PMS Exacerbating Mental Illness Conditions


I have suffered from mental illness since age six. I have been diagnosed with major depression with psychotic features, PTSD, borderline personality disorder and dissociative disorder. Despite these diagnoses, I am very high functioning. I maintain a professional career, I have healthy relationships and I manage to care for my body. I currently work very hard to manage my symptoms with the aid of an excellent therapist.
Ever since I began to menstruate my symptoms of PMS have been characterized by a marked increase in my mental illness symptoms. I suddenly become extremely depressed, anxious and paranoid. I’ll cry desperately for days and I think about dying. (I do not make a plan – the thoughts just occur to me). I feel an excruciating amount of emotional pain that I find overwhelming. I can go from stable to a complete wreck once I enter about the last week and a half of my menstrual cycle. It’s a tremendous burden to have to go through this each month and as a result I am not able to enjoy my life much of the time.

My other PMS symptoms include back pain, headaches, insomnia, irritability, fatigue, slow cognition, sore breasts, bloating.

Any insight you may offer is greatly appreciated.



Last Updated: May 8, 2022
Dear Solange,

You do not mention your age, cycle length or if you are on medications. All of these are pertinent to discussing your situation. Nonetheless, there are some therapies that might be of help to you. In particular, bloating, sore breasts, insomnia and irritability in the premenstrual period can be caused by low progesterone, or an excessive ratio of estrogen to progesterone.

Depression can be a result of low estrogen, which can coexist with low progesterone or even if the ratio of estrogen to progesterone is high. Testing estradiol (the principal type of estrogen) and progesterone several times throughout the cycle is helpful. If progesterone is low, it can be supplemented during the postovulatory period. If estradiol is low estradiol patches can be used or HCG injections given in the post-peak phase. HCG will raise both estradiol and progesterone in the latter half of the cycle. Some women with psychotic symptoms have been helped with HCG. Medical consultants trained by the Pope Paul VI Institute are familiar with this type of therapy, which aims to optimize hormonal levels.

I would also suggest a thorough thyroid workup, as well as cortisol levels. Low thyroid, low estrogen, adrenal dysfuntion can affect cognition.

Some nutritional considerations are important for stabilizing mood. A low glycemic diet that minimizes fluctuations in blood sugar will help stabilize mood. Omega 3 fatty acids are extremely important for mood and brain function; taking a high quality fish oil such as Carlson’s or Nordic Naturals, at least 2000 mg a must. Adequate B vitamins, such as a stress B complex containing 25-50 mg. of B6 in balance with the other B vitamins are important, although a small number of people will have disturbances in Vitamin B metabolism and react to these. Many people benefit from magnesium supplementation.

There are other physical imbalances that can affect brain function, such as neurotransmitter deficiencies due to impaired amino acid metabolism, abnormal liver function, or gut dysbiosis. I would encourage you to explore further in this direction. An excellent book on this topic is Mark Hyman’s “The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First.”

Best wishes, Mary L. Davenport, M.D

Answered By:

Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.

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