What Do Premenstrual Mood Changes, Premenstrual Dysphoric Disorder, Perimenopause, and Postpartum Depression and Anxiety Have In Common?
Reproductive mood disorders are linked to the rise and fall of ovarian steroids and influence the severity of symptoms experienced during the conditions of the premenstrum, postpartum and perimenopause. There is a growing amount of information suggesting that women who experience any of these conditions are more likely to experience some degree of these ovarian changes during their lifetime.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are two menstrual cycle conditions that occur during the premenstrual phase of the menstrual cycle (Futterman & Rapkin, 2006). PMS is characterized as having psychological, physical, and behavioral symptoms associated with it. Depending on the severity of the symptoms, that is mild, moderate or severe symptom patterns determine the degree of interference within a person’s life such as personal, social and occupational aspects (Futterman & Jones, 2000). Mild PMS symptoms occur for 1-3 days; moderate PMS symptoms occur for 7-10 days and severe PMS occur for two weeks. The incidence of PMS is estimated at 20-43% of women (Futterman et al. 2000; Futterman et al, 2006).
The incidence of PMDD in the USA is 5-8% of women (Futterman et al, 2006). It is characterized by psychological symptoms i.e., depression, anxiety, and irritability during the premenstrual phase of the menstrual cycle, causing a marked interference in overall functioning. PMDD is a severe form of PMS. Diagnostic and Statistical Manual of Mental disorders fifth edition, DSM-5-TR, American Psychiatric Association, 2022) diagnostic criteria for PMDD requires two months of perspective calendars or diaries that track daily symptom ratings that are psychological, somatic, and behavioral. This allows for the typology and severity of symptoms to be determined. The symptoms must be:
• Limited to the last week of the premenstrual cycle in the previous year
• Intensified by at least 30% during premenstrual phase during 6 days prior to menses
• Be relieved within the first few days of menses and not recurrent during menstrual part of the cycle
• Limited to affective type symptoms, one or more are present during premenstrual phase. These symptoms can cause
signifcant distess or interference in functioning. (DSM-5-TR, 2022)
Perimenopause is a transitional stage in the life span of ovarian hormones often occurring within the fourth decade of life. This is a gradual change in premenstrual and menstrual change. This results in a time of instability of hormones and a shift from regularly occurring menstrual cycles to irregularly occurring cycles. These dramatic shifts in ovarian hormones influence the stability of one’s mood, cognitions, energy levels and sexual functioning. Varying hormonal changes generate irregular cycles, effect one’s overall psychology and physiology, generate onset of vasomotor symptoms known as hot flushes and night sweats, an increase or decrease in menstrual flow, an intensification of premenstrual symptoms and unpredictability about fertility. All of which influence our daily functioning (Futterman $ Jones, 1999; Cunningham et al, 2025)) There is a greater risk of depression and anxiety and these women are two to four times more likely to experience a major depressive disorder (Cunningham et al, 2025).
Postpartum anxiety and depression occur between 10-20% of women after childbirth (Pawliski, Lonstein, Fleming, 2017).
More specific Incidence and prevalence reported that Postpartum affective disorders can range in severity from “blues” to depressive disorders (6.3%) and may include worry and slight feelings
of tension to anxiety disorders, (18%) such as panic, generalized anxiety, social phobia and obsessive-compulsive disorders (Farr et al., 2014). Occurrence of a history of depression and anxiety can set the stage for postpartum mood disorders. Psychosocial stressors may impact the development and severity of postpartum affective disorder (Patel et al., 2012).
The best way to work with these conditions is through a holistic type of approach:
• Track the type and severity of your symptoms using daily calendars or tracking apps.
• Psychological methods that focus on mood and cognitive stability and ways to modify reactions to stressors
• Consult with practitioners that assist with nutrition, exercise, hormonal stability