Understanding the link between menstrual cycles and anxiety

For many women, the menstrual cycle is more than just a monthly physical experience; it can be a complex interplay of emotions and mental health challenges.


Among these challenges, severe anxiety is a common yet often misunderstood symptom. When anxiety and other emotional disturbances recur predictably with one's cycle, it raises the question: could it be premenstrual dysphoric disorder (PMDD)? Furthermore, how can counselling help manage this condition?

The connection between menstrual cycles and anxiety

It's not uncommon for women to experience mood swings and anxiety during their menstrual cycle. These symptoms are often attributed to premenstrual syndrome (PMS), which affects up to 75% of menstruating people. However, when anxiety becomes severe and disrupts daily life, it may indicate a more serious condition known as premenstrual dysphoric disorder (PMDD).

PMDD is a severe form of PMS that affects about 3-8% of women. Unlike PMS, which includes a range of mild to moderate symptoms, PMDD is characterised by intense emotional and physical symptoms that can significantly impact a woman's quality of life. These symptoms typically emerge in the luteal phase of the menstrual cycle (after ovulation and before menstruation) and subside with the onset of menstruation.

Recognising PMDD

The hallmark of PMDD is its severe psychological symptoms, including:

  • Extreme anxiety or tension: Women with PMDD often feel overwhelmed, anxious, and stressed in ways that are disproportionate to their usual experiences.
  • Depression: Intense feelings of sadness, hopelessness or worthlessness can occur.
  • Irritability or anger: This can lead to conflicts with others, affecting personal and professional relationships.
  • Mood swings: Sudden and severe changes in mood, including crying spells, can be prevalent.
  • Difficulty concentrating: Women may find it hard to focus or complete tasks.
  • Fatigue: An overwhelming sense of tiredness or lack of energy can be present.
  • Physical symptoms: These can include bloating, breast tenderness, headaches, and joint or muscle pain.

The impact of severe anxiety

For women experiencing severe anxiety as part of their menstrual cycle, the impact can be profound. This anxiety can manifest as persistent worry, panic attacks or an overwhelming sense of dread. These feelings can be so intense that they interfere with everyday activities, leading to difficulties at work, in social situations, and in personal relationships.

Is it PMDD?

To determine if severe anxiety is a symptom of PMDD, it's crucial to track the timing and pattern of symptoms. PMDD symptoms typically appear during the luteal phase and disappear shortly after menstruation begins. Keeping a detailed diary of emotional and physical symptoms over a few menstrual cycles can help in identifying this pattern.

A healthcare professional can diagnose PMDD through a combination of medical history, symptom tracking, and ruling out other conditions that might cause similar symptoms, such as thyroid disorders or mood disorders like depression and anxiety disorders.

How can counselling help?

Counselling can be an effective way to manage PMDD and the associated severe anxiety. Here’s how:

Cognitive behavioural therapy (CBT)

CBT is a type of counselling that helps individuals understand the relationship between their thoughts, feelings, and behaviours. For PMDD, CBT can help women identify negative thought patterns and develop coping strategies to manage anxiety and other emotional symptoms.

Stress management techniques

Counsellors can teach stress reduction techniques such as mindfulness, deep breathing exercises, and progressive muscle relaxation. These techniques can help people reduce overall anxiety levels and improve their ability to handle stress.


Understanding PMDD and its effects can empower people to manage their symptoms better. Counselling can provide valuable information about the condition, helping women to make informed decisions about their health and treatment options.

Emotional support

Dealing with PMDD can be isolating and frustrating. Counselling offers a safe space for women to express their feelings and experiences without judgment. This support can be crucial in helping them feel less alone and more understood.

Developing healthy habits

Counsellors can assist those who menstruate in creating and maintaining healthy lifestyle habits that can alleviate PMDD symptoms. This might include guidance on nutrition, exercise, sleep hygiene, and time management.

Seeking professional help

If you suspect that your menstrual cycle is causing severe anxiety and other debilitating symptoms, it's important to seek professional help. A multidisciplinary approach that includes medical, psychological, and lifestyle interventions is often the most effective.

While living with PMDD can be challenging, counselling offers a pathway to managing symptoms and improving quality of life. Through cognitive behavioural therapy, stress management techniques, psychoeducation, emotional support, and healthy habit development, counselling can empower women to take control of their mental health and navigate the complexities of their menstrual cycles more effectively.

If you or someone you know is struggling with severe anxiety related to menstrual cycles, consider reaching out to a healthcare professional to explore the potential of PMDD and the benefits of counselling.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Written by Hope Therapy & Counselling Services, Counselling, CBT, EMDR, Hypnotherapy, Mindfulness.
London W9 & SE19

Hope Therapy & Counselling Services are dedicated to providing comprehensive and compassionate mental health and wellbeing support to individuals, couples, and families. Our team of experienced and qualified counsellors & therapists are committed to helping clients navigate life's challenges and achieve personal growth and well-being.

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