonal birth control experience period-related psychological changes, too.

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Along with hormonal fluctuations, a myriad of other factors contribute to the severity of PMS symptoms. These can include stress (which triggers the release of cortisol into the body), a woman’s environment, whether or not she has a support system, diet, whether she smokes, how much sleep she gets, and how often she exercises, combined with her own personal psychology and brain chemistry. With so many variables, what, if anything, can help curb the changes?

What foods help to combat PMS mood swings?

While we can’t expect a miracle cure anytime soon, we can make lifestyle changes to help ward off premenstrual mood swings. Perhaps more than anything, we can change how we eat.

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You may know that balancing blood sugar is key to overall health. When our blood sugar veers too high or too low, we feel dizzy, irritable, anxious, tired, and generally crappy. In the long run, imbalanced blood sugar can lead to more serious conditions like diabetes and hypoglycemia.

Along with the other chemical changes, in the days leading up to our period our blood sugar levels can fluctuate, too. This is why diet can have a huge influence on the severity of premenstrual symptoms, says Robyn Srigley, a “PMS coach” and holistic nutritionist who helps women manage period-related pain and balance their moods through diet and lifestyle changes. “The first thing every woman has to do is balance her blood sugar and make sure to eat nutrient-dense food,” she explains. “Most meals should be comprised of lean protein, fat, and fiber.”

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One trick for balancing blood sugar is adding a teaspoon of cinnamon to a smoothie. “Ovaries are very sensitive to insulin,” Srigley says. “By adding a teaspoon of ground cinnamon, you can increase your insulin sensitivity and utilize that blood sugar for energy.” Some research suggests that, during the luteal phase, progesterone may lower insulin sensitivity—which isn’t a good thing. Being more sensitive to insulin means you don’t have to pump out as much of it to keep blood glucose levels in the normal range. So by raising your insulin sensitivity, you can better balance your blood sugar. This can help prevent that hangry feeling of “I have to eat or I’ll rip someone’s face off.”

Insulin is not the only hormone affected by diet. Food can also play a role in balancing estrogen and progesterone levels. For example, in order to balance estrogen, Srigley tells her clients to eat cruciferous vegetables such as broccoli, brussels sprouts, and kale. “They’re full of fiber which helps to bind to excess estrogen and then you excrete it when you poop,” she says.

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Another tip for combating irritability, lethargy, and anxiety is increasing protein levels. The hormone progesterone can increase our appetites—and research suggests that eating more protein-rich foods counteracts this effect. This works because progesterone selectively metabolizes protein—meaning it both craves protein and quickly gobbles it up. In fact, when progesterone spikes our bodies can burn protein 10% more efficiently, which is why eating more of it keeps us feeling satiated.

Vitamins may also play a role in combatting mood swings. In her research, Bertone-Johnson found that women who consume more vitamin D and calcium through the foods they eat experience fewer symptoms. In fact, upping these vitamins decreases PMS risk by 30% to 40%, she says. Another key nutrient to preventing PMS, according to her research? Vitamin B. Higher levels of certain B vitamins, such as thiamine and riboflavin, were also associated with a lower risk of PMS. So start chowing down on foods such as salmon, red meat, spinach, bell peppers, broccoli, and lentils.

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Eating sweets, however—a common PMS cliche—is the wrong way to feel better. “As much as you can, avoid sugar,” says Srigley. Refined sugars lead to a quick sugar high, which also means a quick sugar low. The exception? Dark chocolate with no dairy in small quantities.

What role does stress play?

We now know that the environment inside our body can contribute to premenstrual mood swings, but so can the environment outside of it. Namely: Stress. “Anything you can do to reduce stress at this time—reading, walking outdoors, yoga, whatever it may be—seems to help,” says Srigley, the PMS coach.

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When we feel stressed our bodies release cortisol, and an overabundance of cortisol can increase inflammation, lower our immune function, overwork our adrenal system, and put us at greater risk for depression and mental illness. So it’s no surprise that too much cortisol may also exacerbate PMS systems.

In her research, Bertone-Johnson has found that women who were experiencing PMS displayed higher levels of internal inflammation—and we know that more stress leads to inflammation, and more inflammation can lead to PMS. “Stress throws a lot of things out of whack,” she says, “and we’ve seen that stress affects both reproductive function and hormones.”

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One way to combat premenstrual mood swings is to surround yourself with a supportive social network. Studies have shown that women who have a support system to lean on experience fewer symptoms of PMS, in part because of the ways this support can reduce stress. And if you don’t have a good system in place, therapy can help, too.

The most important thing to remember however, says Jaffe, is that it’s okay to ask for help if premenstrual mood swings are getting in the way of your life and your happiness:

“Needing help is not a sign of weakness.”

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.

Is Hormonal Imbalance Making You Crazy, Moody or Overweight?

