When you know you're overreacting before your period

In the week before your period, estrogen and progesterone drop fast, and so does allopregnanolone, a hormone metabolite that normally calms the brain's fear and anger circuits. Brain imaging shows the amygdala, the part of the brain that flags threat and drives anger, reacts more strongly during this phase in women with PMDD ( [1]).

One study found that women with PMDD on placebo showed a link between reactivity in the anterior cingulate cortex and prefrontal cortex, regions involved in regulating aggressive responses, and how aggressively they responded during a provocation task. Women given a hormone-modulating drug didn't show that same link ( [3]). That's often the shift you're feeling: a small thing, like a dish left in the sink or a slow reply to a text, can land with the weight of something much bigger.

For a lot of women, this is ordinary PMS: real, and it eases once your period starts. For others, when anger or sudden mood swings show up with several other symptoms every month in that same week, the pattern points toward PMDD. It can be both: a real disagreement, and a reaction that's bigger than it would be another week.

If this, reacting far bigger than the moment calls for, is familiar every month, here's why it can feel this intense before your period.

If you can feel the heat rising, the first move is physical, not something you can think your way out of.

• Say "I need a minute" and leave the room, even if it's just for 60 seconds.
• If you're with your kids, it's fine to say "I need a grown-up minute" and step into another room, even the bathroom.
• Run cold water over your wrists or splash it on your face. Cold water can help cool a spike within a minute or two (cold water for PMS).
• Breathe out for six counts, longer than you breathe in, and repeat five times. A slow exhale tells your body the danger has passed (breathing exercises for PMS).
• If you want something to follow in the moment, a breathing timer counts the inhale and exhale for you.

None of this makes the feeling disappear right away. It buys you a few minutes where you're less likely to say or do something you'll have to walk back later.

Twenty minutes is usually enough for the first wave to pass. Tell whoever you're with, a partner, a kid, a coworker, that you need 20 minutes and that you'll come back to finish the conversation. Set a timer so it's a real number, not an open-ended disappearance.

Use the time to get the thought out of your head before it comes out of your mouth. Write down what happened, in plain terms: what was said, what you felt, what you actually want to say back. Niyora is a PMS and PMDD support app, and its Moon feature lets you write down the fight, see it from another angle, and draft a reply you can hold onto until you're calmer.

When the 20 minutes is up, go back. The conversation will still be there, and you'll likely have more say in how it goes if you're not still in the middle of the spike.

A few things make the next hour harder, not easier.

• Don't send the text, email or message you're drafting in your head. Save it instead and read it again later.
• Don't make a big decision, about the relationship, a job or money, while you're still in the spike.
• Don't argue about whether you're overreacting. That conversation rarely goes anywhere good, and it isn't the point right now.
• Don't reach for more caffeine or alcohol. Both tend to make the next hour rougher.
• Don't go over the moment again and again in your head. Write it down once, then step away from it until the timer goes off.

Waiting these few minutes keeps the next hour from getting harder than it needs to be.

Once the wave passes, your body still needs something. Eat something with protein or fat, not just sugar or coffee, and drink water. Feeling shaky or wrung out for an hour or two afterward is common, and it's the adrenaline leaving, not a sign you did something unforgivable.

If you said something you regret, a short, specific apology usually helps more than a long one: "I'm sorry I raised my voice, that wasn't fair to you." You don't owe anyone an explanation of your hormones unless you want to give one. The apology is about what happened between you.

If you track your cycle, note where you are in it today. A pattern over two or three months tells you more than any single hard night, and it's useful information to have on hand.

Most overreacting before a period is PMS. It's common, it's real, and it eases once your period starts. PMDD is different: a diagnosable pattern of five or more symptoms, including a mood symptom like irritability or anger, in the week before your period, easing within a few days of it starting.

If an existing condition like anxiety or depression is part of most months and simply gets worse before your period, that's premenstrual exacerbation, not PMDD, though it's still worth mentioning to a doctor.

If the pattern fits more than PMS, PMDD irritability: what it feels like and what helps goes into what makes it different. If you're in the middle of a hard episode right now, here's what to do.

Doctors also have treatments that work with this part of the cycle, including SSRIs that some women take only in the two weeks before a period, some hormonal contraceptives, and CBT. One trial tested sertraline taken only from when symptoms start through the first days of a period, instead of every day of the month ( [2]). A doctor decides what, if anything, is right for you.