Understanding and treating PMS

Hormone fluctuations are intrinsically tied to a number of basic functions and moods, from depression and anxiety to sleep. Learn more about the impact and treatment of hormone-related issues with Louann Brizendine, MD.

Transcript

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LOUANN BRIZENDINE: The effects of hormones on behavior, and particularly the sex hormones like testosterone,

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estrogen, progesterone, and the fluctuation of those hormones in the female brain.

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PMS is the effect of the menstrual cycle when the progesterone at the few days before onset of menses,

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the drop in the progesterone. The average age of onset of menses in the United States

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in Caucasian girls is age 12.1. So not until they're 15, 16 do they usually even notice any

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of what we typically call PMS. After that, between ages 12 and 14 or 15,

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the ovaries are not ovulating every single month. There's a lot of cycles that don't have ovulation.

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Some of them do, but lots of them don't. So you can't get PMS unless you have progesterone. At the day of delivery, that 150,000,

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180,000 level of progesterone crashes down when you deliver the baby and the placenta.

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And for one out of five mothers, that huge drop sets them up then for having depression or anxiety

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postpartum. Some women can have bad PMS before they have a baby. And then after they have a baby, they don't have it anymore.

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Or the opposite can happen. We don't understand why that she never had it before and then after she's had a baby or two, she

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ends up having PMS at the end of her cycle. So we treat that the same way as we would in a younger woman.

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One of the main cornerstones of treating women or anybody with depression or anxiety is to really focus on making sure

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that they're getting deep sleep, restful sleep, and especially during the perimenopause and menopause when the hot flashes or changes

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in your temperature control. The SSRI medications, those medicines

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tend to tweak the PMS at the end of the menstrual cycle for reasons that don't necessarily

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have to do with being on antidepressant. The reason that we need to know about them is anxiety disorders and depression in terms of mood,

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in terms of the types of illnesses I treat at my clinic, the hormone fluctuations can trigger those to come out.

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And if we can modify those, then we can modify her depression or her anxiety or her sleep.