Managing Mood Swings During Your Period and PMS

“Why do I feel so irritable or suddenly low around my period?”

Many people notice emotional ups and downs before or during menstruation. This is a common concern we see in clinical practice.

Mood changes around the menstrual cycle are often related to PMS (premenstrual syndrome). PMS refers to a range of physical and emotional symptoms that occur between ovulation and the start of menstruation, largely due to fluctuations in progesterone. It is estimated that around 60% of women experience some form of PMS.

Symptoms often ease once menstruation begins. However, when physical discomfort such as menstrual pain is present, emotional symptoms may persist.

Some individuals experience more severe symptoms known as PMDD (premenstrual dysphoric disorder), which involves marked emotional distress. These may include intense irritability, negative self-perception, occasional aggressive behavior, difficulty concentrating, changes in appetite, and sleep disturbances.

Symptoms of PMDD (Premenstrual Dysphoric Disorder)

●      Emotional instability (irritability, negative self-perception, increased anger)

●      Fatigue or low energy

●      Difficulty concentrating

●      Increased appetite or overeating

●      Excessive sleepiness or difficulty sleeping

●      Physical symptoms (bloating, breast tenderness, joint pain, etc.)

A helpful first step to managing these symptoms is to understand your own symptom pattern and incorporate self-care strategies that suit you.

For fatigue or sluggishness, simple self-care measures such as stretching, a warm bath with essential oils, or light massage may help improve circulation. When feeling irritable or overwhelmed, prioritizing rest is important. Warming the body—such as with a warm bath or foot bath—may also support better sleep.

Support from people around you can also be beneficial. Letting those close to you know what kind of support you need in advance can make this time easier to navigate.

Treatment Options: Medications, Oral Contraceptives, and Traditional Chinese Medicine

If symptoms are more pronounced, medical treatment may be considered. Please consult a physician to discuss appropriate options.

Low-dose oral contraceptives
Low-dose oral contraceptives suppress ovulation and help stabilize hormonal fluctuations. They are a suitable option for those not currently planning pregnancy and are not associated with reduced future fertility.

Symptom-specific treatments
Medications may be used to relieve specific symptoms such as headaches, abdominal pain, or swelling. If emotional symptoms are more severe, antidepressant medications may also be an option.

Traditional Chinese medicine
Traditional Chinese medicine may be appropriate for those seeking a less intensive approach, those with milder symptoms, or those planning pregnancy.

●      Tokishakuyakusan: for low energy, sensitivity to cold, anemia, fatigue, lower abdominal pain, head pressure, dizziness, shoulder stiffness, ringing in the ears, and palpitations

●      Kamishoyosan: for hot flashes, shoulder stiffness, fatigue, constipation, anxiety and irritability

●      Keishibukuryogan: for lower abdominal pain, shoulder stiffness, head pressure, dizziness, flushing, and coldness in the feet

When to Seek Medical Advice

PMS and PMDD are often associated with hormonal imbalance, which can also affect the uterus and ovaries and may have implications for future fertility. If you are considering pregnancy in the future, it is recommended to seek early evaluation and address any menstrual concerns.

Egg freezing is one option for preserving fertility. Since both the number and quality of eggs decline with age, storing eggs at a younger age may help reduce future infertility risk.

If your monthly symptoms feel difficult to manage, it may be a sign that support or treatment should be considered. Taking the time to understand your body and what works for you is important.

If you have concerns, please consult a gynecologist. We can help you find an approach that works for you.

The AMH test, often used as an indicator of ovarian reserve, is also available. At our clinic, results can be provided on the same day, typically around 30 minutes.

Click here to schedule an AMH test or consultation

Supervised by
Yuko Nagura, MD
Board-Certified Specialist, Japan Society of Obstetrics and Gynecology