The problem appears when our natural wonder drug leaves town to become a star in Hollywood. To understand what happens to our brains then, let's flash back to when estrogen was an ingénue.
Hormones on Center Stage for Puberty
Three hormones start the dance of a girl's body into womanhood. Sometime between ages ten and fourteen, the brain triggers a release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. These two hormones stimulate estrogen production in the ovaries. (In boys, LH and FSH stimulate testosterone and sperm production.)
The domino effect of hormonal changes includes a rise in dopamine and oxytocin (the “love hormone”). The neurotransmitter dopamine stimulates the brain's pleasure and motivation circuits.
Other hormones active in puberty are androgens, which are associated with aggression and sexual response. One type of androgen is testosterone, and another is dihydroepiandrosterone (DHEA). Androgens are primarily male hormones, though females also have them, and girls who have higher levels of DHEA and testosterone tend to have sex earlier than girls with lower levels. Ironically, a good countermeasure for these high levels is oral contraceptives.72They reduce sex drive and aggression because they suppress the androgens produced by ovaries.
Hormones and Aunt Flo (or Your Monthly Visitor)
In our teens, we begin making the monthly menstrual-hormone journey, a voyage of the body and the brain. You're familiar with the route:
It starts with the irritation and/or relief of your period …
moves into the “just fine” weeks that follow …
may encounter a cramp or ache during ovulation …
then goes through the week or two that ranges from just fine to the hell of PMS, until you reach …
the irritation and/or relief of your period.
Such is life for most women for forty years, starting in the preteen or early teen years.
Here's the map of what's happening within your body and brain during the trip.
In the follicular phase, before ovulation, your body pumps up follicles (cavities in the ovary containing the immature egg) with the aptly named follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Both endorphin and estrogen levels are high, giving a real boost to neurotransmitters such as serotonin, dopamine, and norepinephrine. The result? You feel pretty good.
The follicles get all pumped and tell the ovary to release the egg, about fourteen days after the first day of the previous period. Estrogen rapidly spikes and drops during ovulation, and it seems to prime your sensitivity to the next drop in estrogen a few days before your period.73
The egg begins its journey down the fallopian tubes and begins the luteal phase, when the body prepares a home for a possible fertilized egg. During the first part of the luteal phase, the scar (corpus luteum) on the ovary where the egg used to live produces estrogen and progesterone to care for the egg, if it's fertilized.
Estrogen refreshes and recharges cells and areas of your brain, which helps you be more socially relaxed, sharper, and steadier on the emotional level. Progesterone helps the brain by boosting the receptors to enhance GABA (gamma-aminobutyric acid), a neurotransmitter that slows down or calms the nervous system in the brain, which can help reduce anxiety.
Premenstrual Haze
During the premenstrual days (the second part of your luteal phase) your corpus luteum scar realizes its egg is not going to be fertilized,74 and it crumbles. It stops producing estrogen and progesterone, and your body gets ready to shed the uterine lining it had created just in case the sperm and egg had a shindig.
Your body and brain do not like the loss of estrogen and progesterone, nor do they like having more estrogen than progesterone.75 Their reactions range from slight fatigue, tension, or emotional stress to more potent symptoms that keep you from functioning.
The drop in estrogen reduces the production of serotonin, the neurotransmitter that regulates mood, appetite, and sensory perception. Estrogen no longer recharges your brain, so you may feel not as sharp, socially adept, or emotionally steady. The drop of progesterone levels means the brain doesn't have nearly enough receptors for GABA, the soothing brain chemical.76 So the GABA is essentially wasted.
To add fuel to the fire, women have more prostaglandins during this time. Prostaglandins are fatty acids that, on the good side, stimulate the contraction of smooth muscle and the uterus. On the not-so-good side, in the premenstrual week, they cause inflammation, sensitize the spinal nerves to pain, increase bloating, and congregate in the brain, breasts, and reproductive tract, making all three hurt.77 Pain relievers such as Advil (ibuprofen), Aleve (naproxen), and Midol all help at this time because they are anti-inflammatory and/or prostaglandin blockers.
Your poor limbic (primitive) brain also goes into withdrawal. It no longer connects as well to the cerebral cortex, and you have less access to your skills for handling strong emotional reactions.
Your brain can also go “on strike” during these days. Bruce McEwen, renowned professor of neuroscience at Rockefeller University, says all these hormone shifts overload your brain's self-regulatory systems (called allostatic loading) and overcome your brain's capacity to compensate.78
Your brain also gets triggered to respond to more food cues, which may not be all bad.79Your brain might want you to consume chocolate, which has magnesium salts, a mineral that can help with depression.82
Premenstrual Syndrome, Dysphoria, Depression, and More
Premenstrual days mildly affect 75 to 80% of women, says the Women's Health Study.81 Symptoms include irritability, crying, depression, oversensitivity, moods, insomnia, fatigue, bloating, change in sexual interest, headaches, backaches, cramps, aggression, nausea, joint pain, acne, dizziness, and confusion or a lack of concentration ability.
For most of us, the premenstrual week is only annoying. You may have to watch what you say, but your symptoms don't really impair your ability to function. The American College of Obstetricians and Gynecologists estimates at least 85% of menstruating women have at least one premenstrual syndrome (PMS) symptom, and the symptoms they experience are fairly mild and don't need treatment.82 But 20 to 50% of women find that their symptoms interfere somewhat with daily activities, according to the University of Maryland Medical Center.83 When these symptoms become so intense that women are unable to function (which happens to 3 to 8% of women), the diagnosis changes from PMS to premenstrual dysphoric disorder (PMDD).84 (For simplicity, I’ll generally refer to this monthly stress as PMS.)
You might feel all alone when you are in the depths of PMS. But while no one can infuse you with a shower of sunshine or keep your house perpetually clean, you have options. These treatments may reduce the intensity of PMS from that of a cyclone roller coaster to that of a drive on a bumpy road, or maybe even make it as smooth as a limousine ride. As always, check with your doctor before