What is premenstrual dysphoric disorder? Plus, how to cope
Clinically reviewed by Dr. Chris Mosunic, PhD, RD, MBA
Premenstrual syndrome is common, but for some women, there's more to the story. Learn what premenstrual dysphoric disorder (PMDD) is, why it happens, and 9 tips to help you cope.
It’s no secret that premenstrual syndrome (PMS) can often throw you for a loop. But, for some menstruating people, there’s an even bigger beast that rears its ugly head each month. Brace yourselves: Premenstrual dysphoric disorder (PMDD), a condition that affects millions who menstruate, has entered the chat.
If you’ve ever felt totally unlike yourself the week before your period, PMDD could be to blame. Feeling rage, intense anxiety or feelings of doom, experiencing wild mood swings, or even having thoughts of self-harm and suicide can be glaring symptoms that pit your hormones and brain against each other. And not only can PMDD impact your life, but it can negatively affect your loved ones, too.
While your luteal phase comes and goes each month, your mental health and wellbeing doesn’t have to ebb and flow with it. Let’s walk through what PMDD actually is, how it differs from PMS, what causes it, and, most importantly, some manageable ways to help you cope.
What is premenstrual dysphoric disorder (PMDD)?
Premenstrual dysphoric disorder (PMDD) is a medically-recognized, hormone-related mood disorder that occurs 7–10 days leading up to your period. While it shares similar timing with PMS, it’s far more intense and often brings emotional and physical symptoms that interfere with daily life. For many people, PMDD feels like a monthly emotional crash out that throws every aspect of life off balance.
A common misconception is that PMDD is caused by a hormone imbalance, but that’s not accurate. With PMDD, hormone levels are typically normal, but the brain reacts to those hormones in an elevated way. This heightened sensitivity and difficulty processing those hormonal changes, particularly after ovulation, can seriously affect mood and make it feel near impossible to manage stress and overall discomfort.
What are the symptoms of PMDD?
PMDD symptoms can be intense, persistent, and deeply disruptive. They are usually worse during the luteal phase (the phase after ovulation) and ease up once your period begins. During this window, it can feel like your emotions, body, and brain have been hijacked by a truly unrecognizable monster. In other words, it’s the absolute worst.
You don’t need to be experiencing every symptom to be diagnosed with PMDD, as the hallmark of this disorder is severity and how much it interferes with your life, relationships, and your sense of self.
If you feel like you’re a completely different person for part of the month, or you find yourself apologizing for things you did while overwhelmed, it might not be a personality flaw — it might be PMDD.
Here are some of the signs and symptoms:
PMDD symptoms (emotional and physical):
Sudden and intense mood swings
Depression, hopelessness, or heavy sadness you can’t shake
Severe anxiety or panic attacks
Irritability, anger, and snapping at people you love
Feeling overwhelmed or out of control
PMDD symptoms (physical and behavioral):
Fatigue or exhaustion that doesn’t improve with rest
Insomnia or hypersomnia
Cognitive issues, like brain fog, forgetfulness, or difficulty concentrating
Appetite changes, like intense cravings, bingeing, or no appetite at all
Physical discomfort, like bloating, breast tenderness, cramps, joint or muscle pain
4 causes of PMDD
We don’t have every answer yet, but research suggests that PMDD stems from how your brain and body respond to hormonal shifts, especially after ovulation. It’s not about having too much or too little of a specific hormone, but about being highly sensitive to normal changes.
Common contributing factors include:
Hormone sensitivity: Hormone levels are typically normal in people with PMDD, but the brain reacts to them differently. Think of it like being on the same rollercoaster as everyone else, but with a nervous system that hits the panic button at every turn.
Serotonin disruption: Hormonal shifts affect serotonin, a brain chemical tied to mood, sleep, and appetite. This might explain why some people find relief with SSRIs, even when used just during the second half of their cycle.
Genetic predisposition: If mood disorders, depression, or PMS run in your family, you may be more likely to develop PMDD.
