Uncontrollable Crying Before and During Your Period

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

For many women, the days before their period are not just uncomfortable — they are emotionally devastating. Sudden tearfulness without obvious reason, weeping at adverts on television, feeling overwhelmed by minor frustrations, snapping at people you love and then crying about it, a deep low mood that lifts within hours of the period starting — this is the hidden, often unspoken side of the menstrual cycle. It is not a character flaw, not "just hormones to be put up with", and not something women should accept as inevitable. The biochemistry behind it is now well understood, and treatment combining lifestyle changes, supplements, acupuncture and Chinese herbs reliably reduces the emotional intensity of the premenstrual phase. This page explains why it happens, when to consider PMDD, and what works.

On this page

1. What's actually happening
2. The hormonal mechanism
3. PMS vs PMDD — when to investigate
4. TCM understanding
5. TCM patterns behind premenstrual crying
6. Supplements with the best evidence
7. Acupuncture
8. Chinese herbal medicine
9. Diet
10. Lifestyle and self-care
11. When conventional medication helps
12. Timeline of improvement
13. FAQs

What's actually happening

The premenstrual emotional shift is a real, measurable, neurochemical event. In the second half of the cycle (the luteal phase, days 14-28), oestrogen and progesterone rise after ovulation and then fall sharply in the few days before menstruation. This drop is mirrored by changes in serotonin, GABA and other neurotransmitters that govern mood. For many women the drop produces only mild irritability or sentimentality. For some, it produces severe weeping, hopelessness, anxiety, anger and a sense of losing control — symptoms that lift dramatically within hours to a couple of days of the period starting.

The hormonal mechanism

• Oestrogen drives serotonin — when oestrogen falls in the late luteal phase, serotonin drops, reducing emotional resilience.
• Progesterone is converted to allopregnanolone — a metabolite that activates GABA receptors (the calming system in the brain). When progesterone falls, this calming effect disappears.
• Sensitivity to allopregnanolone changes — paradoxically, some women have an abnormal response to its rise and fall, producing severe mood symptoms (this is the basis of PMDD).
• Cortisol response — luteal-phase stress hormones are heightened, magnifying the response to small stressors.
• Inflammation — prostaglandins released during menstruation are pro-inflammatory and affect mood; CRP rises in the luteal phase.
• Sleep disruption — common in the luteal phase; further worsens mood.
• Blood sugar instability — insulin sensitivity drops in the luteal phase, contributing to mood swings.

PMS vs PMDD — when to investigate

PMS (premenstrual syndrome) is the milder, more common picture: irritability, low mood, breast tenderness, bloating, food cravings in the days before menstruation, all settling once flow starts.

PMDD (premenstrual dysphoric disorder) is the severe form. Diagnostic criteria require:

• Symptoms in the week before menstruation that improve within a few days of flow starting and are minimal in the week post-menses.
• At least 5 of 11 specific symptoms, including at least one of: marked depressed mood, marked anxiety, marked affective lability, marked anger or irritability.
• Significant distress or impairment in work, school or relationships.
• Symptoms confirmed prospectively over 2 cycles (cycle tracking apps useful for this).
• Not better explained by another mental health condition.

PMDD affects 3-8% of menstruating women. If your premenstrual emotional symptoms are this severe, see your GP — both medical (SSRIs, hormonal options) and TCM treatments are highly effective.

TCM understanding

In Chinese medicine the Liver stores blood and governs the smooth movement of qi and emotions. In the late luteal phase, blood is drawn from the Liver towards the uterus in preparation for menstruation. When Liver blood is deficient — too little to spare — the Liver loses its capacity to regulate emotions smoothly, and feelings flood out unchecked. When Liver qi has stagnated through the cycle (typical in stressed modern women), the late-luteal phase produces a build-up that explodes as weeping, anger or anxiety, often relieved within hours of the period starting (the "release" some women describe).