Source: Wikimedia: public common domain

Many women are affected negatively by hormonal imbalances. To begin explaining why that is, let’s first settle on a location. Which organ is the culprit?

Your first guess might be the ovaries. That’s a really good, educated guess, but it’s not entirely correct. In fact, we start the story of the potentially nasty effects of hormonal imbalances in women in the brain—not down in the ovaries.

A brain structure called the hypothalamus controls hormonal secretions from the ovaries and all other glands in the body. It does this through intimate connections with the pituitary gland (the master gland), which is also located in the brain. The pituitary then sends chemical messages, broadcast in the bloodstream, to various glands around the body—including the ovaries, the thyroid, and the adrenal gland, which helps regulate stress.

The focus of this post will be on the ovarian hormones estrogen and progesterone. Even though they are typically called “sex hormones,” the brain often interprets them in consequential ways that have nothing to do with sexuality.

For example, the brain has many receptors that interpret and understand the chemical language of estrogen, which is why there are a lot of cognitive changes (memory) and emotional ones (mood) that occurs during menopause, when estrogen plummets. In fact, the body of a man in his 70s makes more than twice as much estrogen as that of a woman the same age. This is because small amounts of testosterone, which the testes produce throughout life, are converted to estrogen.

This fact likely wasn’t yet known by those who came up with the names “estrogen” and “progesterone.” Progesterone means “to bear” or “give birth”; the word gestation comes from the same root. Estrogen means “gadfly” or “frenzy,” though some also trace it to the Greek root “oistros,” which denotes sexual passion and desire. Based on those definitions, it seems that whoever came up with the names thought women were either giving birth, in a state of agitation and hysteria, or experiencing intense sexual desire. This is why, in my view, we should come up with our own scientific names when appropriate—and also why I prefer to refer to these hormones as “ovarian hormones” rather than “sex hormones,” in order to not restrict the vastness of their influences.

It is important to note that all of this brain-hormone communication happens seamlessly and outside of our awareness. This includes the multiple steps of synthesis, the metabolism of these hormones, and even their secretions and presence in our blood.

We have no idea which hormone is being released at any given moment. They are invisible and work in silence. Unfortunately, we often don’t appreciate their diligence to maintain things in homeostasis—and when hormones feel under-appreciated, they can become less silent and demand to be visible. In other words, they scream for attention, and move from the unknown to the known. A diabetic, who may have spent her entire life unaware of what her pancreas was doing and of the hormone insulin, may be shocked to find that upon diagnosis, she’ll have to make sure that her insulin levels are visible to her at all times. Otherwise, she might go into a coma and could even die.

It’s a similar story with ovarian hormones, too. Let’s consider a practical life example: Stress! Do you ever feel stressed out? From too many responsibilities, for example? From trying to be Superwoman? Here’s how stress messes with your hormones:

When you’re too stressed out, the adrenal gland borrows raw material from progesterone to make cortisol, the notorious stress hormone. This leads to lower levels of progesterone—thus, stress can interfere with getting pregnant and sometimes leads to infertility in women. Furthermore, lower levels of progesterone are associated with more severe PMS symptoms and mood instability. In addition, the levels of estrogen and progesterone are thrown out of balance, which can cause gynecological problems. Such factors may lead to long menstrual cycles, which some research has found to be associated with breast cancer.

Finding out about such imbalances can be scary. By the time we catch on to the fact that something is off, our hormones—as commanded by the brain—may have already made us feel vulnerable, weak, anxious, or sad. They may have also dulled our memories, debilitated our thinking process, truncated our life, and dissolved our relationships. Sound familiar?

Symptoms of Hormonal Imbalance

Even if you have been told that your hormone levels are within a normal range, the following signs may be indicative of a potential hormonal war:

  • fatigue
  • mood instability
  • weight gain
  • “foggy brain” or memory loss
  • adult acne
  • hair loss or excessive facial hair growth
  • lower sex drive
  • extreme PMS

These symptoms do not just reduce quality of life—they can also increase one’s chances of stroke, heart disease, cancer, and gynecological problems, including endometriosis, fibroids, tumors, and cysts.

There are solutions, however, and you don’t have to acquiesce to a lower quality of life. If you suspect that you might suffer from a hormonal imbalance, the first step is to consult with a medical professional.

It is possible that your lab results will be within the normal range, even if you have many of the above symptoms; unfortunately, certain tests are not sensitive enough to pick up on all indications of imbalance. This may mean you should begin exploring alternative treatments; the journey to find those that work for you will likely be a long one, but very much worth it.

