Have you noticed that something just feels off in the weeks leading up to your period? You know you have your PMS but have not made the connection yet. Or you have received the diagnosis of PMDD, but do not know how to manage it. PMDD is a severe “mood disorder,” and there is no cure. However, coping strategies, treatments, and medications can help make life more manageable.
I have been living with PMDD since I was 11 years old, and it has been a challenging journey. Over the years, I have developed strategies and coping mechanisms to navigate the mental struggles that come with it. In this article, I share valuable insights and practical tips on living with and managing PMDD from my perspective.
I do have to clarify that the information provided here is solely based on my own experience and is NOT ANY TYPE OF MEDICAL ADVICE. Always contact a doctor or psychologist for proper guidance.
The Female Menstruation Cycle
The menstrual cycle lasts about 28 days (this varies) and it has four phases:
- Menstrual Phase (Days 1–5) – The uterus releases its lining, causing a period. Hormones are low.
- Follicular Phase (Days 1–13) – Estrogen rises causing eggs to mature in the ovary. Energy and mood improve.
- Ovulation (Around Day 14) – The ovary releases an egg. This is when you are most fertile.
- Luteal Phase (Days 15–28) – Progesterone rises. If no pregnancy, hormone levels drop, leading to PMS/PMDD symptoms until the period starts.
Hormonal changes throughout the cycle will affect your mood, energy, and physical well-being.
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a serious condition in which the brain has an abnormal reaction to hormonal fluctuations in the body. Often described as a severe version of Premenstrual Syndrome (PMS), PMDD manifests as emotional, mental, and physical symptoms including depression, anxiety, anger, sadness, pain and bloating. These symptoms typically arise in the two weeks leading up to menstruation and notably improve or completely disappear within the first days of menses. PMDD is recognized as a disorder in both DSM-5 and ICD-11 classification.
How do you test if you have PMDD?
For a diagnosis of PMDD, you will need to keep a calendar or diary of your symptoms for at least three months.
The DSM-5 criteria require at least five or more “cyclical” symptoms, including one mood-related symptom, to qualify for a PMDD diagnosis.The symptoms must drastically improve within the first day of menstruation, with a period during and after menses when symptoms are either minimal or completely absent.
Signs and Symptoms of PMDD
Mental and Emotional Symptoms
- Difficulty concentrating
- Tension
- Suicidal Thoughts – 72% of people with PMDD report being suicidal
- Depressed mood
- Anxiety and Sadness, crying a lot
- Feeling Hopeless
- Feeling Overwhelmed or out of control
- Anger, Irritability, or Rage—Sudden outbursts of rage and irritation lead to simmering anger and irritability throughout the luteal phase. This may lead to conflicts with family members, coworkers, or strangers.
- Ruminating negative thoughts – Irrational and negative thoughts/beliefs regarding oneself, others, the world, the universe, and the future
- Lethargy, Fatigue, lack of energy in general
- Disassociation, derealization, and depersonalization
- Apathy, feeling “off”
- Rejection Sensitivity
- Misophonia – A negative emotional response to certain sounds like when someone is chewing or breathing.
- Loss of interest in “normal” activities, which used to be enjoyable.
- Social isolation
Physical Symptoms
- Insomnia or Hypersomnia
- Food cravings, Changes in appetite, such as overeating
- Sleeping problems (Hypersomnia or Insomnia)
- Joints and muscle pain
- Headaches
- Breast tenderness or swelling
- Bloating
- Cramps
What is the root cause of PMDD?
Not enough research has been done on PMDD. However, it is thought that the brain has an abnormal response to hormonal fluctuations during a woman’s cycle. The hormonal changes can also result in lower serotonin levels in the brain.
PMDD: Medical Treatment
Common medicines for treating PMDD. Consult your doctor to determine the best option for you, as medication reactions vary from person to person.
- Antidepressants – SSRI – PMDD reduces serotonin function during the luteal phase. Antidepressants can be taken continuously throughout the month or only during the luteal phase.
- Birth control – Balances hormones and prevent ovulation.
- HRT – Hormone Replacement Therapy – Balances hormones.
- Chemical Menopause – PMDD symptoms significantly improve when “normal” ovulation is absent. Chemical Menopause stops spikes and drops of hormones.
- Antihistamines – May have a calming or sedative effect
Final line treatment:
Hysterectomy – Surgically removing your uterus or tying your ovaries
Here is a link to a list of commonly used medications:
List of 38 Premenstrual Dysphoric Disorder Medications Compared (drugs.com)
Holistic Medicines
- Ginko – Increase in energy levels
- Ashwagandha – Increase in energy levels
- Calcium – Improves Mood
- Vitamin B6 – Improves Mood
- Magnesium – Improves Mood
- Omega 3 – Improves Mood
- St: Johns Worth – Antidepressant
- 5 – HTP– Antidepressant
Important things to do if you have PMDD:
Track your cycle – Track your cycle by using a monthly schedule, put it up on the wall, marking each phase. This can help both you and those around you better anticipate and navigate changes.
