Irritability

1 March 2017.

A person is said to be irritable when they feel annoyed, impatient, or angry, much more quickly than would be typical for them, or for those around them [1].

It is not technically a ‘medical symptom’, although most people are aware that certain physical, or environmental, conditions can make them irritable.

For example, if someone is hungry they are far more likely to feel irritable, because their blood glucose level drops [2]. Low blood sugar triggers the release of stress-related hormones like cortisol and adrenaline, as well as a chemical called neuropeptide Y, which has been found to make people behave more aggressively towards those around them [3].

Similarly, some people who menstruate may feel more irritable just before their period due to the effects of hormonal changes on their bodies. Changes in sleep patterns, temperature control, blood sugar levels, and fatigue caused by blood loss, can all increase the likelihood of an individual feeling irritable.

Important note: There is an ancient but persistent myth that associates people who menstruate with ‘madness’ or ‘irrational behaviour’. Feeling irritable is NOT the same as thing as being irrational. Whenever you hear someone describe themselves, or others, as ‘irrational’ due to their menstrual cycle, please (politely!) point out that this is not true.

Irrationality is not (and never has been) a listed symptom of PMS (Premenstrual Syndrome), or even PMDD (Premenstrual Dysphoric Disorder). If you are unhappy about feeling irritable at certain times in your cycle, make a note of the things that trigger these feelings e.g. lack of childcare support from a partner, being taken for granted in some way, feeling stressed about financial, or job difficulties etc. It is these issues that need to be addressed, not only your cyclical emotional response to them.

Whilst it can be disturbing to feel like your emotions are taking control of ‘who you are’, this is not a mental health problem, you are simply experiencing heightened, but legitimate, emotional responses to real issues that are annoying you (probably throughout the month). Try to think of premenstrual irritability as a chance to find out what is really bugging you- although remember to wait until you feel more relaxed before calmly discussing these issues with the people involved!

Managing hormone-related irritability:

The steps outlined on our ‘all symptoms‘ page can help to alleviate cyclical irritability:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight a few of the key steps that are especially relevant for irritability, below;

Avoid sugary foods/ drinks– Consuming sugary foods and drinks can result in sharp changes in blood sugar levels that can cause irritability [4].

So, eat more complex carbohydrate foods, instead (e.g. wholegrain wheat, rye, oats, corn, brown rice, lentils, beans, or fresh vegetables).  Also, try to eat small amounts, more often (less than 3 hours apart), rather than just two or three large meals a day. This will keep your blood sugar levels at a more consistent level, and stop you from getting ‘hangry‘ (angry when hungry!).

Avoid caffeine – it stimulates the production of stress hormones, including cortisol and adrenaline, as well as interacting with progesterone, insulin and blood sugar levels[5].

– Try nutritional supplements– Several supplements have been found to alleviate irritability (and depression)- omega 3 fatty acids (found in fish and some seed oils)[6]; Magnesium [7]; and B-vitamins [7].

Research also shows that Vitex Agnus Castus (200-500 mg of extract daily) [8] can be beneficial for hormone-related irritability. NoteVitex Agnus Castus is not suitable for those who are under 18; using hormonal medication (or devices); are pregnant, trying to conceive, or breast-feeding; or have a pituitary problem.


Exercise regularly– Regular exercise, particularly aerobic exercise, may help you combat irritability and release tension. It also encourages your brain to release serotonin, which can improve your mood [9].

 


Boost self-esteem– If you are going to discuss irritating issues with others, it is a good idea to make sure that your self-esteem is healthy! You will need to be able to express yourself clearly and calmly, and resist the urge to ignore the problem…

As with most menstrual cycle-related symptoms, we recommend Cognitive behavioural therapy (CBT). CBT usually involves meeting with a specially trained and accredited therapist for a one-hour session every week for 10-12 weeks, but it is possible to boost your self-esteem on your own- through the use of online resources of books e.g. The Oxford Cognitive Therapy Centre produces a highly effective (and cheap!) booklet; ‘Building self-esteem’.


Take note of what is triggering your irritability– make a note of the things that trigger you e.g. lack of childcare support from a partner, being taken for granted in some way, feeling stressed about financial, or job difficulties etc. It is these issues that need to be addressed, not just your (justifiable) emotional response to them. Once you know what the problem is, you can take steps to improve things…

Reduce stress hormones- Research shows that Mindfulness-based Cognitive Behavioural Therapy (MCBT) is highly effective in reducing menstrual cycle-related low mood, anxiety, and irritability [10]. Mindfulness works by focusing your awareness on the present moment and by acknowledging and accepting certain feelings. Being mindful can teach you how to overcome negative thoughts – for example, being able to challenge hopeless feelings.


If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any other suggestions, or tips, for managing hormonal irritability- please let us know– we can share them with others!


Further information:


Page last reviewed and updated: June 2018


References:

1. Collins Online Dictionary. (2017) Irritable. [ONLINE] Available at: https://www.collinsdictionary.com/dictionary/english/irritable. [Accessed 21 July 2017].

2. Bushman BJ, Dewall CN, Pond RS Jr, Hanus MD. (2014) Low glucose relates to greater aggression in married couples. Proc Natl Acad Sci U S A. Apr 29;111(17):6254-7 doi: 10.1073/pnas.1400619111

3. Coccaro EF, Lee R, Liu T, Mathé AA. (2012) Cerebrospinal fluid neuropeptide Y-like immunoreactivity correlates with impulsive aggression in human subjects. Biol Psychiatry Dec 15;72(12):997-1003. doi: 0.1016/j.biopsych.2012.07.029

4. Aucoin M, Bhardwaj S. (2016) Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Rep Psychiatry. 2016:7165425. doi: 10.1155/2016/7165425.

5. Al’Absi M, Lovallo WR. (2004) Caffeine effects on the human stress axis. In: Nehlig A, editor. Coffee, Tea, Chocolate and the Brain. Boca Raton, FL: CRC Press LLC; pp. 113–31 http://media1.717.cz/files/media1:4b7b05a597b5a.pdf.upl/TF1650_04.pdf

6.  Wani AL, Bhat SA, Ara A. (2015) Omega-3 fatty acids and the treatment of depression: a review of scientific evidence. Integr Med Res. Sep;4(3):132-141. doi:10.1016/j.imr.2015.07.003.

7. De Souza MC, Walker AF, Robinson PA, and Bolland K. (2004) A Synergistic Effect of a Daily Supplement for One Month of 200 mg Magnesium plus 50 mg Vitamin B6 for the Relief of Anxiety-Related Premenstrual Symptoms: A Randomized, Double-Blind, Crossover Study Journal of Women’s Health & Gender-Based Medicine. July 9(2): 131-139

8. Schellenberg, R. (2001). Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ : British Medical Journal322(7279), 134–137.

9. Tsai SY, Kuo FC, Kuo HC, Liao LL. (2017) The prevalence of self-reported premenstrual symptoms and evaluation of regular exercise with premenstrual symptoms among female employees in Taiwan. Women’s Health. Mar 20:1-13. doi: 10.1080/03630242.2017.1296056.

10. Panahi F, Faramarzi M. (2016) ‘The Effects of Mindfulness-Based Cognitive Therapy on Depression and Anxiety in Women with Premenstrual Syndrome’ Depress Res Treat. 9816481. doi: 10.1155/2016/9816481.


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