Inside a PMDD episode: Recognizing and managing premenstrual dysphoria
Answering a FAQ: Can you just "snap out of" this reproductive disorder?
Every time I’ve been open about my mental health and medical history — hysterectomy, hormone therapy (HRT), or PMDD — I’ve received at least one private message saying:
“OMG I thought I was the only one,” or “I think I have this!”
PMDD — premenstrual dysphoric disorder — in particular is not a well-understood disease, and because many medical providers are still unfamiliar with it (PMDD was only added to the International Classification of Diseases in 2022). That’s one reason I share authentically about my experiences with PMDD. I think there are thousands of menstruating people out there struggling with their mental health who do not realize yet they have PMDD.
What’s PMDD?
Premenstrual dysphoric disorder is a severe, chronic mood disorder that causes psychological, emotional, and physical problems during the luteal phase of your menstrual cycle. The exact cause is still somewhat of a mystery, but there’s evidence to suggest that hormone changes during the menstrual cycle cause the brain to stop producing serotonin, a hormone that regulates mood and memory.
I was diagnosed with PMDD 2022 and successfully treated it with surgical menopause. Here’s my response to one of the top PMDD-related internet searches:
🔎 What does a PMDD episode look like?
What does a PMDD episode look like?
A PMDD episode can vary in its intensity and symptoms depending on the circumstances (mine were always worse with stress or lack of sleep), but generally, it occurs in the luteal phase of the menstrual cycle (the two-ish weeks leading up to your period).
PMDD is characterized by the onset of emotional, psychological, social, and physical symptoms:
🧠 Emotional and psychological symptoms of a PMDD episode:
Severe mood swings: Sudden feelings of sadness, anger, or irritability that can come on without a clear cause. Small things might trigger overwhelming emotional responses.
Depression or hopelessness: A deep sense of despair or sadness, often feeling like life is not worth living (and even suicidal thoughts or suicidal ideation).
Anxiety or panic attacks: A heightened sense of anxiety, tension, or nervousness, sometimes leading to panic attacks.
Extreme irritability or anger: Feeling easily annoyed, quick to anger, or having an unusually short temper.
Difficulty concentrating: Trouble focusing on tasks or staying productive, feeling mentally foggy or scattered.
Emotional outbursts: Crying spells or rage episodes without clear reasons, often feeling out of control.
🫁 Physical symptoms of a PMDD episode:
Fatigue: Feeling overwhelmingly tired, no matter how much you sleep. I had a hard time staying awake past dinner time.
Sleep disturbances: Difficulty falling asleep, staying asleep, or insomnia.
Appetite changes: Food cravings (often for carbs or sweets), increased hunger, or loss of appetite.
Breast tenderness: Soreness or swelling in the breasts.
Bloating: A sense of fullness or swelling in the abdomen.
Headaches or migraines: Some people experience severe headaches during PMDD episodes.
📱 Social and behavioral changes during a PMDD episode:
Social withdrawal: A desire to avoid social interactions, even with close friends or family, often due to feeling emotionally overwhelmed or irritable.
Low motivation: Finding it difficult to engage in daily activities, including work or personal hobbies. A total loss of interest in things that otherwise you’d enjoy (often associated with depression).
Self-criticism or feelings of worthlessness: Feeling like a failure, having negative self-talk, or an overwhelming sense of inadequacy. I’ve also read that rejection sensitivity is associated with PMDD episodes.
How do you snap out of a PMDD episode?
A PMDD episode often feels like an emotional and physical rollercoaster. Once your period begins, the symptoms typically subside or disappear, but the intensity during the luteal phase can be extremely disruptive and even scary.
Unfortunately, there is no way to “snap out” of a PMDD episode; you just have to wait for your hormones to shift and the symptoms to subside. There are ways to treat PMDD to lessen the overall intensity, including SSRIs and hormonal birth control (in extreme cases, medication to inhibit ovulation).
Here are some things that help me manage episodes:
Managing a PMDD episode
Pay attention to your cycle
As my primary care provider told me, just knowing when you might experience symptoms can lessen the feeling of a total loss of control during PMDD episodes. You can use a DRSS — Daily Record of Severity of Symptoms — or an app like Clue or any other period tracking app that won’t share your data.
I used the Flo app even though I had a hysterectomy by the time I was diagnosed with PMDD. It helped to know when I might begin to feel “off” ahead of time, because I’d inevitably start to doubt my reality.
Find a realistic way to move your body
When you’re fatigued and depressed, “working out” often feels like the last thing you want to do, but the little boost of endorphins you get from just walking around the block can help lift the fog during a PMDD episode.
Consider alcohol and sugar intake
I’ve read in PMDD literature that it’s associated with alcohol intake. My suspicion is that lots of folks with PMDD use alcohol as a way to cope with symptoms, whether they know it or not (I know I’ve done this). But excessive sugar and alcohol can make symptoms worse.
Giving up alcohol, even for a little while, is a good way to gauge whether it’s affecting or exacerbating PMDD.
Therapy
This one’s easier said than done. I wish I could snap my fingers and make it so that everyone had access to good mental health care, but, unfortunately, great therapists aren’t always easy to find, and can be cost prohibitive.
The thing is, there’s reason to believe that PMDD is associated with childhood emotional abuse, from which healing can only be a good thing.
Connect with other people with PMDD
You don’t have to go it alone! PMDD and other mental illnesses are isolating and confusing, and just hearing that other folks have dealt with the symptoms too is is a great reminder that there’s hope. And, even when it does feel hopeless, you know you can get validation and support from people who truly understand you.
Read more here:
What to do next
Join me for an upcoming Women’s Sharing Circle
Women’s Sharing Circles are monthly roundtables for *real talk* about women’s issues like mental health, motherhood, menopause, and marriage. They’re free and online; get on the “interested” list here.
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I post about motherhood, inner child healing, mental health, and our farm in Western Montana: @micahlarsen_
Comment
Do you have PMDD? Do you have questions? Tell me in the comments; I’d love to hear from you.