Benjamin Alexander Huseby

Mood swings like you’re a teenager again. A feeling of brain fog. About as much interest in sex as in doing your taxes. These are some of the shockingly common complaints heard in doctors’ offices around the country. The one thing these varied woes share? Fluctuating hormones. “Your body is a finely tuned hormonal symphony,” says integrative physician Tami Meraglia, author of The Hormone Secret, and, consequently, even very slight changes can yield enormous side effects.

“Somewhere in your mid-30s to early 40s, levels of key hormones shift as the body progresses through perimenopause toward menopause,” says Sara Gottfried, an integrative physician and the author of The Hormone Reset Diet. “Many women don’t realize that these changes can happen as young as 35,” she says. How to fight back? Every woman is different, but the experts agree that dietary supplements and bioidentical hormones can be effective tools.

Unfortunately, it’s not as simple as having a blood test to determine your hormone levels. For one thing, hormones can rise and dip dramatically over the course of six months, says Mary Jane Minkin, a clinical professor of obstetrics and gynecology at the Yale School of Medicine. What’s more, you can have levels that fall within the “normal” range but still suffer dramatic side effects, notes Meraglia. So ask your doctor for blood tests to determine your levels, but then have her repeat them once you’ve had treatment and feel better so that you know “what your levels are when they are optimized,” says internist Erika Schwartz, author of Don’t Let Your Doctor Kill You. Here, a hormone cheat sheet.

PROGESTERONE: “THE PEACEKEEPER” This is the hormone that starts to dip first as you age, says Meraglia. Sometimes called the Valium of the female mind, progesterone can cause you to feel increasingly anxious, frustrated, and short-tempered when levels dip. Sinking levels can also cause insomnia, and since progesterone has a natural diuretic effect, a lack can leave you feeling perpetually bloated. What to do: Hormone therapy (either bioidentical or traditional) can help. But supplements may also give significant relief, says Gottfried, who suggests 750 milligrams a day of vitamin C or 500 to 1,000 milligrams of chasteberry.

TESTOSTERONE: “THE LOVER AND THE FIGHTER” Next up for departure: testosterone, which plays a key role in our sex drive as well as in our ability to hang on to muscle. “Dwindling testosterone affects your muscle-to-fat ratio—tilting more toward fat,” says Meraglia. “And with less muscle tissue, your metabolism slows down.” A lack of testosterone can also put a serious damper on your libido. “Getting it back to normal really moves the needle on how people feel quickly,” Meraglia adds. What to do: Because the amount of testosterone in a woman’s body is so small, raising it just a teeny bit can make a huge difference, explains Schwartz. Taking 500 to 1,000 milligrams of the herb ashwagandha daily can increase testosterone by helping support the adrenal glands, says Meraglia. Something as simple as changing your posture can boost it too. Think Wonder Woman: hands on hips, chest up and out. In one study, people who held “high-power poses” for two minutes had a 19 percent increase in testosterone. For some, there’s also the option of testosterone therapy: “The best way to safely prescribe it in low doses is to have it compounded for a particular woman in a cream or gel,” says Schwartz.

ESTROGEN: “THE MOOD LIFTER” Estrogen helps make you feel even-keeled and keeps you on task. “It’s nature’s Prozac, adjusting the levels of available serotonin so it’s in more ready supply,” explains Gottfried. So when estrogen dips, you may find yourself weathering unpredictable and stormy moods. “It also keeps your libido high by keeping genital skin sensitive with an active blood supply,” she adds. What to do: For some women, simply going on a low-dose combination birth-control pill can be a relatively fast, easy way to even things out, Minkin says. Prescription estradiol in a cream, patch, or gel may also be an option, says Schwartz: It can “not only improve your mood and clear your brain fog but help you lose weight.” More natural relief can be found in the herb maca (1,000 to 2,000 milligrams) or black cohosh (40 milligrams).

Always speak to your doctor about the possible risks and side effects of any medical treatment.

“Many women don’t realize that these changes can happen as young as 35,” says integrative physician Sara Gottfried.

Every person has experienced the various ways hormones affect our bodies. Think about the pang of hunger when it’s getting close to lunchtime, or the way your heart begins to race during a bout of stress. As women, hormones are the chemical messengers in the body that are responsible for the ebb and flow of the monthly menstrual cycle. But have you ever wondered what’s going on in your body week by week?

There are generally four phases to a woman’s menstrual cycle: menstrual, follicular, ovulation, and luteal. Hormones like estrogen and progesterone play integral roles in the cycle of menstruation, yielding different physical symptoms and changes in your mood and emotions.

Here’s exactly how hormones can affect you during each menstrual phase — and how you can stay one step ahead of fluctuations, according to experts.

1. Menstrual

In the menstrual or bleeding phase, a drop in estrogen and progesterone collapses the lining of the uterus, resulting in the release of an egg. This phase typically lasts three to seven days and of anywhere in between light spotting to heavy flow, says Hal Danzier, M.D., reproductive endocrinologist and cofounder of Southern California Reproductive Center.

