Managing Premenstrual Anxiety: Coping with Relationship Doubts

Despite taking medication before my period, I still find myself doubting whether my boyfriend loves me?

I have been on anxiety medication for about 3-4 years, and recently I have seen some improvement.
I was originally taking Lexapro and Wellbutrin, along with other sleep medications like Ambien.
Recently, I have been doing better and no longer need to use any sleep medications; I am only using Lexapro and Wellbutrin, and I have reduced my dosage from 2 pills to 1 pill in the morning and evening.
Generally, I feel quite good.
Currently, I am in a long-distance relationship with my boyfriend in the U.S.
He is pursuing his PhD and has a personality that is not very expressive with words of love, but I can feel it through his actions.

Although I am gradually getting used to his lack of overt affection, I think because he just started his PhD, he is a bit more dependent on me.
Recently, we had sweet video calls for Valentine's Day and our anniversary, but these past few days, as my period is approaching, he has been more tired before bed and tends to read my messages without responding or gives short replies.
I find myself getting anxious and scared, thinking, "How come he was so loving two days ago, but now he seems distant?" even though I am still taking my medication.

I would like to know if I should increase my medication dosage due to this premenstrual anxiety.
I still feel low during this time and have thoughts like, "Why isn't he saying he loves me or hugging me anymore?" (My boyfriend took a year to say "I love you" for the first time; previously, he only expressed that he liked me, and he has mentioned that saying "I love you" is very difficult for him.) Thank you, doctor.

V, 20~29 year old female. Ask Date: 2021/02/22

Dr. Lin Mianzhang reply Psychiatry

Hello, it sounds like you only experience these symptoms before your period.
If that's the case and your anxiety and fear are not severe, it may not be necessary to increase your medication, as many women experience similar emotional fluctuations premenstrually.
However, if you feel that your anxiety and fear are significantly impacting your daily life, you might consider increasing the dosage of your medication, such as Rifampin, and then tapering it down after this period has passed.
While considering medication adjustments, it might also be helpful to discuss your emotional struggles with your boyfriend, allowing him to better understand your situation, which can help strengthen your relationship and enhance mutual understanding.
Wishing you a speedy recovery!

Reply Date: 2021/02/22

More Info

Managing premenstrual anxiety, especially in the context of relationship doubts, can be quite challenging. It’s commendable that you have been proactive in managing your anxiety with medication and have noticed improvements over the past few years. The fact that you have reduced your medication dosage is a positive sign of your progress. However, it’s also important to recognize that fluctuations in mood and anxiety can be influenced by hormonal changes associated with your menstrual cycle.

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) can significantly affect emotional well-being, leading to increased anxiety, irritability, and mood swings. These symptoms can be exacerbated by external stressors, such as relationship dynamics. In your case, the distance in your relationship and your boyfriend's current academic pressures may contribute to feelings of insecurity and anxiety, particularly during the premenstrual phase when emotional sensitivity is heightened.

Your feelings of doubt and anxiety regarding your boyfriend's affection are understandable, especially given the context of your relationship. It’s common for individuals in long-distance relationships to experience fluctuations in emotional connection, particularly when one partner is under significant stress, such as pursuing a doctoral degree. Your boyfriend’s reduced communication during this time may not necessarily reflect his feelings for you but could be a result of his academic pressures and fatigue. It’s essential to consider these factors before jumping to conclusions about his feelings.

Regarding your question about whether to increase your medication dosage, it’s crucial to consult with your healthcare provider before making any changes to your medication regimen. They can assess your current symptoms in the context of your overall mental health and determine the best course of action. It’s also worth discussing the specific premenstrual symptoms you are experiencing and how they relate to your anxiety levels. Sometimes, adjusting the timing of medication or incorporating additional therapeutic strategies, such as cognitive-behavioral therapy (CBT) or mindfulness practices, can be beneficial in managing premenstrual anxiety without necessarily increasing medication.

In the meantime, consider implementing some coping strategies to help manage your anxiety during this period. Here are a few suggestions:
1. Open Communication: Share your feelings with your boyfriend. Expressing your concerns about his recent behavior and how it affects you can foster understanding and strengthen your connection. He may not be aware of how his actions impact you, especially during your premenstrual phase.

2. Mindfulness and Relaxation Techniques: Engage in mindfulness practices, such as meditation or deep-breathing exercises, to help ground yourself during moments of anxiety. These techniques can help you stay present and reduce the tendency to ruminate on negative thoughts.

3. Journaling: Writing down your thoughts and feelings can provide an outlet for your emotions and help you process your experiences. It can also serve as a tool to track your mood changes in relation to your menstrual cycle, which may help you identify patterns and triggers.

4. Self-Care: Prioritize self-care activities that promote relaxation and well-being. This could include exercise, spending time in nature, or engaging in hobbies that bring you joy.

5. Seek Support: If you find that your anxiety continues to interfere with your daily life or relationships, consider reaching out to a mental health professional for additional support. They can provide tailored strategies to help you navigate your feelings and improve your coping mechanisms.

In conclusion, managing premenstrual anxiety and relationship doubts requires a multifaceted approach. By maintaining open communication with your boyfriend, utilizing coping strategies, and consulting with your healthcare provider, you can work towards achieving a more balanced emotional state. Remember, it’s okay to seek help and take the time you need to navigate these challenges.

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