History of trauma or stress: Chronic stress or past trauma can make your system more reactive to hormonal changes. If you’ve lived through hard things, your body may be carrying that sensitivity.
How to cope with PMDD: 9 mindful self-care tips
The best way to cope with PMDD is to manage symptoms in ways that feel doable for you. Telling you to self-care can feel like a cruel joke when your body hurts, your emotions are all over the place, and your to-do list is a mile long. But even small, steady shifts in your routine and perspective can help reduce the intensity of PMDD over time.
Here are some self-care tips to help you cope with PMDD:
1. Track your cycle
Tracking your cycle helps you anticipate when the PMDD phase is close, so you can prepare accordingly. That could mean scheduling fewer social plans or just giving yourself extra grace when everything is getting on your nerves.
Look for patterns after 2–3 months. You might notice PMDD shows up like clockwork around days 18–28 of your cycle, which can help you plan proactively to support your mental health instead of reacting in real-time crisis mode.
Read more: How the phases of your menstrual cycle affect mental health
2. Create a low-energy self-care list
You won’t always have the bandwidth for a yoga class (unless it’s restorative yoga) or elaborate skincare routine during this phase of your cycle, so keep a list of nourishing activities that are actually realistic when you're in the thick of it.
Here are a few examples:
Sit in the sun for five minutes
Drink water before caffeine
Hug your pet or a pillow while you take a nap
Listen to a favorite playlist while lying on the floor or making a low-effort, nutritious meal
Wrap yourself in a blanket and do absolutely nothing
Read more: How to create a self-care plan personalized to your needs
3. Move your body (but only in ways that feel good)
Exercise helps regulate mood and hormones, but forcing yourself through a bootcamp when your body feels like it's falling apart isn’t necessarily a great idea. Instead, opt for gentle, low-impact movement.
Try this:
Go for a 10-minute walk and take in the sights and sounds around you.
Do a slow stretch session on the floor while watching TV.
Practice yoga for relaxation in your living room.
4. Prioritize sleep above everything else
Poor sleep worsens every PMDD symptom, and, yet, sleep is often the first thing to fall apart. Make it a priority to get quality sleep each night. If you also feel like you need a nap during the day during this phase of your cycle, feel empowered to do so.
Try to:
Go to bed at the same time each night.
Use a weighted blanket which may help to reduce anxiety.
Avoid screens 30 minutes before bed.
Listen to calming audio like Sleep Stories, brown noise, or 432 Hz music.
💙 You could also dive into a guided sleep meditation at bedtime, like Tara Brach’s Letting Go Into Sleep.
5. Feed your body and honor your cravings
PMDD can mess with appetite. Some days you may be ravenous, some days you may succumb to stress eating, and other days you may forget to eat. Aim to keep your blood sugar balanced with foods that combine protein, fiber, and fat.
Try eating:
Greek yogurt with berries and chia seeds
Hard-boiled eggs and whole grain toast
Warm soups with protein like beans, lentils, or chicken
It’s also important to honor your cravings in a balanced way. That chocolate you’re craving might be your brain begging for a serotonin re-balance, or maybe you’re just wanting some chocolate.
Read more: How mindful eating can boost your physical and mental health
6. Communicate with your support system
This part can be hard, especially when feelings of shame or irritability are front and center. But telling a trusted friend, partner, or roommate what PMDD looks like for you can reduce your emotional load and help you remember that you’re not alone.
You can say, “Around this time of the month, I go through a really rough phase called PMDD. It’s hard to talk about, but I’m not myself during it. I may seem more distant or emotional. But please know it’s not about you, and it will pass.”
If you need help advocating for yourself at work or school, having a name for your experience (and maybe a doctor’s note) can go a long way.
💙 Learn how to express yourself with Tamara Levitt’s tips on Kind Communication.
7. Limit doom-scrolling and overstimulation
PMDD can make your brain feel like it’s on high alert, and social media, loud environments, or nonstop emails can add fuel to the emotional fire. Press pause. Take a break.