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How the menstrual phase makes you feel

The physical symptoms during this phase vary from woman to woman, though it typically includes bleeding, abdominal cramping, and bloating. Cramping ranges from light to very painful due to the presence of prostaglandin, a hormone-like compound that causes the uterus to spasm. However, if you’re experiencing heavy bleeding that lasts longer than a week, you should speak to your doctor. “Very heavy or extended bleeding could indicate the presence of fibroids or other disease states such as precancerous changes or symptoms of endometriosis,” says Bruce McLucas, M.D., OB/GYN, assistant clinical professor at the UCLA School of Medicine and founder of the Fibroid Treatment Collective. Menopause may also result in an irregular period, he adds.

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According to Healthline, you may feel a bit fatigued during the bleeding phase, and it has to do with — you guessed it — hormones. “When your uterine lining isn’t invaded by a fertilized egg, the hormones sustaining the environment aren’t needed anymore and the hormone levels plummet,” Dr. Molly O’Shea, M.D., Detroit-based pediatrician, told Good Housekeeping. “When this happens, your body goes from high alert to nothing hormonally and that shift causes other changes, too, and all of those changes are exhausting. Until your hormone levels increase again, you are really tired.”

How to feel your best during this phase

If you’re extra tired during your period, take it easy and rest more than you usually do. Erika Schwartz, M.D., an internist and author of The Hormone Solution, recommends using heating pads for aches and discomfort as well as low doses of Advil, Aleve, or Tylenol with codeine if pain is persistent. And avoid caffeine, she says, as it constricts blood vessels and increases tension.

2. Follicular

Your period is over — phew! The second stage of the menstrual cycle, the follicular phase, slightly overlaps with the menstrual phase. It begins on the first day of your period and ends when you ovulate. In women, the follicle stimulating hormone (FSH) from the pituitary gland stimulates the ovary to produce an egg from one follicle at ovulation, says Dr. Maxine Barish-Wreden, M.D., an internist with Sutter Medical Foundation.

How the follicular phase makes you feel

In this week, your estrogen and testosterone levels begin to build again. Increased hormonal activity means you may have a heightened sense of smell, along with clearer thinking and better coordination. Many women, in fact, report feeling their best at this time of the month — physically and mentally. “You’d be likely to do better with a final exam if you’re in school, or a presentation if you’re at work,” Dr. Danzier says. You may also experience an increase in sex drive during this phase.

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According to Lauri Grossman, chair of the Department of Medicine and Humanistic Studies at the American Medical College of Homeopathy,”Women also experience positive sensations such as relief, release, euphoria, new beginning, invigoration, connection with nature, creative energy, exhilaration, increased sex drive and more intense orgasms.”

Consider brainstorming or problem-solving during this phase, as well as doing things that capitalizing on your creative energy. Be social and go out with friends!

3. Ovulation

This is the phase where you can get pregnant. During the ovulation phase, Luteinizing hormone (LH) surges from the pituitary gland, triggering ovulation about 24 to 36 hours later. Your ovary will then release a mature egg that travels towards the uterus in search of a sperm. According to Heathline, you’ll begin to ovulate right in the middle of your menstrual cycle, which is around day 14 if you have a 28-day cycle. It lasts about 24 hours, and if the egg isn’t fertilized it will die.

How the ovulation phase makes you feel

Estrogen and testosterone rise to peak levels, boosting the effects of the follicular phase. “Women feel more energy, more sex drive, and often they notice more cervical mucus,” Dr. Danzier explains. “The chemistry of your body is preparing for reproduction, so it makes sense that chemically you start feeling more inclined to have sex.”

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There are some downsides, though. “Right around ovulation is also the time when many women experience acne breakouts, or single pimples, usually recurring in the same area,” Dr. Danzier says. Additionally, you can expect breast tenderness, weight gain, headaches, and water retention.

As this phase is a period of “renewal of sexual relationships,” you can take the time to try to reconnect with your lover, says Inga Zilberstein, MD, a New York City-based OB/GYN. And, for women post-menopause, read these 10 facts about sex after menopause. No matter what stage of life you’re in, there’s a lot you can do to heat things up in the bedroom.

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4. Luteal

The last phase of the menstrual cycle is the luteal phase. According to VeryWell, it begins after ovulation, post-day 14, and continues until the first day of your period. In this phase, hormones thicken and ripen the uterus to get it ready for pregnancy.

How the luteal phase makes you feel

Feeling warm or even downright feverish? It’s not in your head. During this post-ovulation phase, many women feel hot. “Increased progesterone acts on the temperature-regulating area in the brain,” Dr. Danzier explains. “It can rise about four-tenths of a degree in this phase, from 98.6 to about 99 degrees.” Increased progesterone also relaxes the smooth muscle of the uterus as well as your gallbladder, sphincter and intestines, says Dr. Zilberstein. That means you may look and feel more bloated.

