What is PMDD, and how might therapy help?

Premenstrual Dysphoric Disorder (PMDD) is a hormone-related condition that can significantly affect both you and the people around you.

The condition causes intense physical and psychological symptoms during the luteal phase of a woman's cycle (the last two weeks before your period, starting during, or after ovulation); it can be debilitating and confusing to experience.

Symptoms of PMDD

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.

(If you're experiencing suicidal thoughts, support is available - you don't need to be alone in this.)

Why does PMDD happen?

Rather than being caused by unusual levels of hormones, PMDD is triggered by a 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 within the first few days of your cycle.

If you experience PMDD, it can be difficult to predict from one cycle to the next how your symptoms will affect you - this can sometimes make planning ahead difficult, which can leave you feeling restricted. 

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 believe you were “just being dramatic”.

Outside of your luteal phase, your experience of PMDD may not even feel fully real. 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 even behaviour when affected.

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 - 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 - 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.

Due to crossover in symptoms, PMDD is sometimes misdiagnosed as bipolar 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 option for PMDD, and some women find it takes time to discover the right treatment for them. 

Although therapy can’t cure PMDD, alongside treatment, it can make living with it significantly easier.

How therapy can help

Some of the ways therapy can support you with PMDD, emotionally, relationally and practically:

Emotional

• 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

• 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 heal these parts) may help to alleviate some of the psychological symptoms you experience in your luteal phase.
• A good therapist can help you navigate systemic gaslighting and facilitate processing your experience of this in relation to women's issues and PMDD.

Relational

• 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 may misunderstand PMDD and the feelings of loneliness that might accompany this.

Understanding, acceptance and 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/make the experience as easy as possible.
• 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 impact

• 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 and who will have compassion for your 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.