PMDD: When “PMS” Is More Than Just Hormones

Written By Greg Norris

Most women are familiar with PMS — the mood changes, bloating, or cramps that show up before a period. But for some, those days aren’t just uncomfortable. They’re overwhelming. If mood swings feel extreme, if sadness or anxiety disrupt daily life, or if relationships and work suffer every month, it may be something more than PMS. This condition is called PMDD, and it deserves more awareness and understanding.

What Is PMDD?

PMDD stands for Premenstrual Dysphoric Disorder, a severe form of PMS that affects about 5–8% of women of reproductive age. The difference isn’t just intensity. PMDD symptoms interfere with normal daily life. These impacts will interfere with work, relationships, and self-care. Women often describe feeling like “a different person” for a week or two each month.

How PMDD Shows Up

PMDD can include a mix of emotional and physical symptoms, such as:

Emotional:

  • Severe mood swings

  • Depression or hopelessness

  • Intense irritability or anger

  • Anxiety or tension

  • Difficulty concentrating

Physical:

  • Bloating

  • Breast tenderness

  • Headaches

  • Sleep changes (insomnia or oversleeping)

  • Low energy or fatigue

These symptoms usually begin in the luteal phase (the week or two before menstruation) and resolve shortly after a period starts.

PMDD vs PMS

PMS is uncomfortable. PMDD is disruptive.

  • PMS might cause mild irritability, fatigue, or cravings.

  • PMDD can cause rage, despair, or panic. It interferes with work, relationships, and overall functioning.

The difference is not about being “too sensitive” or exaggerating. It’s about biology. PMDD is a recognized medical condition, not a personality flaw.

Why Hormones Play a Role

PMDD is linked to the body’s sensitivity to normal hormonal changes, particularly estrogen and progesterone. These shifts affect neurotransmitters like serotonin, which help regulate mood.

In other words, it’s not that hormone levels are “abnormal.” It’s that the brain responds differently to these changes. This explains why SSRIs (medications that increase serotonin) can sometimes help — but also why many women benefit from a broader approach that looks at hormones, mental health, and lifestyle together.

Treatment Options

There isn’t one “right” treatment for PMDD. Options include:

  • Lifestyle support: Prioritizing sleep, balanced nutrition, and regular exercise.

  • Therapy: Cognitive behavioral therapy (CBT) and mindfulness practices can help women cope with cyclical mood changes.

  • Medication: SSRIs or birth control pills are sometimes prescribed when a woman reaches out to traditional providers.

  • Hormone evaluation: Checking for imbalances and supporting estrogen, progesterone, and testosterone levels when appropriate.

  • Integrative care: Combining mental health support with hormone optimization can often bring the most relief.

My Role in Supporting Women With PMDD

This is where my training comes together. As both a hormone specialist and a psychiatric mental health nurse practitioner, I can look at PMDD from both angles. That means I don’t see your mood changes as “just hormones” or “just mental health.” I see the full picture — and that often leads to faster, more lasting relief.

For women with PMDD, this dual perspective means:

  • Symptoms are taken seriously and validated

  • Treatment options go beyond trial-and-error

  • Care plans respect both your mind and your body

Greg Norris