Try to:
Reduce screen time.
Turn off notifications or use “Do Not Disturb” mode.
Say no.
8. Explore therapy or group support
A therapist—especially one experienced with mood disorders or reproductive mental health—can be a game-changer. If therapy isn’t accessible, support groups (online or in person) can help you connect with people who actually get it.
9. Don’t rule out medical help
There is zero shame in needing more than lifestyle adjustments. PMDD is biological, and for many, self-care isn’t enough. Antidepressants, like SSRIs, are one of the most effective treatments, and they can be taken daily or only during the luteal phase. Hormonal birth control, GnRH agonists, and even surgical options exist for severe cases.
What is premenstrual dysphoric disorder FAQs
What is premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (PMDD) is a hormone-related mood disorder that causes severe emotional and physical symptoms in the weeks leading up to menstruation. It’s similar to PMS in timing, but far more intense in its impact.
People with PMDD may experience extreme mood swings, anger, anxiety, depression, and physical symptoms like fatigue, headaches, and bloating. What makes PMDD distinct is how much it interferes with daily life.
Relationships may be strained, work can become overwhelming, and even basic tasks may feel impossible. PMDD is recognized as a legitimate medical condition and is thought to result from the way the brain responds to normal hormonal changes throughout the menstrual cycle.
Read more: How to manage your mental health during your menstrual cycle
How is PMDD different from PMS?
While premenstrual syndrome (PMS) can cause discomfort and mood changes, PMDD is a much more severe and life-disrupting condition.
PMS might make you feel a little irritable, bloated, or tired in the days before your period. PMDD, on the other hand, can lead to debilitating mood swings, overwhelming anxiety or depression, and physical symptoms that interfere with your ability to function.
The key difference lies in the intensity and impact. PMDD affects mental health, relationships, work, and self-esteem in a way PMS does not.
What are the symptoms of PMDD?
PMDD symptoms are intense and cyclical, showing up about one to two weeks before menstruation and easing once your period begins. Emotionally, you may experience severe irritability, anger, sadness, anxiety, or even despair.
Some people describe feeling like they’ve fallen into a black hole with no warning. Physically, PMDD can bring fatigue, headaches, bloating, breast tenderness, and joint or muscle pain. You may also struggle with insomnia, brain fog, or changes in appetite.
The symptoms aren’t just unpleasant — they can be completely consuming. These aren’t just bad days. They’re cycles of emotional and physical distress that repeat monthly and can feel impossible to climb out of.
What causes PMDD?
PMDD appears to stem from an extreme sensitivity to the natural hormonal fluctuations that occur during the menstrual cycle, particularly in the luteal phase, before menstruation. This sensitivity affects neurotransmitters in the brain, like serotonin, which can play a major role in mood regulation. It’s not that your hormones are out of balance — it’s that your brain and body are reacting to them differently.
Genetics may play a role, as people with a family history of mood disorders or severe PMS are more likely to experience PMDD. Trauma, stress, and underlying mental health conditions can also influence how the disorder shows up and how hard it hits.
How can I manage PMDD naturally?
Natural approaches to PMDD aren’t about curing the condition but about building a foundation that helps you feel more steady and supported. Regular exercise, especially low-impact movement like walking or yoga, can help ease anxiety and improve your mood. Eating balanced meals, staying hydrated, and avoiding excessive sugar, caffeine, and alcohol may also reduce how severe your symptoms are from one month to another.
Also, sleep is crucial. Aim for consistency in bedtime and limit screen time before sleep. Mindfulness practices like breathwork, body scans, and gentle meditation can help you stay grounded when emotions feel overwhelming. It’s also important to find a supportive therapist or group, and to track your cycle so you can anticipate and plan around difficult days.
That said, natural strategies often work best when paired with medical treatment, especially in moderate to severe cases. PMDD is not a mindset issue. It’s a medical condition. And you deserve every available tool.
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