The Link Between PMS and Postpartum Depression

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postpartum depression researchI’ve said it more than once in speeches and been told I was wrong by an expert or two. There’s no data, they said. Yet it only makes sense to me that those of us who are highly sensitive to hormonal changes would be more likely to experience mood problems all across our lifespan. And it’s not just me. I have heard this from the thousands of women I have spoken to throughout the 8+ years I’ve been doing this blog. Sure, a history of PMS wouldn’t be the only risk factor for PPD, but certainly it is one, right?

Mood problems with PMS? Check.

Postpartum depression? Check.

Mood seriously affected prior to periods during perimenopause? Double freaking check.

More than one person has told me no. Now a study from the University of Iowa published in the Archives of Women’s Mental Health finds that there is an association between premenstrual symptoms and a risk for postpartum depression.

Yes. We could have told you that. And now there’s some data. It will be interesting to see whether more studies come out finding the same.

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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  1. I never had PMS or any other “hormonal problems” before being pregnant, and I don’t technically have it now. Rather than *pre*-menstrual syndrome, I have *during*-menstrual syndrome (yes, my psych has already mentioned how abnormal that is). It’s 3-4 days every two months (thank you BCPs!) where it’s as if I never started recovering from PPD – I’m really angry and then guilty and upset. But, about 3 days after my cycle starts – I’m totally fine. I totally believe that being hormonally sensitive at anytime in your life would raise the risks of PPD.

    • I agree Laura, it seems plausable that having hormonal sensitivity would most likely only be aggrivated by the dramatic fluctuations in hormones we experience during childbearing. Although I had run of the mill pms prior to the birth of my youngest child, I now struggle with mood symptoms for 1 1/2 weeks prior to starting my cycle each month. The severe symptoms lasting from 2-5 days. Thank you for sharing your experience. I had not heard of other women who have had this experience while recovering from PPD/A. I was diagnosed as bipolar but did not have any real relief untill my Drs started treating the PMDD as the primary cause of my symptoms. Although I continue to have moderate to severe symptoms monthly, now their grip is not as tight on me and they are not as intense and quite as debilitating as they were over the prior past two yrs.

  2. Over the years of being with DH, it’s become really obvious that my mood and cycle are directly linked – to the point that we can both usually tell where I am by how I’m acting.

    I took BCP for a while, but eventually learned that I’m too sensitive to them, as well as any other outside estrogens (like herbal lactation aids), to take them. I wonder if a study was done, focusing on women who react to hormonal birth control and PPD/etc symptoms, what the result would be?

    • I’d love to see such a study – in my case, the hormonal BC (combo) is *good* for me – I’m fine until I take the sugar pills and start my cycle.

  3. It’s sad to me that so many “experts” still fail to understand the impact of hormones on women’s emotional health, Katherine. No wonder we women feel crazy when trying to seek help for our emotional issues–those we are turning to often don’t have a clue!

    There absolutely IS a link between hormone changes and changes in the brain. In fact, it’s a direct link–as hormones change, the brain’s neurotransmitters change as a result. Life experiences can also change the brain, and all of these things can lead to “earthquakes” like postpartum depression and PMS. In fact, the most common age for severe PMS is in a woman’s 30’s, BECAUSE of all the hormonal shifts (like PPD) her body and brain have been through.

    While I’m happy there is a little more research now to back this up, I have to say, it really disturbs me that more “experts” don’t already know these basic aspects of how women’s emotions work. If we say we are “experts” on women’s mental health, we’d better learn the facts to back it up!

    Thanks for the article and beginning this important discussion! For more on the menstrual cycle, hormones & the female brain check out my series, Women’s Emotions: :) http://www.drchristinahibbert.com/womens-emotions-the-3-components-of-emotional-health/

    • It disturbed me too. But I have to remind myself that it hasn’t been that long, really, that so much research was devoted to postpartum depression and related illnesses, so I’m trying to be patient. ;-)

  4. sarah freeman says:

    me to. I notice, and I choose the word deliberately, as I’m still learning to notice, my symptoms return, around 5 to 7 days before my period begins. I take some medication to help and its a pretty good indicator of how I am going as to how much I feel I need to take. Recently my GP suggested a whole range of supplements to take from day 14, Magnesium being the most important. Havent yet tried to follow this.
    Also it does seem a little weird that the studies are only just starting to be done…why the delay?

    • Sarah–Supplements can be great–magnesium, Fish Oil, and B-Complex vitamins being the most recommended. Once you know how your “cycle” influences your moods you can much better manage your symptoms and it can be easier during that last, or pre-menstrual week.

