How The HPA Axis Dysregulation Affects PMS and Your Menstrual Cycle

Amy Sergeant
Nov 16
5 min read

Updated: 4 days ago

Introduction

Stress triggers a full-body response, affecting hormones, the nervous system, and the brain all together. In women with PMDD or PMS, the HPA axis (hypothalamus–pituitary–adrenal axis) often becomes more sensitive and less adaptable to hormonal shifts. This can make mood changes, fatigue, and emotional swings feel more intense during vulnerable phases of the menstrual cycle.

Knowledge is power and when you begin to understand how your stress response works, you can:

Make sense of mood shifts
Stop blaming yourself
Learn how to regulate symptoms
Protect your cycle balance
Reduce cortisol spikes that worsen PMDD

This guide will help you breakdown the science into calm, clear steps to help you feel grounded and supported.

What Is the Stress Response System?

Your stress system evolved to keep you alive. It’s your body’s way of responding to any kind of “threat”. Whether it’s deadlines, emotional conflict, poor sleep, trauma memories, or skipped meals, your brain treats them almost the same as danger.

Once a “threat” is sensed, your body releases:

Cortisol
Adrenaline
Inflammatory signals
Nervous system activation

For women with PMDD or PME, this response is more active, especially during the luteal phase. That means stress feels stronger and takes longer to recover from as your window of tolerance for stress in this time is lower.

What Is the HPA Axis?

The HPA Axis stands for Hypothalamus–Pituitary–Adrenal axis. It’s your main stress circuit, it’s essentially a communication loop between your brain and body.

It works as follows:

The hypothalamus notices when you’re stressed, whether it’s something outside (like a problem or argument) or inside your body (like pain or low blood sugar).
It sends a message to the pituitary gland by releasing special chemicals called CRH and AVP.
The pituitary then tells your adrenal glands to get ready by sending out a hormone called ACTH.
The adrenal glands respond by releasing stress hormones: cortisol and adrenaline.
Cortisol helps you handle the stress but also talks back to the brain to say, “Okay, the stress is over now.”
This feedback helps your body calm down and stop the stress response.

When this loop functions smoothly, you feel stable and resilient. When it becomes dysregulated, the body and brain begin to have symptoms such as the below:

Emotional crashes
Fatigue
Anxiety or irritability
Insomnia or brain fog

These experiences are often amplified in the luteal phase for women with PMDD.

How PMDD, PMS & PME Interact With the HPA Axis

Women with PMDD don’t have “more stress” they have a more sensitive stress response system.

Research shows that in PMDD:

The brain reacts more strongly to cortisol.
Stress hormones rise faster and drop more slowly.
The luteal phase increases the overall stress burden.
Past trauma can further amplify this sensitivity.

This means you’re not “too emotional.” Your body is simply reacting faster and more intensely to stress and therefore needs more tools to understand how to build the window of tolerance and sooth the system.

Signs Your HPA Axis Is Dysregulated

You might have HPA axis dysregulation if you notice:

Feeling wired but tired
Trouble waking in the morning
Afternoon energy crashes
Stronger PMDD irritability
Panic or overstimulation
Cravings or emotional eating
Low motivation
Mood swings
Brain fog

During the luteal phase, these patterns can become even clearer.

Everyday Triggers That Strain the HPA Axis

Everyday life can quietly overload your stress system. Some common culprits, especially during the luteal phase include:

Skipping meals (low blood sugar = stress signal)
Too much caffeine
Poor sleep or late nights
Constant phone notifications
Ongoing conflict
Perfectionism or pressure to “keep it together”
Trauma reminders
Overexercise
Emotional suppression

Noticing these triggers with compassion helps reduce their impact.

