PMDD Isn't Just 'Bad PMS'

For years, one of my clients lived in silence with painful cycles. As a teenager, she masked her discomfort because no one in her family had experienced the same struggles. After becoming a mother, her body felt like a stranger: “One day I was fine, the next, I was consumed by rage or despair. It felt like I was losing my mind.”

Doctors suggested antidepressants. Friends told her she was “just hormonal.” But deep down, she knew something bigger was happening. It wasn’t until she began tracking her cycle that the truth became clear, she wasn’t dealing with postpartum depression or “bad PMS.” She was living with Premenstrual Dysphoric Disorder (PMDD).

That moment was both devastating and relieving. “I realised I wasn’t broken. My brain and body were responding in patterned ways.”

More Than “Severe PMS”

PMDD affects around 5–8% of women of reproductive age, yet many go undiagnosed for years. Unlike PMS, which may cause temporary discomfort, PMDD is rooted in the sensitivity to normal hormonal shifts (especially oestrogen and progesterone) that disrupt brain chemistry, mood regulation, and physical functioning.

Research shows that PMDD isn’t about having “too many hormones,” but rather how the brain responds to them, particularly in systems involving serotonin, GABA, and stress regulation.

Recognising the Symptoms

The hallmark of PMDD is it's cyclical nature. Symptoms appear in the luteal phase (the two weeks before menstruation) and ease once bleeding starts. This pattern is key for diagnosis.

Women often describe PMDD as a rollercoaster they didn’t sign up for. My client put it this way: “It was like someone else moved into my body for half the month. I’d go from calm to chaos overnight.”

Emotional and cognitive symptoms include:

• Intense mood swings

• Irritability, rage, or heightened conflict in relationships

• Deep sadness, hopelessness, or suicidal thoughts

• Anxiety, panic attacks, or feeling on edge

• Emotional eating

• Brain fog, difficulty concentrating, or memory lapses

• Feeling out of control or disconnected from reality

  
  

Physical symptoms often overlap with PMS but feel magnified:

• Breast tenderness

• Bloating or fluid retention

• Migraines or headaches

• Joint or muscle pain

• Severe fatigue or insomnia

  
  

It’s the severity and life impact that separates PMDD from PMS. Women with PMDD often report disrupted relationships, challenges at work, and loss of self-trust.

If this sounds familiar, you can start by taking the PMDD Test.

“I Don’t Have to Heal From PMDD; I Can Heal Through It.”

When my client discovered she had PMDD, she stopped seeing herself as a failure. Instead, she began to treat her symptoms as signals. With support, she reframed PMDD not as a punishment, but as an opportunity for self-understanding.

She told me, “I used to believe PMDD was destroying my life. Now I see it’s pointing me toward the parts of myself I’d buried. It’s still hard, but it’s teaching me self-compassion in a way nothing else ever has.”

How to Recognise PMDD in Yourself

If you’re wondering whether your symptoms may be PMDD, here are practical steps:

1. Track your cycle for at least 2–3 months. Note when symptoms appear and when they ease. Look for the luteal-phase pattern.

2. Use a PMDD test or symptom tracker to bring clarity. Get your free tracker here.

3. Reflect on life impact: Are your relationships, work, or sense of self being regularly disrupted?

4. Rule out PME: Sometimes underlying conditions (like depression, anxiety, or ADHD) worsen premenstrually. This is different from PMDD.

Support and Next Steps

Living with PMDD is hard, but you don’t have to navigate it alone. Support can look different depending on your needs:

• Peer connections: Join the Support Group (peer support for PMDD) to reduce isolation and share coping strategies.

• Nervous system tools: Explore the Somatic Course (healing through body practices → PMDD support) for body-based tools to regulate stress and emotions.

• Personalised coping strategies:  1-1 Coaching to map your cycle, understand your triggers, and build resilience.

• Education + stories: Learn through Podcast on my PMDD story, and When the Cycle Feels Like a Storm: My Journey with PMDD.

Professional treatment may also include:

• SSRIs or SNRIs, antidepressants used in the luteal phase or daily.

• Hormone therapy, like transdermal oestrogen with cyclic progesterone.

• Lifestyle supports consistent sleep, nutrition, exercise, stress management.

• Therapies like CBT for emotional regulation and coping strategies

  
  

PMDD as a Pathway

PMDD is often misunderstood and dismissed, leaving women to feel ashamed, broken, or alone. But recognising the symptoms is the first step in reclaiming power.

As my client beautifully put it: “PMDD is still a storm, but it’s one I can learn to sail through. It’s teaching me resilience I didn’t know I had.”

Read her full story here.

 References

• Halbreich, U. (2008). The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder—clinical procedures and research perspectives. Gynecological Endocrinology.

• Epperson, C. N., Steiner, M., & Hartlage, S. A. (2012). Premenstrual dysphoric disorder: Evidence for a new category for DSM-5. American Journal of Psychiatry.

• Yonkers, K. A., Simoni, M. K. (2018). Premenstrual disorders. American Journal of Obstetrics & Gynecology.