Mood Swings and Irritability: Coping Strategies

Why Do Mood Swings Happen?

• Hormonal fluctuations: Declining levels of estrogen and progesterone in the luteal phase influence serotonin and gamma-aminobutyric acid (GABA), leading to mood changes.
• Neurotransmitter sensitivity: Some individuals are more sensitive to these hormonal shifts, resulting in heightened irritability and emotional lability.
• Lifestyle and environmental stressors: Poor sleep, high stress, and inadequate nutrition can worsen symptoms.

Coping Strategies

1. Lifestyle Modifications

• Regular exercise: Aerobic activity and yoga release endorphins, which stabilize mood and reduce irritability.
• Sleep hygiene: Adequate, consistent sleep reduces mood instability. Limiting screen time before bed supports melatonin production.
• Balanced diet: Meals rich in whole grains, lean proteins, magnesium, and omega-3 fatty acids may improve neurotransmitter regulation.

2. Stress-Reduction Techniques

• Mindfulness and meditation: Proven to decrease perceived stress and improve emotional regulation.
• Breathing exercises: Slow, diaphragmatic breathing reduces sympathetic nervous system activation.
• Journaling: Helps track mood patterns and provides an outlet for emotional expression.

3. Nutritional and Supplemental Support

• Calcium and vitamin B6: Evidence suggests supplementation can reduce PMS-related mood symptoms.
• Magnesium: Supports neurotransmitter balance and may reduce irritability.
• Herbal remedies: Chasteberry (Vitex agnus-castus) has shown modest benefit in PMS, though further studies are required.

4. Social and Behavioral Support

• Communication: Sharing experiences with friends or family can provide reassurance.
• Structured routine: Predictability in daily tasks can lower stress during vulnerable phases.
• Professional counseling: Cognitive-behavioral therapy (CBT) is effective in improving coping mechanisms for PMS and PMDD.

5. Medical Management (For Severe Cases)

• Selective serotonin reuptake inhibitors (SSRIs): First-line pharmacologic option for PMDD and severe PMS-related mood disturbances.
• Hormonal therapy: Continuous combined oral contraceptives may reduce cyclical mood swings by stabilizing hormone levels.
• Anxiolytics or antidepressants: Reserved for refractory cases, under specialist supervision.

When to Seek Medical Advice

• Mood changes interfere with daily functioning or relationships.
• Symptoms suggest PMDD (severe irritability, anxiety, or depression confined to the luteal phase).
• Self-care measures provide inadequate relief.

Conclusion

References

1. Yonkers KA, O’Brien PMS, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200–1210.
2. Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Women’s Health (Lond). 2013;9(6):537–556.
3. National Health Service (NHS). Premenstrual syndrome (PMS). NHS UK. Updated 2023. Available at: https://www.nhs.uk/conditions/premenstrual-syndrome-pms/
4. Freeman EW. Premenstrual syndrome and premenstrual dysphoric disorder: definitions and diagnosis. Psychoneuroendocrinology. 2003;28 Suppl 3:25–37.