How to Regulate Your Stress Response System

Your body can learn to relax again. Here are evidence-based steps that support the HPA axis and PMDD symptom relief:

Eat protein within one hour of waking
This steadies blood sugar and prevents cortisol surges that worsen PMDD symptoms.
Reduce caffeine during the luteal phase
Caffeine heightens cortisol and anxiety levels.
Prioritise sleep
Sleep loss disrupts the stress system and intensifies PMDD.
Use nervous system support tools to build your window of tolerance
Try slow exhale breathing, grounding, somatic shaking, or progressive muscle relaxation, self touch.
Create steady, predictable routines
The PMDD brain thrives on consistency. However this is something women with PMDD struggle with, you can start small in the first month to build a sense of self efficacy. Such as a 5 minute workout routine a day. This begins to train the mind to believe it is possible. Ultimately routine helps buffer stress.
Focus on anti-inflammatory nutrition
Foods rich in omega-3s, magnesium, and antioxidants can reduce cortisol load.

The Connection Between Trauma & the HPA Axis

Trauma does train the body to stay alert for danger, even long after the original threat is gone. According to recent studies, around 61% to 83% of women diagnosed with PMDD report a history of trauma, with emotional abuse being particularly common. This trauma history can show up as:

Emotional flashbacks
Fear of abandonment
Shutdown or dissociation
Intense anger or sadness

Luteal hormone shifts often bring old memories, unmet needs, or unresolved sensations closer to the surface. From a Jungian perspective, this is when the shadow self begins to emerge the parts of you that you’ve rejected, suppressed, or struggled to integrate start to speak more loudly.

The luteal phase becomes a powerful window for healing when you learn to work with it rather than judging yourself for it. When navigated intentionally, this phase reveals emotional truths, unmet boundaries, and past wounds that are ready to be processed.

Using a combination of somatic tools, cognitive behavioural therapy, self-compassion practices, and Jungian psychology creates a deeply effective framework for transforming old patterns and healing trauma held in the body.

If you feel called to explore this more deeply, you can book a 1-1 consultation.

Conclusion

Supporting your stress system is one of the most powerful ways to ease PMDD, PMS, and PME symptoms. When the HPA axis finds balance again, emotional resilience returns. Your mood steadies, your energy evens out, and your body feels safer inside.

At The Feminine Rhythm, we believe knowledge creates power, and power creates freedom. We support women in understanding their bodies, their patterns, and their emotional responses so they can live with greater clarity, ease, and sovereignty. If you’re ready to begin that journey:

Peer Connections

Support Group (peer support for PMS, PME & PMDD) shared experiences reduce isolation and help normalise what can otherwise feel overwhelming or confusing.

PMDD 1–1 Healing

1–1 Coaching (personalised PMDD support) structured, individual guidance that helps you build routines and rituals that work with your cycle rather than against it.

Nervous System Regulation

Somatic Course (body-based healing → PMDD support) — practical tools to retrain stress responses and build resilience across every phase of your cycle.

References

Hamidovic et al. (2024) — Found a blunted cortisol response to acute psychosocial stress in women with PMDD, reflecting impaired adaptability of the HPA axis. https://academic.oup.com
Hantsoo et al. (2023) — Reviewed dysregulated HPA axis function in PMDD across menstrual phases and its interplay with trauma and mood symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10965026
Cheng et al. (2025), Frontiers in Psychiatry — Detailed the role of neuroinflammation and HPA axis dysregulation in PMS/PMDD symptom exacerbation during luteal phase hormone fluctuations. https://www.frontiersin.org/articles/10.3389/fpsyt.2025.00079/full
Mischra et al. (2023) — Discussed HPA axis dysfunction in mood disorders including PMS/PMDD and impact on symptoms. https://www.ncbi.nlm.nih.gov/books/NBK570607/
Girdler et al. (1998) — Classic study of altered HPA axis responsiveness during stress in women with PMDD. Cited in multiple reviews.
Reviews by Kiesner and Granger (2016) and Hantsoo et al. (2023) exploring PMDD and stress axis literature for consistent findings of HPA dysregulation.
Research on trauma prevalence in PMDD: Studies show 61% to 83% of women with PMDD report trauma history, often emotional abuse (e.g., Schmalenberger et al., 2022).
Evidence for lifestyle and nervous system interventions supporting HPA regulation comes from integrative clinical research and somatic psychology resources.