If implantation does not occur, progesterone levels decline. An imbalance of estrogen and progesterone can affect your levels of serotonin and bring on strong premenstrual-syndrome symptoms like anxiety, depression, irritability and mood swings. “PMS is a common side effect of poor-quality or low-level progesterone,” explains Dr. Shwartz. “When we give bioidentical progesterone to women at this time of the month, we find the cravings disappear and the moods stabilize.”

Avoid salty foods, which can contribute to water retention and more bloat. Also try to avoid sugar and processed foods whenever possible, says Dr. Danzier. “Roller-coastering your blood sugar will only exacerbate the chemical reaction of your hormones,” he adds. Plus, try not to blow off the gym — even if you really don’t feel up to it. “Forty five minutes of walking, swimming or any mild to moderate exercise has a positive effect on many women,” he continues. For some women, though, PMS can bring on extreme mood swings. You’ll want to talk to your doctor about an action plan if you think you may be experiencing PMS.

Nicol Natale Freelance Editorial Assistant Nicol is a freelance Editorial Assistant at WomansDay.com and is a Manhattan-based journalist who specializes in health, wellness, beauty, fashion, business, and lifestyle.

Identity, Moods, and Emotions

Discovering who you are is one of the biggest challenges of adolescence. In the adolescent years, a teen’s identity may change from one month to the next. They have the opportunity to experiment with their personal values, style, beliefs, and sexuality. If they have healthy self-esteem and a strong support system, they can build their new identity with confidence. But many teenagers struggle with their sense of self-worth, feeling that they don’t measure up to the standards of their parents, teachers, or friends.

Teenagers who suffer from low self-esteem are more vulnerable to the negative influences of peer pressure and more likely to abuse drugs and alcohol. Furthermore, they are more likely to become depressed. Parents and educators can help teenagers build a strong sense of identity by nurturing their self-esteem and validating their self-confidence.

Adults should be aware of the signs of low self-esteem in teenagers, such as:

  • Withdrawal from friends and social activities
  • Poor hygiene or a lack of concern for appearance
  • Abandoning good friends in favor of a new social crowd
  • Sleeping too much or too little
  • Changes in weight or eating habits
  • Unusual mood swings
  • Tearfulness and a sense of hopelessness
  • Expressing thoughts of suicide.

It’s not unusual for teens to go through periods of feeling sad, lonely, or irritable. But if these feelings persist for more than a week or two, your teen might be depressed. The emotional turmoil of adolescence can sometimes hide a serious mental health condition that must be treated promptly.

How to Help Your Growing Teen

As your teen matures and the effects of teenage hormones continue to create change, it’s vital for you to stay engaged and present in your child’s life. Here are a few ways you can do that.

  • Encourage your teen to try new things and take on new challenges.
  • Keep the lines of communication open by checking in frequently at times when it feels natural, such as riding in the car or at mealtimes.
  • Talk with your teen about the importance of staying true to themselves and their beliefs even in the face of peer pressure.
  • Let your teen know that if they’re not comfortable talking with you about sexuality or other issues, they can talk to another trusted adult, like a school counselor or a relative.
  • Even though your teen is increasingly independent, continue to provide discipline and boundaries where appropriate.
  • Find ways to spend time together, even if your teen is resistant at first. It’s worth it!

When to Look for Support

If the natural hormonal changes of adolescence turn into something more dangerous, don’t hesitate to turn to professionals for help. In today’s challenging world, many families need support to handle the effects of emotional disturbances, impulse control disorders or substance abuse. In some cases, a personalized teen rehab program is what it takes to get a teenager’s life back on track.

For answers to your questions about teenage drug abuse, sexuality or emotional identity, contact the professionals at Newport Academy. We specialize in helping young people and their families build the futures that they deserve.

Image courtesy of Redd Angelo via Unsplash.

The adolescent brain: Beyond raging hormones

Published: March, 2011

Originally published in the Harvard Mental Health Letter, July 2005

In every generation, it seems, the same lament goes forth from the parents of adolescents: “What’s the matter with kids today?” Why are they so often confused, annoying, demanding, moody, defiant, reckless? Accidental deaths, homicides, and binge drinking spike in the teenage years. It’s the time of life when psychosis, eating disorders, and addictions are most likely to take hold. Surveys show that everyday unhappiness also reaches its peak in late adolescence.

Plenty of explanations for teenage turmoil are available. Adolescents need to assert their independence and explore their limits, taking risks, breaking rules, and rebelling against their parents while still relying on them for support and protection. (“What’s the matter with the older generation?”) They have to cope with disconcerting new sexual impulses and romantic feelings. Cultural change heightens incompatibility between the generations. Now scientific research is suggesting a new reason for the clashes between teenagers and their environment. Unsettled moods and unsettling behavior may be rooted in uneven brain development.

