What is PMDD, and how might therapy help?
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD), is a hormone-related condition that can significantly affect both you, and the people around you. PMDD causes intense physical and psychological symptoms during the luteal phase of your cycle (the last two weeks before your period, starting during, or after ovulation); it can be debilitating, confusing and overwhelming to experience.
Symptoms
Symptoms appear in the two weeks before your period, and although the pattern repeats each cycle, the intensity, and symptoms, can vary widely, and can include:
Mood symptoms, such as: intense anxiety, depression, grief-like sadness, tearfulness, irritability or rage, suicidal ideation
Cognitive symptoms, such as: brain fog, feelings of overwhelm, a busy mind, or a lack of energy, lack of motivation, impulsive decision making
Physical symptoms, such as: insomnia (loss of sleep), or hypersomnia (excessive sleepiness), headaches, muscle or joint pain, changes to appetite, bloating
Why does PMDD happen?
Rather than being caused by hormonal imbalance, PMDD is triggered by an atypical sensitivity to the normal hormonal fluctuations that occur as part of the menstrual cycle. Symptoms can last from a few days, to the full two weeks of your luteal phase, and typically subside with the first few days of your cycle (when your period comes). It can be difficult to predict from one cycle to the next how your symptoms will affect you - and this fluctuating capacity can make planning ahead feel impossible.
PMDD amnesia
It's not unusual to experience something known as “PMDD amnesia” - an inability to afterwards relate to the person you are, or the feelings and thoughts you have, during your PMDD phase. This may cause you to minimise your experience, or believing you were “just being dramatic”. Outside of your luteal phase, your experience of PMDD may not even feel fully real - it might feel like a ‘blip’; once you are in your follicular phase again and things are feeling more ‘normal’, it might even seem unfeasible that you'll end up feeling that way again. This disconnect can make it harder to trust your own experience, which is one reason PMDD is under-recognised, even by those who live with it. When your hormones level out at the beginning of your cycle, you may feel as though you have ‘recovered’, only to experience the same rollercoaster in your next luteal phase. It can be exhausting. Having PMDD can make you feel as though there are two (or more) high-contrast versions of yourself, and that you are out of control of your thoughts, feelings and behaviour, during hormonal fluctuation.
A misunderstood condition
Sometimes PMDD is described as “severe premenstrual syndrome” (PMS), although there are similarities (both are as a result of normal cyclical hormonal fluctuation), PMDD is so much more than this, and the comparison does a disservice to women with PMDD. A recent study concluded that 34% of participants with PMDD had attempted suicide, and 72% had experienced suicidal ideation (BMC Psychiatry, 2022)*. PMS is short lived and manageable, whereas PMDD can be truly debilitating - and life-changing. If you have a shorter menstrual cycle, or are perimenopausal, PMDD can leave you feeling as though you only have a couple of good days per month, before symptoms start again. Often the ‘down time’ is not enough to enable you to properly recover, and rather than experiencing respite, many women are left processing their experience of their luteal phase. This might include trying to understand decisions made, relationships damaged, and coming to terms with the intensity of the PMDD experience - often with anticipatory anxiety in relation to their next luteal phase.
Due to crossover in symptoms, PMDD is sometimes misdiagnosed as bi-polar disorder, personality disorders, or depression, preventing women from being able to access the help they really need.
Some studies have suggested that PMDD may commonly occur alongside Autism and ADHD (British Journal of Psychiatry, 2025)**, there is also a strong association between a history of trauma and PMDD, with one study suggesting that 83% of women with PMDD also had experience of early-life trauma (PubMed, 2022)***.
If you have PMDD, during your luteal phase, you might:
Damage or end relationships as a result of PMDD
Experience mood swings that appear to come out of nowhere
Feel overwhelmed or out of control
Experience extreme fatigue, insomnia, or other sleep disturbances
Feel incredibly depressed, low in energy, flat, indifferent, hopeless or worthless
Have difficulty concentrating, thinking, and speaking (brain fog)
Experience suicidal thoughts or feelings (for some women this can result in self-harm or suicide attempts)
Feel ‘on edge’, tense, or increased anxiety
Experience headaches or migraines
Feel bloated, or gain weight
Experience joint or muscle pain
Experience changes in appetite, such as food craving or overeating
Outside of your luteal phase, you might feel intense guilt or shame for the way you think, feel or behave during a PMDD episode. You may also deeply regret impulsive decisions you've made in your luteal phase, which no-longer make sense a few days later (such as quitting your job, breaking up with your partner, or ending a friendship).
Next steps, if you think you might have PMDD
There are thought to be a number of possible underlying causes for PMDD, which can make it difficult to identify the right treatment. Although there is no cure for PMDD, treatments are available (including hormonal treatments, SSRIs, stress and lifestyle management, therapy - and in extreme cases, surgery) - and finding the right combination of treatments and lifestyle changes can significantly improve your quality of life. If you think you may be experiencing PMDD, the best thing you can do is to start keeping a diary of symptoms in line with your cycle, so you can better understand how and when your symptoms affect you - this is something you can then share with your GP (or hormone specialist), to aid diagnosis, and explore treatment options.
