Free The Female Brain by Louann Md Brizendine Page A

When it doesn’t get them, the brain becomes irritated, so irritated that it’s on the same spectrum of discomfort as a seizure. This is true in a small percentage of women, to be sure, but it’s not fun. So stress and emotional reactivity can increase dramatically the few days before the onset of bleeding. At the National Institute of Mental Health in Bethesda, Maryland, David Rubinow and colleagues have been studying menstrual mood changes. They’ve now found direct evidence that the hormone fluctuations during the menstrual cycle increase brain circuit excitability, as measured by the startle reflex, which most of us think of as being jumpy. It is also related to the stress response. This helps explain why women often feel more irritable during maximal hormone withdrawal.
    Although 80 percent of women are only mildly affected by these monthly hormone changes, about 10 percent say they get extremely edgy and easily upset. Females whose ovaries make the most estrogen and progesterone are more resistant to stress because they have more serotonin (a chemical that makes you feel at ease) cells in their brains. Those women with the least estrogen and progesterone are more sensitive to stress and have fewer serotonin brain cells. For these most stress-sensitive individuals, the final days before their periods start can be hell on earth. Hostility, hopeless feelings of depression, plans for suicide, panic attacks, fear, and uncontrollable bouts of crying and rage can plague them. Hormone and serotonin changes can result in a malfunction in the brain’s seat of judgment (the prefrontal cortex), and dramatic, uncontrolled emotions can push through more easily from the primitive parts of the brain.
    Shana was in this category. During the week or two before her period, she was constantly in trouble for talking out of turn and being disruptive in class. She was obnoxious and aggressive one minute, bursting into tears the next. Pretty soon, her moods turned wild, and she began to intimidate her parents, peers, and teachers. Repeated meetings with the principal and school counselor did nothing to curb her outbursts, and when her parents finally sent her to a pediatrician, he too was baffled by her extreme behavior. It was a female teacher who noticed that Shana’s behavior was at its worst during two weeks of each month. The rest of the time she was like her old self—or more like a typical teen—sometimes moody and oversensitive but mostly cooperative. On a hunch, the teacher called me at the clinic to suggest that Shana had bad PMS.
    Shana’s mood and personality swings, while extreme, were no surprise. In twenty years of practice in psychiatry and women’s health, I’ve seen hundreds of girls and women with similar problems. Most blame themselves for their flare-ups of bad behavior. Some have been in psychotherapy for years trying to get to the bottom of their recurring sadness or anger. Many have been regularly accused of substance abuse, bad attitudes, and bad intentions. Most of these assumptions are unjust, and all of them completely miss the point.
    These adolescent girls and adult women have regular, dramatic shifts in their moods and behavior because, in fact, the very structure of their brains is changing, from day to day and from week to week. The medical name for an extreme emotional reaction during the weeks before the period, triggered by ovarian estrogen and progesterone hormones, is premenstrual dysphoric disorder (PMDD). Women who have committed crimes while suffering from PMDD have successfully used it as a defense in France and England by establishing temporary insanity. Other common conditions—such as menstrual migraine—are also caused by increased brain circuit excitability and decreased calming right before the period starts. Researchers at the National Institute of Mental Health found that the emotion and mood changes these women experience during the menstrual cycle disappear when the ovaries are