TCM patterns behind premenstrual crying

• Liver blood deficiency — pale tongue, scant flow, dizziness, sleep disturbance, anxious-tearful PMS. The most common pattern.
• Liver qi stagnation — irritability, breast tenderness, sighing, pent-up emotions; relief once period starts.
• Liver qi stagnation transforming into heat — irritability tipping into rage, premenstrual hot flushes, headaches, then weeping with exhaustion.
• Heart and Spleen blood deficiency — anxious-exhausted weeping, palpitations, broken sleep with vivid dreams, postnatal women, vegetarians.
• Lung qi deficiency with grief — deep, inconsolable sadness without specific trigger; often after loss.
• Kidney yin deficiency with empty heat — perimenopausal weeping with hot flushes, night sweats, restless sleep.
• Phlegm misting the spirit — heavy, foggy, weighted-down sadness with bloating and weight gain.

Supplements with the best evidence

• Magnesium glycinate or citrate (300-400 mg daily) — the single most useful supplement for premenstrual emotional symptoms. Take from day 14 to day 1 of the cycle, or daily.
• Vitamin B6 (P5P, 25-50 mg) — supports serotonin synthesis. Don't exceed 100 mg long-term.
• Calcium (1,000 mg) — RCT evidence for premenstrual mood symptoms.
• Vitamin D3 — deficiency worsens premenstrual mood; correct to >75 nmol/L.
• Omega-3 (EPA-rich, 1-2 g) — reduces premenstrual depression.
• Saffron (30 mg standardised extract) — RCT evidence for PMS and PMDD.
• Vitex (chasteberry, 20-40 mg) — improves PMS symptoms in trials, particularly breast tenderness and irritability. Not appropriate in all PMDD presentations.
• Inositol — useful particularly in PCOS-related PMS.
• 5-HTP (50-100 mg) — useful but don't combine with SSRIs.
• Probiotic with L. helveticus + B. longum — emerging evidence for premenstrual mood.

Acupuncture

Acupuncture for PMS and PMDD has good evidence — multiple meta-analyses show clinically meaningful reduction in premenstrual mood symptoms. Mechanisms include serotonin and beta-endorphin release, HPA-axis modulation, reduction in inflammatory cytokines, and Liver qi regulation in TCM terms.

Treatment weekly across the cycle, with extra emphasis on the luteal phase. Typical points: LR 3, LR 14, GB 34, LI 4, PC 6, HT 7, SP 6, SP 4, CV 17, Yintang. Auricular acupuncture (Shen Men, Liver, Heart, Endocrine) often added.

Chinese herbal medicine

• Xiao Yao San — Liver qi stagnation with blood deficiency; the workhorse for PMS.
• Jia Wei Xiao Yao San — when irritability and heat are prominent.
• Chai Hu Shu Gan San — strong qi-moving for marked premenstrual breast tenderness.
• Gui Pi Tang — Heart and Spleen blood deficiency with anxious-exhausted weeping.
• Tian Wang Bu Xin Dan — Heart yin and blood deficiency with insomnia and palpitations.
• Gan Mai Da Zao Tang — three simple ingredients (liquorice, wheat, jujube); classical for "restless organ disorder" with crying spells.
• Si Wu Tang or Ba Zhen Tang — Liver blood deficiency with scanty pale flow.
• Zhi Bai Di Huang Wan — perimenopausal Kidney yin deficiency.
• Ban Xia Hou Po Tang — globus sensation in throat with emotional constraint.

Pharmaceutical-grade granules from Sun Ten Taiwan, blended individually for the actual presenting pattern.

Diet

• Stable blood sugar — protein at every meal; avoid skipping meals; reduce refined carbs and sugar.
• Reduce alcohol in the luteal phase — worsens both sleep and next-day mood.
• Reduce caffeine in the luteal phase — particularly afternoon and evening.
• Adequate protein and iron-rich foods — supports neurotransmitters.
• Oily fish 2-3 times weekly.
• Magnesium-rich foods — dark leafy greens, nuts, seeds, dark chocolate.
• B-vitamin-rich foods — eggs, leafy greens, whole grains, liver.
• Don't restrict eating — undereating is a common hidden contributor to premenstrual mood.
• Increase blood-building foods in TCM blood-deficient types — beetroot, dark berries, slow-cooked meat, bone broth.

