15 Things You Should Know About Premenstrual Dysphoric Disorder (PMDD)

What is the first thing that comes to mind when someone tells you about premenstrual dysphoric disorder (PMDD)?

If you are like most people, you likely thought of PMDD as just “really bad PMS” or just moodiness before someone gets their period. 

This misunderstanding can lead to misdiagnosis, inadequate treatment outcomes, and reduced help-seeking.  People may also blame themselves for symptoms they cannot control.

In reality, PMDD is a serious mental health condition that goes far beyond. If you are experiencing MPDD, a neurodiversity-affirming therapist in Ontario, Canada, at Blue Sky Learning could support you. 

But first, let’s continue to explore further what PMDD is and 15 essential facts about PMDD, including root causes, who is at risk, how PMDD affects the brain and body, its connection to neurodivergence, and practical strategies for support.

What Is PMDD?

PMDD is a chronic mood disorder that is related to hormones. It affects people during the luteal phase of their menstrual cycle, which is typically 1-2 weeks before menstruation. 

During this time period, individuals may experience severe anxiety, feelings of hopelessness, difficulty concentrating, or extreme fatigue. 

These symptoms can feel overwhelming, intrusive, and disruptive to every aspect of life.

Understanding PMDD can help individuals find validation and support. It can also support workplaces, families, and communities in creating environments where people can thrive with the right accommodations and care.

So, let’s discuss this more. 

PMDD Is More Than “Bad PMS”

PMDD is not just an intensified form of PMS. It is a severe mental health condition that disrupts the lives of those who experience it. 

For example, someone may experience intense emotional, cognitive, and physical symptoms that make them unable to complete tasks in the workplace or at school. They may also have a difficult time maintaining relationships or engaging with everyday chores and responsibilities. 

Unlike PMS, PMDD symptoms follow a distinct cyclical pattern where the symptoms appear and are more intense in the luteal phase and ease once menstruation begins. The shifts in mood and functioning are more pronounced than is the case with typical premenstrual discomfort. 

PMDD Is Linked to Hormone Sensitivity, Not Abnormal Hormone Levels

People with PMDD don’t necessarily have atypical hormone levels. This means that hormone levels are usually not “too high” or “too low.”

Instead, PMDD tends to be the result of hormone sensitivity differences. This means that the brains of those with PMDD are more sensitive to natural hormonal fluctuations that occur during the menstrual cycle.

This heightened sensitivity can make feelings of sadness, irritability, indecisiveness, or overwhelm feel more intense.

Understanding that these reactions are biological can help you stop blaming yourself for symptoms.

Emotional Symptoms Are Intense, Cyclical, and Very Real

One core feature of PMDD is the fact that it can result in emotional intensity. These emotional symptoms can resemble depression, anxiety, or borderline personality disorder. 

However, the key difference is that the symptoms of PMDD have a more cyclical pattern compared to the other diagnoses. 

The intensity of these symptoms can vary depending on the person, but common emotional symptoms include:

• Mood swings

• Hopelessness or worthlessness

• Heightened sensitivity to rejection

• Feeling overwhelmed or out of control

• Increased tearfulness

• Anxiety and tension

• Irritability or anger

  
  

These symptoms often appear suddenly about 1-2 weeks before your period and lift almost completely once menstruation begins.

PMDD Also Causes Physical and Cognitive Symptoms

The fact that PMDD is a mood disorder may lead you to believe that it only causes emotional or mood-related symptoms. But this simply isn’t true. 

PMDD can also impact your body and the brain and lead to severe physical and cognitive symptoms. Individuals with PMDD may experience some or all of the following:

• Fatigue or low energy

• Brain fog, difficulty focusing, or forgetfulness

• Body pain, bloating, or headaches

• Sleep changes, including insomnia or oversleeping

  
  

For many, the contrast between the weeks when you have PMDD symptoms and the rest of the month can be difficult to manage. 

Serotonin Plays a Key Role in PMDD

The exact cause of PMDD is unknown. However, some research suggests that individuals may have an abnormal reaction to hormone fluctuations. 

This sensitivity to hormone fluctuations can impact key neurotransmitters, including serotonin. 

The disruption in serotonin levels can lead to some of the key symptoms involved in PMDD because serotonin impacts:

• Mood

• Irritability

• Appetite

• Sleep

• Pain regulation

  
  

This is one reason why selective serotonin reuptake inhibitors, or SSRIs, are commonly prescribed for the treatment of PMDD. They help to stabilize serotonin during the luteal phase of the menstrual cycle. 

Some People Are at Higher Risk for PMDD

Anyone who menstruates can experience PMDD. But there are certain factors that may increase an individual's risk of developing the condition. These risk factors include:

• A personal or family history of PMS or PMDD

• A history of depression, postpartum depression, or mood disorders

• A family history of mood disorders

• Less access to education and healthcare regarding menstrual health

• Cigarette smoking

  
  

It is important to note that these factors do not cause PMDD, but they may increase an individual's susceptibility to hormone sensitivity, which may increase the risk of PMDD developing.