There's no one-size fits all treatment for PMDD, and most women find it takes time to discover the right treatment for them.
Although therapy can’t cure PMDD, alongside treatment, it can help you to process, and manage, your experience of living with it.
Some of the ways therapy can support you with PMDD, emotionally, relationally and practically:
Emotional support
Being able to talk with someone who shows empathy for your experience (especially if you're finding it difficult to treat yourself with kindness), can help you to feel less alone, and can help you to develop self-compassion over time
Therapy that integrates techniques to help calm your nervous system, may help to alleviate and manage symptoms related to mood surges and physical overwhelm. This could include mindfulness, breathwork or somatic techniques, and can help you to develop emotional regulation skills
Therapy can provide a safe space to experience the feelings of shame, grief, confusion and anticipatory anxiety or fear that commonly accompany the experience of PMDD
Speaking with a therapist enables you to process the shock of some of the intense emotions, behaviours, psychological and physical symptoms of PMDD
You can use therapy to work through underlying trauma, which may help to reduce some symptoms
Cognitive / psychological support
If negative thought patterns are something that still affect you during your follicular phase (the first two weeks of your cycle, when your hormones are more settled), using therapy to work towards a more positive mindset (with exploration of the experiences which led to the unhelpful beliefs you might hold about yourself, others and the world around you, where they come from, and ‘inner child work’ to help these parts) may help to alleviate some of the psychological symptoms you experience in your luteal phase
A good therapist can help you to navigate systemic or medical gaslighting, and facilitate processing your experience of this in relation to women's issues and PMDD
Relationship issues
Speaking with a therapist allows you to process the relationship issues that may be caused or made worse by PMDD, or life changes that have occurred as a result of your PMDD
A therapist can help you find ways to strengthen communication with your partner, family or friends - so you can help the people around you to better understand your experience and how to support you. They can also help you to develop accountability (with compassion for yourself), to improve the relationships that may be negatively impacted by your experience of PMDD
You can spend time exploring the ways in which others frequently misunderstand PMDD, and the feelings of loneliness that commonly accompany this
Understanding, acceptance & planning
A therapist can help you to process your experience, so that you can gain a deeper understanding of the early indicators of symptom onset, and put boundaries in place to help look after yourself
You can work with your therapist to build a support plan for days that you're symptomatic, helping you to identify the resources available to you
Processing your experience, can help you learn to view yourself through a more nurturing and compassionate lens; a therapist can support you on your journey towards acceptance of your experience of PMDD (and the grief that might accompany this)
Focussing on yourself and your experience in therapy, can empower you to better understand your needs, and to feel confident in asking for help - so that you can request the support you need from your workplace
Identity support
Therapy can help you to process the impact of having lived without a diagnosis, or understanding of what you're experiencing, or having been misdiagnosed, and misunderstood
You may find that living undiagnosed with PMDD has led you - or others, to shape your identity around this experience (for example, being labelled as ‘dramatic’). Therapy can provide a space to separate yourself from PMDD, allowing you to explore who you are beyond the condition and to challenge any beliefs about yourself, or your identity, that have developed as a result of your experiences
Shockingly, PMDD was only officially recognised as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, and the World Health Organisation first included PMDD in the 11th version of the International Classification of Diseases (ICD-11), in 2019. As a result, many GPs and therapists are still underinformed about what it means to have PMDD, leaving many women feeling very alone in their experience.
It's important to find a therapist who understands the complexity of PMDD - who is able to work with your symptoms (including adjusting their approach and use of interventions to your cyclical experience), and who will have compassion for PMDD - recognising that what you experience is involuntary.
Support for partners & loved ones
If you are the partner or close family member of someone with PMDD, you may also benefit from seeing a therapist who has an understanding of this condition - it can be distressing and exhausting to be close to someone who experiences the highs and lows of PMDD (you inevitably end up riding that rollercoaster alongside them) - it can leave you feeling powerless, and hurt, and can be especially challenging if you are drawn towards ‘fixing’ problems. Sometimes, partners are worried about addressing the relationship issues that arise during PMDD, with awareness of their partner's vulnerability (and not wanting to make the situation worse, or to “ruin” the follicular phase) - this leaves you carrying a lot. Your experience matters too. Therapy can be a helpful space for partners to process their feelings, the things that surface for them when their loved one is experiencing PMDD, and to find ways to improve communication, so that you are able to voice your experience within the relationship. It can also be an opportunity for you to find new ways to support your partner (and yourself) during her PMDD experience.
You’re not alone
Living with PMDD can be incredibly challenging, but with the right support, understanding, and treatment, it's possible to feel more in control - finding ways to live with the unpredictability of this condition, and to better look after yourself. You deserve clarity, support and compassion while you learn to navigate this.
***https://pubmed.ncbi.nlm.nih.gov/34999294/
Article originally published on Counselling Directory 17th December 2025
