Moody Bitches: The Truth about the Drugs You’re Taking, the Sleep You’re Missing, the Sex You’re Not Having and What’s Really Making You Crazy.... Julie Holland

serotonin are implicated in depression, panic disorder, and obsessive-compulsive disorder (OCD), so don’t be surprised if you feel a bit like a psych patient (or three) before your period starts. Less serotonin is like less insulation available to protect you from the outside world. You’re even more physically sensitive to pain than usual, and more emotionally sensitive to criticism. You’re less resilient in the face of stresses and feel sadder, hungrier, and more scared, tearful, and angsty. When you stack up PMS symptoms against those of a major depressive episode, there is a massive overlap. The big difference is that PMS goes away once your period starts. Major depression persists for weeks or months.

      Typically PMS arises in the three or four days before your period starts, but a handful of my patients report their PMS symptoms starting a day or two after ovulation. They become terribly depressed, hopeless, and despairing. They get into fights more easily with family members and coworkers. They have trouble getting to sleep or staying asleep and feel bloated and crabby. A few of my patients assure me their PMS is mild, but pretty much everyone notices that “the period before their period” does bring some significant and noticeable changes in mood. Because it is perfectly normal to have mood fluctuations throughout your monthly cycles, you don’t necessarily need to medicate PMS away, but you do need to educate yourself about it. I also strongly recommend that you keep track of your cycle, jotting down when your period starts and when you ovulate. If you keep track of when certain mood symptoms occur, not only will it help you to plan your monthly calendar but it might help to keep certain family members, and maybe even coworkers, in the loop on what to expect.

      Besides getting a good sense of when you’re fertile, keeping track of your cycle will give you a heads-up about when you’re going to be more emotionally sensitive and reactive. You can plan to take on more challenging assignments at the beginning of your cycle right after your period, when your resilience is higher. The peak estrogen levels seen toward the middle of your cycle mean improvement of verbal and fine motor skills, so plan your business presentations and sewing projects for that time of the month. You should definitely leave the tasks best suited to someone with OCD, like cleaning out your closets, for during the PMS part of your cycle. Also, your pain tolerance is at its lowest point during PMS. Not a great time to go to the dentist or get waxed. Schedule those appointments during the first half of your cycle.

      Commonly my patients tell me that it’s easier for them to cry during the few days before their period. There is a phenomenon called rejection sensitivity that is often seen in clinically depressed patients. When your serotonin levels are bottomed out in depression, you’re more sensitive to everything, and it takes less of an insult or slight from someone for your feelings to be hurt. It’s no different in the days leading up to your period. Hurtful comments are going to hit you harder. Women cry more easily during PMS, and it’s not just the mean things that others say. There is an increased sensitivity to schmaltzy television commercials and corny country songs on the radio. If I get a lump in my throat when I see anything poignant on the streets of New York—a homeless schizophrenic rooting through the garbage, a businessman stopping to help tourists fumbling with a map—I know just where I am in my cycle.

      Our emotional lives revolve around our own internal clockwork, and understanding that schedule requires attention. Keep track of when you’re horny, when you’re bitchy, when you’re flirty, and when you want to kick ass and take names. Becoming intimate with your rhythms will allow you to use natural fluctuations to your advantage, and establishing a baseline is the only way to accurately identify changes. This becomes especially important when starting or stopping a medication, especially those—such as oral contraceptives or SSRIs—that provide an unnatural stability. Their potential impact on mood, libido, and more is real, and you may find that that they’re taking more than they’re giving.

      Learning from PMS

      Being a crybaby is one thing, and maybe you could say that it is an endearing exacerbation of womanly empathy and vulnerability, but it hardly ends there. This increased sensitivity, especially to criticism, can cause explosive reactivity. My patients with PMS notice that they get snappy and easily irritated by things they would typically let slide the rest of the month. They become more unpredictable in their responses, and they can let loose with utterances or actions that are not in their repertoire the other three weeks of their cycle. This has to do with the frontal lobes inhibiting the emotional centers, which require solid doses of serotonin. Closer to PMS means lower serotonin levels, so for some of us, the closer we get to our periods, the more likely it is that the “bitch switch” is on. But it’s not that we’re getting upset over nothing.

      We are getting upset over real things, it’s just that we usually hide our sadness and anger better. Thanks to high estrogen levels, we are usually more resilient. Breezy, even. We allow for others’ needs better and can remain detached more convincingly. Natural cycles of caring less and more correlate with our menses. A good way to think of estrogen is as the “whatever you want, honey” hormone. Estrogen creates a veil of accommodation. Designed to encourage grooming and attracting a mate, and then nurturing and nourishing our family members, estrogen is all about giving to others: keeping our kids happy and our mates satisfied. When estrogen levels drop before our periods, that veil is lifted. We are no longer alluring and fertile; we are no longer so invested in the potential daddy sticking around. It’s time to clean house. During the rest of the month you put up with all kinds of bull that you won’t tolerate the week before your period.

      I say, let it be a lesson to you. Perhaps you should be putting up with less all month long. The dissatisfaction that comes on a monthly schedule is a gift to you, a chance to make some much-needed changes in how you’re living your life and how much you’re giving, bending, and stretching to meet everyone else’s expectations. What I stress with my patients is this: the thoughts and feelings that come up during this phase of your cycle are real; they are genuine. If you’re feeling overwhelmed or underappreciated, that you’re taking on more than your partner, or that things are out of balance, chances are it’s all true.

      Remember that our animal imperative is to reproduce. Every cycle is a chance to propagate the species. Just as your hormones allow your uterus to fluff up and prepare for a new embryo, they also push you to “nest.” When a woman is in the later months of her pregnancy and progesterone levels are at their highest, there is a frenzy that overtakes her to clean the house and prepare for the arrival of her baby. Every month, when your body prepares for a possible embryo implantation, progesterone levels are building and causing a smaller form of nesting. Toward the end of the cycle, a woman might become dissatisfied with her environment and obsessive about making changes in order to make sure the setting is appropriate next month for the burrowing of the embryo into the uterine lining. PMS is a time of psychological inventory, to take stock and make sure you are where you want to be in your life. Every cycle is an opportunity for a fresh start, to make your life over the way you want it. Pay attention to that critical eye, to those judgmental thoughts. They are probably more valid than you’d like to believe, and I bet they’re actionable, too.

      Women’s empathic skills can be a great source of useful information and strength, and there is some evidence that they are highest during our premenstrual days. PMS is a great time to tune in to intuition. Because of lower serotonin levels, we are more “raw” and less emotionally blanketed before we menstruate. It is a time to rest and reflect and to honor deep feelings. Sensitivity is dismissed in our culture, but it really does have its advantages. PMS is an opportunity to listen to your body and to honor your feelings. Trust your PMS bitchiness. And put it to good use the rest of the month. Harness the knowledge you garner when you’re more critical, write it down, and put it into action when you’re more genteel and diplomatic, as soon as your period ends. Try this for a month or two and see if you don’t have some “new month’s resolutions” of your own.

      Chocolate and Other Treatment Options

      In both depression and PMS, food cravings, typically for carbohydrates, are common. The usual suspects are comfort foods like breads, pastas, and desserts,