Educate yourself – Educate yourself as much as possible about PMDD. Many doctors and gynecologists lack expertise in this area due to limited research. Since your body and mental health are at stake, it’s crucial to take charge of your diagnosis and stay informed.
Find a solution for every symptom you have – This may be one of the most important steps you can take for yourself. Identify how to handle moments of anger, irritation, lethargy or episodes of misophonia. Write down solutions for each situation and post them somewhere visible as a reminder for both you and your family. Recognize your patterns and establish personal guidelines to help prevent conflicts at work or in relationships.
Self-Care
Having strong self-care routines is essential for managing daily life, especially for those with PMDD. Aligning your exercise according to your cycle can be highly beneficial, as hormones and energy levels fluctuate throughout the month.
Follicular Phase:
During the follicular phase, when energy levels are higher, focus on productivity and active workouts.
- Exercise – Gym, boxing, martial arts, or anything that is fast-paced and energetic. Going to the gym is good because you can regulate the intensity. It is better to push yourself during this phase.
- Social Activities – Activities that involve social interaction, especially with “difficult” “toxic” people, are best scheduled during your follicular phase, allowing you to fully enjoy or engage in them accordingly.
- Preparation – Prepare for the luteal phase by completing important tasks during the follicular phase. As your energy and motivation decline, you will lose interest in your surroundings and struggle with responsibilities, so getting ahead while you have the drive can make things a lot easier.
Luteal Phase:
During the luteal phase, as your pace naturally slows, a gentler and more calming self-care approach can be especially beneficial. Remember, you are facing a significant challenge—PMDD is a mental health condition that, while not constant, still impacts your well-being. Be kind, patient, and compassionate with yourself during this time. Prioritize activities that bring you joy and comfort, allowing yourself the care you truly deserve.
- Exercise – Yoga, stretching, swimming, any type of exercise that keeps your body moving at a slow harmonious pace. Touch base with your soul and honor the body you live in.
- Creative projects – Plan creative projects in advance—whether it’s trying something new or engaging in activities you love that lift your spirits. The key is to create a positive and uplifting environment during your luteal phase so you have something to look forward to during this challenging time.
- Peer Support – Support from friends and family can be of great comfort, if possible, have them check in on you during this phase. If it feels right, grab a coffee with them to take a break from your thoughts. However, always check in with yourself first—socializing isn’t always the best choice, and it’s okay to prioritize your own well-being.
- Singing and Dancing – A fast way to shift your mental state is through music and movement — singing, dancing, and drumming can be great options.
- Angry Dance – If you’re struggling with intense emotions, release them by screaming into a pillow and moving your body. Dance, jump, and stomp to loud, fast-paced music to let out all pent-up emotions.
- Pamper yourself – Take the opportunity to treat yourself with spa days, massages, salt baths, or any activity that soothes your body, mind, and soul.
- Watch Movies – For the worst days, when you do not want to leave your bed, put on funny movies or series for a mental distraction.
PMDD from a Spiritual Perspective
PMDD makes us look within and process past emotions and traumas. Instead of focusing on emotional distress we need to shift it to emotional healing. From a spiritual standpoint, PMDD pushes you to release what no longer serves you. When we suppress our emotions, we store them in our body, often worsening the PMDD symptoms.
The key is to allow yourself to fully feel and release emotions — when you are sad, cry; when you are angry, scream it out. As stated previously, unprocessed trauma (emotions) are stored in the cells of our body resembling an “energetic dust”. When we experience challenges in life or have hormonal “crashes”, it triggers the stored trauma (energetic dust) causing intense emotional reactions. By actively healing and releasing stored trauma, you become more emotionally stable. While PMDD may not completely disappear, addressing these underlying issues lead to significant improvements.
Picture taken by Sydney Sims, Unsplash
Here are some useful therapies that can be helpful for the various aspects of PMDD
Childhood trauma therapy
As children, we lack the tools to process heavy emotions and abuse effectively. The trauma inflicted leaves us with deep emotional wounds that do not fade over time. Instead, these experiences shape our adult life, influencing how we process emotions, perceive and value ourselves, how we form relationships, and how we maintain our mental well-being. Through childhood trauma therapy, you identify and learn how to process the emotions stemming from your childhood.
Primal Scream Therapy
In my opinion, this therapy is one of the most effective methods for releasing stored trauma. It is believed that deep- seated childhood trauma and repressed emotions affect our mental well-being as adults. Primal therapy encourages you to vocalize these heavy emotions – such as anger, sadness and fear – through primal screams. This process contributes to releasing the energetic residue (in the form of stored “repressed” emotions and trauma) allowing you to process them on a deeper level and to heal them fully.
CBT – Cognitive Behavioral Therapy
This therapy is highly beneficial for managing the recurring negative thoughts during each luteal phase. By bringing awareness to your negative thought patterns, you can reshape them into something more positive. If reshaping them is not possible, simply recognizing the thought patterns and knowing that they will disappear with your menstruation, brings tremendous relief. Studies show that CBT is particularly effective in reducing suicidal ideation and intrusive thoughts.