PMDD Is Frequently Misdiagnosed. It May Take Years

PMDD is frequently misdiagnosed for one of the following conditions because its cyclical nature is often overlooked:

• Major depressive disorder

• Generalized anxiety disorder

• Bipolar disorder

• Borderline personality disorder

• Thyroid conditions

  
  

Because symptoms only occur during one part of the month, many people may minimize what they are going through and assume that it is just bad PMS. They may spend years trying to cope without knowing there’s a name for what they’re experiencing.

Some studies show individuals wait an average of 12 years and see an average of six providers before receiving an accurate diagnosis.

Getting a diagnosis can finally explain why certain weeks feel unmanageable and relieve the self-blame that accumulates over time.

PMDD and Neurodivergence Often Overlap

Many autistic individuals and individuals with ADHD report experiencing PMDD symptoms. This overlap can make the already intense experiences of PMDD feel even more overwhelming.

For example:

• ADHD-related emotional dysregulation becomes more intense.

• Autistic sensory sensitivities increase before menstruation.

• Executive function challenges worsen during the luteal phase.

  
  

For neurodivergent individuals, PMDD may feel like “a shutdown, meltdown, or burnout on repeat.”

Understanding this overlap helps individuals create neurodiversity-affirming self-care plans and routines that are compassionate, rather than based on blame and shame.

Symptoms Must Follow a Specific Pattern to Be Diagnosed as PMDD

PMDD is typically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This manual outlines the criteria for a PMDD diagnosis. 

To receive a PMDD diagnosis:

• Symptoms occur during the luteal phase (1–2 weeks before menstruation).

• Symptoms ease within a few days after menstruation begins.

• They are present in most cycles over the course of a year.

• PMDD must include at least 5 symptoms, with at least 1 being a mood-related symptom.

• PMDD symptoms cause significant distress or impairment at work, school, home, or in relationships.

Tracking symptoms daily for 2–3 cycles and sharing this information with your healthcare provider can help them make an accurate diagnosis.

PMDD Is Not Rare. It's More Common Than You Might Think

Many people assume that PMDD is rare and that it can never happen to them. 

But PMDD affects an estimated 5.5% of individuals who experience periods and are of reproductive age. That’s approximately 920,000 people, assuming about 16.8 million people of reproductive age in Canada.

In addition, around 1.6% of people who menstruate, or 31 million people worldwide, have symptomatic Premenstrual Dysphoric Disorder (PMDD), according to a new review of global studies.

Despite this, many people have never heard of PMDD, which can lead to underdiagnosis and years of unnecessary suffering.

PMDD Can Be Dangerous Without Support

One of the most important facts to point out about PMDD is that it can temporarily intensify your risk of suicidal ideation. 

According to the International Association for Premenstrual Disorders (IAPMD), there is research that indicates that up to 70% of individuals with PMDD have experienced suicidal ideation.

Furthermore, approximately 50% of these individuals have made suicide plans, with approximately 34% going on to attempt suicide. 

These numbers reflect the severity and reality of PMDD. It is not overreacting. It is a legitimate and life-threatening condition. They also underscore the importance of early diagnosis and comprehensive treatment.

PMDD Can Continue Until Menopause

For many, PMDD becomes more intense with age. It may also last until menopause if left untreated.

The symptoms may shift over time. Medication adjustments throughout the reproductive years may help manage the symptoms. 

Needing this long-term support is not a sign of weakness. It’s an acknowledgment that PMDD is a chronic condition that deserves consistent care.

Treatment Options Exist, and They Are Effective

PMDD is a treatable condition. The treatment for it isn’t one-size-fits-all, but many individuals find relief using:

• SSRIs (i.e., during the luteal phase)

• Lifestyle changes (i.e., exercise or stress reduction)

• Therapy and coaching, including neurodiversity-affirming therapy

• Community support, including PMDD-focused groups

• Hormonal treatments, including birth control pills

• Supplements, like magnesium, calcium, or vitamin B6

• Anti-inflammatory medications for physical symptoms

  
  

Regardless of the treatment used, treatment is often most successful when tailored to the individual.

Myths About PMDD Contribute to Misunderstanding and Stigma

Despite the positive strides we have made in society in understanding PMDD, there are still many myths that remain. Some of the most common myths about MDD are:

• “People with PMDD are overreacting.”

• “You can diagnose PMDD in one appointment.”

• “A hysterectomy cures PMDD.”

  
  

These myths prevent individuals from seeking support or feeling validated in their experiences. Education helps replace shame with understanding and empowerment.

You’re Not Overreacting. Your Experience Is Valid

PMDD is real. Your reaction to hormonal changes is real.

Understanding your cycle allows you to stop blaming yourself for the emotional and physical experiences that were never your fault. 