It’s not a question of intellectual maturity. Most studies show that abstract reasoning, memory, and the formal capacity for planning are fully developed by age 15 or 16. If teenagers are asked hypothetical questions about risk and reward, they usually give the same answers as adults. But the emotional state in which they answer questionnaires is not necessarily the one in which they make important choices. In real life, adolescents, compared to adults, find it more difficult to interrupt an action under way (stop speeding); to think before acting (learn how deep the water is before you dive); and even to choose between safer and riskier alternatives. It is easy for them to say that they would not get into a car with a drunk driver, but more difficult to turn down the invitation in practice. Adolescents’ judgment can be overwhelmed by the urge for new experiences, thrill-seeking, and sexual and aggressive impulses. They sometimes seem driven to seek experiences that produce strong feelings and sensations.

Resisting social pressure is also more difficult for teenagers. Much of their troubling behavior, from gang violence to reckless driving and drinking, occurs in groups and because of group pressure. In a psychological experiment, adolescents and adults took a driving simulation test that allowed them to win a reward by running a yellow light and stopping before they hit a wall. Adolescents, but not adults, were more likely to take extra chances when friends were watching.

Another revealing psychological experiment is the Iowa gambling task. Subjects can choose from one of two decks of cards in the hope of picking a card that provides a reward. The “good” deck contains many cards that provide some reward; the “bad” one, many cards that provide nothing and insufficient compensation in the form of a few that hold a jackpot. The choices of adults correspond fairly well to their tested reasoning capacity. In adolescence, the correlation is much weaker.

Evidence is appearing that these differences have a definite basis in brain structure and functioning. Recent research has shown that human brain circuitry is not mature until the early 20s (some would add, “if ever”). Among the last connections to be fully established are the links between the prefrontal cortex, seat of judgment and problem-solving, and the emotional centers in the limbic system, especially the amygdala. These links are critical for emotional learning and high-level self-regulation.

Beginning at puberty, the brain is reshaped. Neurons (gray matter) and synapses (junctions between neurons) proliferate in the cerebral cortex and are then gradually pruned throughout adolescence. Eventually, more than 40% of all synapses are eliminated, largely in the frontal lobes. Meanwhile, the white insulating coat of myelin on the axons that carry signals between nerve cells continues to accumulate, gradually improving the precision and efficiency of neuronal communication — a process not completed until the early 20s. The corpus callosum, which connects the right and left hemispheres of the brain, consists mostly of this white matter.

Another circuit still under construction in adolescence links the prefrontal cortex to the midbrain reward system, where addictive drugs and romantic love exert their powers. Most addictions get their start in adolescence, and there is evidence that adolescent and adult brains respond differently to drugs. In both human beings and laboratory rats, studies have found that adolescents become addicted to nicotine faster and at lower doses. Functional brain scans also suggest that teenagers and adults process reward stimuli differently; the adolescents are hypersensitive to the value of novel experiences.

Hormonal changes are at work, too. The adolescent brain pours out adrenal stress hormones, sex hormones, and growth hormone, which in turn influence brain development. The production of testosterone increases 10 times in adolescent boys. Sex hormones act in the limbic system and in the raphe nucleus, source of the neurotransmitter serotonin, which is important for the regulation of arousal and mood. The hormonally regulated 24-hour clocks change their settings during adolescence, keeping high school and college students awake far into the night and making it difficult to rise for morning classes.

As long as the brain is still in formation, things can go wrong in many ways, and some of them involve the onset of psychiatric disorders. Stress can retard the growth of the hippocampus, which consolidates memories. According to some theories, the pruning of gray matter or the thickening of the myelin coat in late adolescence allows the early symptoms of schizophrenia to emerge.

At least one important social policy conclusion may have been drawn in part from the neuroscience research on the adolescent brain. In 2005, the Supreme Court, affirming a Missouri high court decision, declared by a vote of 5–4 that the execution of 16- and 17-year-olds is unconstitutionally cruel and unusual punishment. The minimum age for capital punishment is now the same as the minimum age for voting and serving on juries. In writing their decision, the justices referred to evolving standards of decency, practices in other countries, the immaturity of adolescents, and their greater potential for change. They did not specifically mention brain research, but they had the opportunity to read friend-of-the-court briefs citing this research that were submitted by the American Bar Association, American Academy of Child and Adolescent Psychiatry, and American Psychiatric Association, among others.