      As for the research, it has long been known by some that PMS and PPD are linked–I know we teach about it in our 2-day PMAD course and I teach about it in my Women’s Emotions Across the Lifespan series. But I think most of the research has focused on how women who are sensitive to shifts in hormones (and get symptoms like PMS) are also sensitive to postpartum shifts (and are prone to PPD). This study looked specifically at PMS as a predictor of PPD. Almost the same thing, but not quite.

      I recommend the book “Women’s Moods” on this topic. It is an excellent resource–every woman should read it!:)

  5. Thank you for this. I’m experiencing something along these lines now. The hormonal shifts from both weaning and my cycles returning have been challenging for me. It absolutely makes sense!

  6. Gosh, I love this site! Even 4 years out and fully recovered, I still find such comfort in the information posted here. I am also surprised that “experts” still don’t completely realize the impact of our hormones on our well-being. Oh, the struggles I’ve had with doctors! I had pms prior to having my daughter at 34. It was a rotation of sorts. One month I would get all of the physical manifestations and very little mood stuff. The next month it would be mostly the mood stuff and minor physical discomfort. Irritability, sensitivity, depression, crying spells, anxiety for a day or two (or the “krispies” as I liked to call them). Looking back, I kind of agree with my Mom that I was leaning more towards PMDD, but at the time it was what I was used to dealing with every month and I just thought every woman felt that way.

    Then came hell on earth for me in the form of antepartum anxiety/depression coupled with severe insomnia in my 3rd trimester. And it was unlike anything I had ever been through. The sudden and severe onset felt like a nervous breakdown. Sometimes I feel like it was. And it still gives me chills when I allow myself to think about that time. Not surprisingly, I developed postpartum depression after my daughter’s birth. It never got as severe as it did while I was pregnant, due to being able to take different medications, but it didn’t fully go away for more than 2 years. Monthly bouts of severe pms didn’t help matters. It took me right back to the darkness. Through my research over the last few years, I have discovered among many things hormone related, that a woman’s progesterone levels are through the roof during this time. It only makes sense to me that this played a huge role in what happened to me, considering how sensitive I am to hormonal changes. I literally felt the hormones coursing through my veins.

    I have definitely suffered more intense bouts of pms (have been diagnosed with PMDD) since giving birth. They were like mini PPD episodes. Awful! After several years of trying numerous medications, supplements and creams, I feel I have just now gotten a handle on it….I hope! Seems I’m super sensitive to meds and hormone creams as well. Yay me! I’m 38 now, so I suspect my age has something to do with all of this as well. Anyway, I’m on a green smoothie regimen (one a day) and take a supplement with St. Johns Wort, Holy Basil, 5htp, Valerian and some other stuff that is escaping me at the moment. Oh, and Klonopin if things get super awful. They haven’t though. Something finally worked! I had almost lost hope. I still feel like I’m being cautiously optimistic, since I had so many letdowns leading up to this. Anyway, thank you so much for this post and for confirming what I already knew. Being a woman is hard, yo! And hormones are awful! :)

  7. Since developing Postnatal depression with my 2 year old son i now have PMDD that i never had before or didnt notice. Now before my period and ovulation time i am extremely depressed and anxious. Its as if my PND is never going to leave. My gynocologist said that he has heard it quite a lot from patients that have had PND to then develop PMDD.

  8. sarah freeman says:

    think thats how it is for me too, not sure if I just didnt notice, or if its changed, but its pretty blerk. Am really glad my doctor and psych take it seriously, as I certainly do!

  9. There absolutely is a link, and I hope that more research goes into this. I never had premenstrual symptoms until after my 2nd child. I fell into a crippling postpartum depression, and treatment was complicated by the fact that I had developed PMDD. It took a year to figure out what was going on and find the right medications. I am so relieved and grateful to have the worst of that hell behind me. I would say to any woman being treated for PPD to watch out for PMDD, especially if break through symptoms are happening.

    • Phoenix this is exactly my story. No symptoms till after my second child and then ppd developed and a year of hell trying to work out why I was not getting well. Just recently figured out I have pmdd. Can I ask you what you found that worked for you?

    • That’s me, Phoenix. While it’s been 10 years since I had postpartum OCD, I still take medication for my OCD, and I will tell you prior to my period that I get horrible breakthrough symptoms. It’s awful. Definitely something we need to talk about more.

  10. I suffered with postpartum depression for several months. I would always feel better until my period came around. I couldnt understand why it kept “coming back”. It took awhile to link the 2 together, but now I agree 100%! It seems to be estrogen dominance. I was put on progesterone and Im much better!