Lifestyle and self-care

• Track your cycle — apps like Clue, Flo, Natural Cycles let you confirm the luteal-only pattern needed for PMDD diagnosis.
• Sleep 7-9 hours — particularly important in the luteal phase.
• Daily movement — exercise reduces PMS severity; even 30 minutes of walking helps.
• Yoga and breathwork — calms the autonomic nervous system.
• Plan around your cycle — schedule demanding tasks early in the cycle if possible; protect the luteal week.
• Communicate with partners and family — share what's happening; ask for support.
• Reduce stress in the luteal week — say no to non-essentials.
• Light therapy in the morning — useful for some, particularly if SAD overlap.
• Limit alcohol on the days of worst mood — paradoxically worsens it next day.
• Counselling or CBT — useful adjunct, particularly for PMDD.

When conventional medication helps

• SSRIs (sertraline, fluoxetine, paroxetine) — first-line for PMDD; can be taken continuously or only in the luteal phase.
• Combined oral contraceptive — particularly drospirenone-containing pills; suppresses cycle and the hormonal swings.
• GnRH analogues — for severe PMDD not responding to other treatment; need add-back HRT.
• Cyclical progesterone — controversial; helps some, worsens others.
• HRT in perimenopause — when PMS becomes worse with perimenopausal fluctuations.

Conventional and TCM treatment combine well. Many women on SSRIs use acupuncture and Chinese herbs to reduce dose or wean off over months.

Timeline of improvement

• Cycle 1: some improvement in irritability and tearfulness for many women.
• Cycle 2-3: meaningful reduction in premenstrual emotional intensity.
• Cycle 3-6: stabilisation; many women describe their PMS as "manageable" rather than "overwhelming".
• Cycle 6-12: long-standing PMDD reaches full benefit; some women come off SSRIs.

Frequently asked questions

Why do I cry uncontrollably before my period?

The drop in oestrogen and progesterone in the late luteal phase reduces serotonin and GABA — the mood-stabilising neurotransmitters. For some women this drop produces severe weeping, hopelessness and anger that lifts dramatically when the period starts.

Is this PMDD?

If symptoms are confined to the week before menstruation, settle within days of flow starting, and significantly affect work or relationships — and have done so for at least 2 cycles — yes, it likely meets PMDD criteria. See your GP.

Will magnesium really help?

Yes for many women. Magnesium glycinate or citrate at 300-400 mg daily is the single most useful supplement for premenstrual emotional symptoms. Allow 2-3 cycles for full effect.

Can Chinese medicine treat PMDD?

Yes. Acupuncture and tailored herbal formulas (Xiao Yao San and variants) have good RCT evidence for both PMS and PMDD. Often combine well with SSRIs and can reduce the SSRI dose needed.

Should I take antidepressants?

SSRIs are first-line for PMDD and work for many women. They can be taken continuously or only in the luteal phase. Discuss with your GP. Combine with TCM, lifestyle and supplements for best results.

Will the contraceptive pill help?

Drospirenone-containing pills (Yasmin, Yaz) are licensed for PMDD and help many women. Other pills can worsen mood — track carefully.

Why do I feel better as soon as my period starts?

Hormone levels reach their lowest point and start to rise again, the prostaglandin storm passes, and in TCM terms the stagnation that built through the cycle is released with the menstrual flow.

To discuss PMS, PMDD or premenstrual emotional symptoms, contact me or book a consultation at my Wokingham clinic.

Related reading: Jia Wei Xiao Yao San | Herbs to boost mood | Natural remedies for PMS

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