Some critics, even if they welcome the Supreme Court decision for other reasons, have complained that this research stereotypes adolescents and provides a biological rationalization for irresponsible behavior. Animal experiments have limited value because laboratory animals do not undergo a lengthy human childhood. And human brain development does not unfold automatically and uniformly. There is much individual variation that reflects experience as well as genetic programming. The problems of teenagers are not all in their brains but have many causes, social and individual, genetic and environmental. At present and probably for a long time, researchers will be getting better information on the mental and emotional development of adolescents from interviews, observations, and behavioral tests than from brain scans.

But neuroscience research is becoming more sophisticated. There are already long-term studies in which people undergo frequent periodic brain scans over the course of their lives. The results are being used to investigate the effects of behavioral and cognitive therapies on attention deficit disorder and reading deficiencies in adolescents. Scientists are also looking at typical adolescent brain development to provide clues to the ways in which things go wrong. Some day, this research may provide results that will influence treatments for psychiatric disorders and other problems in adolescence.

Rosso IM, et al. “Cognitive and Emotional Components of Frontal Lobe Functioning in Childhood and Adolescence,” Annals of the New York Academy of Sciences (June 2004): Vol. 1021, pp. 355-62.

Sisk CL, et al. “The Neural Basis of Puberty and Adolescence,” Nature Neuroscience (October 2004): Vol. 7, No. 10, pp. 1040-47.

Spessot AL, et al. “Neuroimaging of Developmental Psychopathologies: The Importance of Self-Regulatory and Neural Plastic Processes in Adolescence,” Annals of the New York Academy of Sciences (June 2004): Vol. 1021, pp. 86-104.

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Many women dismiss their periods as annoying and disruptive. They just want them to go away, no matter their age. But your period is an important indicator of your overall health. The menstrual cycle is considered a vital sign, just like your blood pressure and your pulse, and to ignore it or wish it gone is to do your whole body a disservice.

Whether you’re in your 20s, 30s, 40s, or 50s, the real issue isn’t having a period. The issue is having period problems and, despite what you’ve been told, period problems aren’t normal. When your hormones are balanced, your periods will be symptom-free. When you’re living in sync with your cycle, you won’t dread your period every month because you won’t experience acne, bloating, fatigue, irritability, PMS, heavy or irregular periods, or severe cramps.

Instead, you will feel great AND you will be able to tap into the unique strengths of each phase of your 28-day cycle. A healthy hormone cycle means that some weeks you’re predisposed to being creative and generative, some weeks you’re set up to be focused and productive, some weeks you’re primed to be a tip-top communicator. When you tap into this rhythm, not only will you not want your period to disappear… you will welcome it as a superpower.

But how to keep your hormones healthy changes as you move through different phases of your life. What worked for you at age 23 may not work as well at age 33 or 43.

Today, I’m going to explain how to optimize your hormonal health during each decade of your menstrual years so you can feel, look, and perform your best at every age.

The 7 Different Life Phases of Female Reproductive Hormones

Here are the seven different hormone phases women move through during adulthood. You will know where you are by your age or your life experiences (or both), but I also recommend taking my Period Type quiz to assess your hormone health and cycle status. I recommend re-taking the quiz time every time you enter a new phase. This will help you get in touch with what your cycle is telling and how to best take care of yourself during each new phase of your life.
1. Puberty (9-21 years old)
This is a time where you might notice irregularity with the menstrual cycle. It takes time for the body to build up enough of a hormonal concentration for you to ovulate and menstruate regularly. This is worth reiterating: some irregularities with your menstrual cycle during this time are normal. As a culture, however, we’re quick to assume that these normal fluctuations need to be regulated with medication, i.e. the birth control pill. This means that so many young women are—needlessly and often harmfully—put on the hormonal birth control.

The better route to managing the normal ups and downs of this hormonal phase is to support adolescent girls and young women with food and lifestyle choices. You can work with your daughter or niece (or your own body) during this phase by limiting exposure to endocrine disruptors (everything from chemical-based shampoo to pesticides in her food) and making sure food is working in her (or your) favor.

The birth control pill only masks reproductive health issues and delays proper treatment and care. A great book to help start a teen on this journey is Cycle Savvy by Toni Weschler (who wrote the comprehensive cycle knowledge bible Taking Charge of Your Fertility).
2. Adult Menstrual Years (21 – 35 years old)
This phase of life brings with a lot of stressors—some of the bad, but many of them good, don’t get me wrong! There’s moving to a new place, going to graduate school and/or finding your first job, having caffeine and alcohol for the first time, and more. Whether the life change you’re experiencing during this phase is exciting or just straight-up stressful, it will affect your hormones. This is when you are likely to notice new period problems or a continuation of the symptoms you experienced in puberty.

Addressing hormonal imbalances in this phase requires the same attention to diet and toxin exposure as the puberty phase. But you will likely need even more focused support during this phase, when regular caffeine consumption may be depleting key micronutrients and a sedentary lifestyle (thanks to the demands of internships or entry-level jobs) may be making hormone problems worse.

