Do I Have PMDD?
- Amy Simpson
- Jun 22
- 4 min read
Updated: Sep 6
If you’ve ever felt like a completely different person in the lead-up to your period: more anxious, more reactive, more overwhelmed? you’re not alone. And you’re not imagining it.
PMDD is not just “bad PMS”
It’s a severe, cyclical condition that can impact your mood, your energy, your relationships, and your quality of life. It can feel like you’re living in two bodies: one that functions well for part of the month, and one that turns against you before vanishing the moment your bleed begins.
I am seeing more and more PMDD in clinic, especially after birth and in the early whispers of perimenopause. For many, these two major hormonal transitions are happening at once (#millenialmotherhood). If this feels like you, you are not alone, and you’re not broken.
This blog unpacks what PMDD is, why it happens, and where support can begin:
Understanding PMDD
PMDD is a mental health condition that affects around 5–8% of menstruating people, though many go undiagnosed. It’s characterised by intense psychological symptoms like anxiety, rage, depression, or hopelessness, that arise in the luteal phase (the week or two before menstruation), then ease or disappear entirely once bleeding begins.
You might feel fine for part of the month, then suddenly find yourself:
Feeling highly emotional or sensitive
Experiencing conflict in relationships
Struggling with motivation or focus
Battling physical symptoms like headaches or bloating
Questioning your sense of self or stability
Diagnosing PMDD
Premenstrual Dysphoric Disorder (PMDD) is diagnosed based on the presence, timing, and severity of symptoms. A formal diagnosis requires at least five distinct symptoms to occur in the luteal phase (the two weeks before menstruation) across a minimum of two consecutive menstrual cycles. These symptoms must interfere significantly with daily functioning, relationships, or overall quality of life.
Because of overlapping mood-related symptoms, PMDD is sometimes misdiagnosed as other psychiatric conditions, such as bipolar disorder. It wasn’t until 2019 that the World Health Organization formally recognised PMDD as a distinct clinical condition requiring its own diagnostic and treatment approach.
You can visit the International Association of Premenstrual Disorders website for a free symptom tracker.
Please note that I treat my patients as a whole and do not require a formal diagnosis to begin exploring and addressing the underlying drivers of their symptoms.
Current Medical Model of Care
The American College of Obstetricians and Gynecologists (ACOG) Practice Guidelines currently recommend two main treatments for managing premenstrual mood disorders. This is also practiced in Australia:
Selective serotonin reuptake inhibitors (SSRIs)
→ Strong recommendation, based on moderate-quality evidence
→ First-line treatment aimed at regulating serotonin levels in the brain
→ 50-70% users report benefit leaving 30-50% with little or no symptom relief
Combined oral contraceptives (COCs)
→ Strong recommendation, but based on low-quality evidence
→ Intended to suppress ovulation and stabilise hormonal fluctuations
→ Not proven to work for everyone.
Note: The terms “moderate” and “low-quality evidence” come directly from ACOG's own grading, this is not my critique. Yes, they strongly recommend treatment with low evidence.
Naturopathic Model of Care
Naturopathic care for PMDD takes a whole-body approach, recognising the complex relationship between the nervous system, endocrine system, lifestyle, trauma, genetics and genomics. Rather than simply suppressing symptoms, treatment focuses on addressing underlying drivers such as hormone sensitivity, inflammation, and neurotransmitter imbalances. Care is individualised and may include support for mood regulation—particularly depression and anxiety alongside strategies to stabilise and modulate hormonal rhythms.
→ This neuroendocrine + epigenetic lens offers a more integrative and long-term path to relief.
Support for PMDD you can start right now
In my clinical practice, I approach PMDD gently and holistically, addressing both the biological drivers and the emotional toll it takes. Here are some of the core strategies you can try right now
1. Protein-Rich, Blood Sugar–Balanced Diet
Blood sugar stability is essential for mood and hormone regulation. Protein at every meal supports neurotransmitter production (like serotonin and dopamine), which are often disrupted in PMDD. Protein can calm the nervous system and reduce internal volatility.
2. Cycle Awareness and Symptom Tracking
PMDD doesn’t look the same in everyone. Tracking your cycle helps us identify your personal symptom window, uncover triggers, and tailor support to your unique hormonal rhythm. I use the Kindara App with my patients.
3. Nervous System and Supporting Sleep
Sleep is one of the most powerful tools we have to stabilise mood and detoxify hormones, but many with PMDD struggle to get enough of it. Check out my previous blogs on how to achieve a better night sleep:
4. Movement To Reduces Inflammation
Exercise isn’t about intensity, it’s about consistency. Exercise will reduce inflammatory markers, improve brain chemistry, and improve resilience through the luteal phase.
5. Individualised Herbal Medicine
Herbal medicine offers beautiful support for the cyclical brain changes of PMDD. Some herbs help modulate how your brain responds to fluctuating hormones, while others support energy, mood, detoxification, and sleep. We will also address common nutrient deficiencies.
You Are Not Broken, You Are Cyclical
Symptoms are messages. PMDD is not a sign that your body is failing, it’s a sign that your system is under strain and needs support. If you suspect you’re living with PMDD, ADHD, or struggling with challenging moods and anxiety, I'd love to support you to find steadiness in your cycle:
References (examples, I have a huge database of ongoing research as I plan to complete mt PhD)