You weren’t “too sensitive” or “overly dramatic.” Your body and brain are responding to a legitimate biological process, and you deserve care, compassion, and support.

Strategies to Support Yourself with PMDD

Strategy 1: Track Your Symptoms Consistently

If you are experiencing the symptoms of PMDD, start by tracking your symptoms daily for 2-3 of your cycles. This can help you recognize patterns, predict days when things may be difficult, and share accurate information with your healthcare providers. When you are able to recognize when your PMDD symptoms start and what kind of patterns they follow, this can support you with scheduling rest, reducing your workload, or setting boundaries proactively based on this information. Tracking your cycle can also help with self-validation. You are able to see that what you are experiencing is real and not “all in your head.”

Strategy 2: Build a Neurodiversity-Affirming Care Team

There is an overlap between PMDD and other neurotypes, including autism, anxiety, and trauma-related conditions. For this reason, you may wish to work with a PMDD-informed clinician who is also neurodiversity-affirming. This ensures that you are supported without judgment or pressure to mask your symptoms. If a clinician uses a neurodiversity-affirming approach, they should aim to validate your sensory needs, executive functioning differences, emotional responses, and cycle-related patterns while helping you create sustainable, compassionate routines.

Strategy 3: Prioritize Rest and Reduce Cognitive Load During Luteal Days

When you are experiencing the symptoms of PMDD, your brain may experience lower serotonin levels or cognitive capacity. You may also experience more difficulty with regulating your emotions. Instead of pushing through these challenges and moving yourself closer to exhaustion, try to intentionally reduce your workload. This may look like simplifying tasks, using checklists, or delaying non-urgent decisions. It may also look like preparing meals in advance. This rest isn’t avoidance. It’s a purposeful strategy to support your nervous system during predictable cycles.

Strategy 4: Use Movement to Stabilize Mood and Reduce Tension

Exercise can help regulate serotonin, reduce irritability, and ease physical symptoms. If you choose to engage in exercise to help with PMDD, it doesn’t need to be intense. Even gentle movement, such as walking, yoga, swimming, or light weight lifting, can help to reduce cramps, lower stress levels, and support your emotional health. 

Strategy 5: Incorporate Stress-Reduction Practices Daily

When you are experiencing PMDD symptoms, minor stressors can feel big and overwhelming. If this is the case for you, aim to prioritize stress reduction. This may involve mindfulness, grounding exercises, breathwork, or meditation, which work to calm the amygdala (the emotional centre of your brain) and work to stabilize your intense responses to emotions. These techniques also help to strengthen your ability to move through emotional experiences with self-compassion instead of blame. 

Strategy 6: Create a Sensory-Friendly Environment

If you are neurodivergent, you may experience an intense sensitivity to sensory stimuli, which is also known as sensory overload. PMDD can intensify these sensory experiences and heighten the experience of sensory overload. This means that during PMDD weeks, you may want to seek out tools that can help to make your environment more sensory-friendly. These tools may involve dim lighting, weighted blankets, noise-canceling headphones, soft textures, and calming scents. By creating predictability and reducing sensory triggers during PMDD weeks, you can reduce overwhelm and increase your ability to regulate your emotions. 

Strategy 7: Nourish Your Body with Supportive Foods and Supplements

There is a connection between gut health and nervous system health. As a result, nutrition can support hormone balance and the regulation of your energy levels during PMDD weeks. If you are experiencing PMDD symptoms, you may want to consider increasing protein and complex carbohydrates while reducing caffeine, sugar, alcohol, and salt intake. This may help stabilize your mood and decrease bloating. Supplements such as magnesium, calcium, and vitamin B6 are also often beneficial. But before trying any supplements, it is important that you consult your healthcare provider before starting.

Strategy 8: Use Medication When Needed. It’s a Valid and Effective Option

Many people with PMDD find that there are certain SSRIs, hormonal birth controls, or anti-inflammatory medications that significantly reduce symptoms. If you are concerned about the side effects, your healthcare provider can discuss options with you. This may include taking SSRIs only during the luteal phase. It is also important to remember that medications are not meant to be a last resort. If you need them, they are a legitimate and evidence-based tool for managing PMDD.

Strategy 9: Know Your Rights

People with PMDD deserve accommodations and support. In Canada, provincial human rights codes and workplace policies support accommodations for chronic health conditions. In the U.S., the ADA and workplace accommodation acts protect individuals needing flexible schedules, time away during symptomatic days, or modified workloads.

These accommodations are not special treatment. They support equitable participation.

Book a Free Consultation

If you are navigating PMDD and feel overwhelmed, support is available.

At Blue Sky Learning, our neurodiversity-affirming coaches and counsellors help individuals understand their cycles, identify patterns, and build compassionate support systems that align with the needs of their brain and body.

Book a free 20-minute consultation by emailing hello@blueskylearning.ca or visiting our website below.