During this phase, you will want to pay attention to replenishing key micronutrients and syncing your exercise with your cycle.
3. Pregnancy (age varies)
The degree to which you’re hormonally sensitive in this phase indicates the degree to which you did or didn’t address your hormonal symptoms in the adult menstrual phase. You should and can feel great during pregnancy, but it usually needs some preparation. I suggest women prep their bodies with diet and lifestyle changes at least 3 months prior to trying to conceive, but preferably a year prior. If you’re a hormonally-sensitive person like me, then it’s even more important to prep for pregnancy as the surge of pregnancy hormones is more likely to lead to health issues.
4. Post-Partum (age varies)
What you’ve been eating for the decade leading up to having your baby will leave you vulnerable to developing postpartum issues. This is something you want to prevent, but if it’s happening there’s still a lot you can do by engaging in phase-based self care. I’ve shared my postpartum food choices after giving birth to my baby girl—a daily diet that helped me to breastfeed for the next two years, lose the extra baby weight quickly, avoid the mood swings that can arise from my hormone sensitivity, and get my period back at the right time.
5. Perimenopause Phase One (35-45 years old)
This hormonal shift starts at 35 no matter what! You shouldn’t have to feel symptoms during this phase if you’re healthy. You should be ovulating and menstruating regularly and have good muscle tone, skin quality, energy, and sex drive, i.e. still making enough hormones to feel vital and youthful.

It’s key to really pay attention to what your body is telling you in this phase so you can adjust your diet and lifestyle accordingly. It’s very likely that because your hormones are changing, your body will be giving you insight into the underlying problems that need addressing. If you’re not healthy, your body will let you know. Difficulty with fertility, vaginal dryness, wrinkles in skin, and drying of hair are not to be solved at a spa or a salon. These are messages that your hormones need attention—especially before you get into the next phase of perimenopause. You can avoid the effects of premature hormonal aging with the right foods and supplements.
6. Perimenopause Phase Two (45- 55 years old)
This should be a relatively smooth process where FSH levels rise to the point where you no longer ovulate. But for women who have hormone imbalances in phase one of perimenopause, stage two can be unnecessarily rocky—with symptoms and problems starting as early as one’s early 30s!

When hormones are in balance during this stage, the body will manufacture slightly less, though still a balanced amount, of estrogen and progesterone and testosterone. If you’re having hot flashes, night sweats, no libido, etc., you can adjust your diet and lifestyle to ease symptoms and feel better.

Perimenopause is an amazing opportunity to check in with your body, make sure you are doing everything you can to keep your hormones happy and healthy, and to set yourself up for healthy aging.

7. Post-menopause (55 +)
In this phase, FSH levels are now at their new, permanent elevated levels (between 20 and 30) and your estrogen, progesterone, and testosterone should be at stable concentrations, which will be lower than they were in your menstruating years, but still in balanced ratios. If you’ve been eating and taking care of yourself during the previous hormone phases, you should have enough micronutrient building blocks to make this phase symptom-free. Continuing to focus on diet and lifestyle in this phase is key. It’s also a good time to support your digestion and ability to absorb nutrients, which can be compromised with age.

When you care for your hormones with diet, lifestyle, and micronutrient support at every stage of life, you will feel better now—and all down the road.

Always remember, that once you have the right information about how your body really works, you can start making health choices that finally start to work for you! You can do this – the science of your body is on your side!

Need more Hormone Help?

If you’re needing some health upgrading, it’s time you started you looking into what’s going on with your hormones.
I’ve designed a 4-day hormone detox and evaluation to help you understand exactly what’s out of whack and how you can start getting back to balance so that your hormones no longer have to suffer.

Hot Flashes, Mood Swings, Anger & Rage, Irregular or Missing Periods, Infertility, Low Sex Drive, Depression, Eating Disorders

By Linda M. Rio, M.A., Marriage and Family Therapist

WELCOME! This site is dedicated to providing reliable information for those who want to be informed about their bodies and the hormonal system that affects us all.

Men and women, children and teens are affected by hormones. Hormones are amazing components of our bodies and when in the right balance help our physical and mental health function properly. Hormones are important and necessary for growth and health.

Physical imbalances and disturbances within the hormonal system do, however, occur frequently and can lead to ill mental and physical health and even changes in the outward appearance of the body. Behavior, mental/emotional changes can occur as well that can lead to tension within a marriage, the family, social and work relationships. The information on this site comes from some of the top medical and mental health experts in the world. Also, sometimes hormonal problems, or those “raging hormones”, are an indication of a deeper medical issue that needs to be dealt with by properly trained physicians and mental health professionals.

Additional information on such issues can be found at www.pituitary.org.

My hormones are raging

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