  11. Catherine Morgan says:

    I had PMS before my pregnancy at age 23, I suffered from postpartum depression and have suffered from PMDD since. I am now 43 and for 20 years have been told there is no link, I found this thread looking for evidence of a link as it also seems to make sense to me that the hormonal sensitivity would be relevant. I have also had 7 miscarriages and found that the hormone changes then also had a similar effect.

    Whilst I wouldn’t wish these symptoms on anyone, I can honestly say that it is a relief to hear other people describe the same experiences. I am reluctant to discuss my PMDD with anyone as I find most people are unable to understand and assume I am just exaggerating, a skin specialist told me recently that as I was on the second day of my period I couldn’t blame my mood on the PMDD (she wanted to give me oral steroids and I refused because I didn’t want to risk my mood being altered further). I find the attitude of some health professionals patronising and I worry for people who are treated in this way whilst initially seeking help and trying to understand their own behaviour. I am fortunate enough to have an enlightened GP that is fully onboard with helping me to best manage my PMDD.

    I have learnt to cope with my condition but it is still limiting, I work for myself so I can work from home one week a month and I don’t schedule any social activities that week either.

    I was better on birth control but after having a DVT, I can no longer take it. I have lost weight and quit alcohol and cut down on sugar and processed foods, that has made me feel better the rest of the month but hasn’t eased the symptoms greatly. I do think it helps me bounce back a bit quicker than before.

    Thank you all so much for sharing your stories – When women support other women the world becomes a better place!!

  12. I was never diagnosed with PMS I was diagnosed with PPD. But the reason I was never diagnosed with the other was because growing up as a young woman in the 90’s it was something that was just expected. Oh she’s being a b$%^*, it must be that time of the month. When I got married and started having babies though that is when the real fun began. Once a month, like the moon becoming full, I would turn into a monster. I remember being in the back of my head watching me scream at my husband, my children, the vacuum, anything that set me off. I got mad about everything and would hold the rage in until I got home and could let loose because I was terrified enough to not do that in public.
    By my second baby I contemplated suicide by the time she was 5 months old. I didn’t do it because I would have to put her down to pick up the gun, and I didn’t want her to fall off the bed (totally rational right?). Then there was the once a month I would turn into a monster episode. By three weeks postpartum with my third I would get up feed my girls, turn on Dora, and go back to bed and cry. If my son woke up I would nurse him and weep (still in bed his bassinet was one of those next to the bed things) I would get up and get the girls lunch and turn it to spongebob. Go back to bed and get up at 4 put on sweats and cook something so no one would know how bad it was all day. I lost interest in everything except sleeping and crying. He got thrush, while I may have had an interest in self harm, I did not have an interest in hurting my kids or letting them suffer (I know no mom and Dora and spongebob weren’t exactly great for them either but I definitely was not full of a lot of rational thought I don’t think I was capable of it) so I took him to the doctor. She happened to be my doctor as well (family practice) She took one look at me and made a face, I could tell she was concerned but she didn’t say anything. She examined him and wrote the necessary prescriptions. Then she asked me how I was doing. I just started to cry, like silent tears of anxiety and overwhelming sadness. I tried not to cry but I couldn’t hold them back. She wrote me a prescription for Zoloft and told me that I needed to see her again in a week. I took it, I saw her again. We got me some psychiatric help as well but the most amazing thing was by the time I was 6 months postpartum and had started cycling again, I didn’t have any symptoms. No cramps, headache, or fatigue. But best of all, I no longer turned into a monster. I was myself every month all month long. That to me was a testament that there has always been something largely wrong with my brain soup that made sure I was at the mercy of my own hormones every month since I was 12. Something exacerbated by the large changes brought on by pregnancy and child birth. I have never needed a clinical test that proves there is a connection because I was a walking testament to that connection. I’ve had two children since and taken Zoloft after the birth of my fourth, and before the birth of my fifth (a good Certified Nurse Midwife who realized I was getting nutty 2 months before my due date. I’d also like to add that was my best birth experience and that I immediately bonded to my baby and never had any symptoms of PPD after she was born I was ecstatically happy)
    I think that doctors don’t have all these facts because for to long PMS, PMD and PPD were issues that we were told we had to live with, or deal with, and they were just TMI to talk about. I no longer have that attitude. I want to talk, I want every woman to talk about everything that we go through, because if there is something off the only way you will get help is if you know what isn’t normal, We can’t substantiate a normal if we put up with the abnormal as if it was the norm. This is not something wrong with us because of hormones. It is something wrong with us because our brain soup is not being used correctly by our brains, or has too much of an ingredient and is overwhelming our receptors. When we started dealing with our hormones in puberty it kicked off this lifelong odyssey of hormone reactions that has gotten progressively worse through our lives as we have done nothing about it.