DBT – Dialectical Behavior Therapy
DBT is psychotherapy originally developed to treat personality disorders and interpersonal conflicts. Many people with PMDD reportedly turn to DBT since research suggests that DBT can be effective in managing mood disorders, reducing suicidal ideation, and addressing harmful behaviors like self-harm and substance use.
General Counseling
General counseling provides professional, confidential support to help you navigate a wide range of personal, relationship, and social challenges more effectively.
Couples Therapy
If you are in a relationship, having support outside of the relationship is highly beneficial for both parts. Ensure your therapist has a solid understanding of PMDD to provide the right support for you. PMDD does not just affect the person experiencing it—it can also take a toll on the person you are with, sometimes even leading to breakups or strained marriages. It is important for both parts to understand PMDD patterns and work on finding ways to navigate through the challenges together.
Meditations for PMDD
While traditional meditation may help with PMDD, I find that more hands-on approaches are often more effective for healing trauma and soothing an intensely agitated mind.
Dynamic Meditation
Dynamic Meditation was developed in the 1970s by spiritual teacher Osho, who created a series of active meditations designed to help individuals break free from limitations, release stored (energy) trauma, and overcome limiting beliefs.
The practice consists of five stages: deep, fast, chaotic breathing; catharsis; chanting the mantra “Hoo” while jumping up and down; silence; and dancing. Another way of performing it is to scream at the top of your lungs and smash a big pillow in the ground.
Research has shown that Dynamic Meditation can reduce aggressive behavior, relieve anxiety and stress, effectively alleviate symptoms of depression and balances hormones.
Read more in my previous blog post how to handle heavy emotions: https://expandinspirit.com/2023/04/02/5-practical-strategies-for-handling-heavy-emotions/
Breathwork
Breathwork has been a foundation of Eastern medicine for thousands of years. It is believed that practicing intentional breathing patterns can enhance physical and mental well-being while also promoting deeper states of consciousness. The intense breathing practices stimulate the release of endorphins, dopamine, and serotonin while also activating DMT, this can be particularly effective in relieving PMDD symptoms.
Mystic Rose – Osho
This meditation was also created by spiritual teacher Osho. It focuses on releasing stored trauma and pent-up emotions, often referred to as “energetic dust.” Releasing past trauma is especially important for those with PMDD, as unresolved emotional wounds can be triggered, intensifying mood swings and meltdowns.
The Mystic Rose is a three-week process, with sessions lasting three hours per day. In the first week, you laugh freely, breaking through barriers to inner joy. The second week focuses on releasing emotions through crying, while the third week is dedicated to silent observation and meditation.
Self Love Meditation (Metta Meditation)
Loving-kindness meditation, or metta meditation, is a Buddhist practice focused on cultivating love, compassion, and kindness toward oneself and others. If you struggle to connect with the feeling of love towards yourself and others, try visualizing yourself filled with bright white light, then extend that light toward family, friends, and others around you.
Many people with PMDD struggle with self-love, compassion for others, and finding joy in life. Practicing Metta Meditation helps open up your heart, encourages self-love, acceptance and finding a sense of peace with your diagnosis.
Conclusion
The best way to describe PMDD is that with every luteal phase, a cloak of darkness falls over you, distorting your perception and making the world feel harsh and hostile. Then, as soon as your period arrives, the veil lifts, and the sun shines once again.
PMDD is a serious condition and should be treated as such. Talk to your family and friends about what the illness entails, helping them understand its impact. Raising awareness to our surroundings is important, as battling this alone is overwhelming— we need all the support we can get. Remember, you are not alone!
If you come from Sweden and consider suicide, here are some helpful websites and telephone numbers
Suicide line webbsite in Sweden, www.mind.se
Suicide line number 90101
Nationella Hjälplinjen, tel 020-22 00 60 (kl 13-22)
Jourhavande medmänniska, tel 08-702 16 80 (kl 21-06)
Cori
Really great post! Thank you for sharing. This is something I also struggle with and it is so hard to deal with. I’ll definitely be giving scream therapy a go!
Spirit.expanding
Thank you Cori ❤ Scream therapy is soooo effective and liberating! Please do try it! I think you will love it ❤
Lydia
Wow, great article! I had no idea about PMDD. It’s sad that us women aren’t taught much about our bodies and cycles in general. Wonderful work for spreading awareness!!
Spirit.expanding
Thank you Lydia 💗
Hari
I am hearing about PMDD for the first time. Thanks for educating me on this critical topic.
Andrea | MomLifePlans
I know some people with PMDD and so many people have never heard of it, so thank you so much for sharing this and educating people on it.
Spirit.expanding
I am glad you found this post helpful! Thank you!
Catherine
This is interesting! I have never heard of PMDD, but I am glad to be learning about it now. It’s so important for us to know what is going on with our bodies and minds. Thank you for sharing!
Spirit.expanding
Hi Catherine! I am glad you found this post enlightening.
Jordan Palmer
I have PMDD, so this is a good read! Thank you!
Spirit.expanding
Thank you Jordan 💗 PMDD is not fun at all… I am glad you liked the post 💗
Sheenia Denae | Live Love & Blossom
I struggle with this as well. Thanks for sharing these tips. ❤️