It's Not 'Just Hormones'--Understanding PMS, PMDD, and Your Emotional Cycle
- Janelle De Guzman
- 8 minutes ago
- 4 min read
Have you ever felt “off,” and then heard a comment like, “Oh she’s on her period,” “She’s definitely about to start her period,” or “Is it that time of the month again?” Does it ever bring feelings of guilt and shame? Perhaps you’ve thought, “What is wrong with me?” or “Why can’t I control how I feel during this time of every month?” or “Why can’t I just stop being so hormonal?”
If you’ve ever felt or thought this way, you’re not alone. Your hormones aren’t flaws. They’re information. Hormones fluctuate each month and affect our mood; appetite; sleep; focus; energy levels, and even our confidence levels. One’s luteal phase, or the week leading up to a period, can involve physical and emotional changes that can feel uncomfortable or confusing. This is typically called premenstrual syndrome, or PMS.
For about 3% of women, however, these symptoms can be so debilitating and severe that it can lead to a PMDD diagnosis (Premenstrual Dysphoric Disorder). Thus, understanding the differences between PMS and PMDD, how they’re diagnosed, and how to cope with compassion can be both validating and empowering.
Effects of Hormonal Shifts
PMS and PMDD occur not because of abnormal hormones, but rather, how our brains respond to estrogen and progesterone changes throughout the menstrual cycle. Here’s some more specific information:
Estrogen
Estrogen increases serotonin (regulates mood, sleep, appetite) and dopamine (regulates motivation, pleasure, focus) levels.
When estrogen is high early in the cycle, people feel more emotionally regulated, focused, and motivated.
During the luteal phase (PMS week), estrogen levels drop, leading to lower serotonin and dopamine, which ultimately increases emotional sensitivity, anxiety, and appetite, and worsens motivation and mood. This is typically why people feel low, lethargic, fatigued, less focused, or out of control.
Progesterone
After ovulation, progesterone increases, which also increases GABA (responsible for regulating stress and sleep).
For some people, more progesterone can feel “calming.” However, others may have a sensitivity to progesterone, which can lead to a less calming effect and lead to more severe symptoms.
PMS vs. PMDD
With PMS, symptoms are typically manageable. For those who may have PMDD, their brains are highly sensitive to hormonal shifts, which can cause more severe emotional distress. Below is a chart that highlights similarities and differences between PMS and PMDD.
Feature | PMS | PMDD |
Timing | Luteal phase | Luteal phase |
Severity | Mild-moderate | Severe, disabling |
DSM-5 Diagnosis | No | Yes |
Emotional Symptoms | Irritability Mood swings Tearfulness Anxiety | Intense irritability/anger/rage Severe mood swings Depression/SI Hopelessness Heightened anxiety Feeling out of control Sensitivity to rejection Emotional numbness/despair |
Behavioral Symptoms | Difficulty concentrating Low motivation | Difficulty concentrating Loss of interest Isolation/social withdrawal |
Physical Symptoms | Bloating Breast tenderness Fatigue Headaches Changes in sleep/appetite | Similar to PMS |
DSM-V Criteria for PMDD
Below is what the DSM-V states is needed to get a PMDD diagnosis. Diagnosis involves collaboration with mental health providers and other medical professionals, like gynecologists.
Self-Compassion > Shame
Now, what does one do with all this information? Having an understanding of what could be happening can help us respond to these symptoms with curiosity and compassion rather than criticism and shame.
We may have been told (or have even told ourselves), “You’re overreacting,” “It’s just hormones,” “You’re being dramatic,” or “Get over it.” These statements can make us feel shame and guilt. Understanding the biology behind these symptoms can help give us a different perspective and leave room for compassion.
Self-compassion can sound like the following:
This is hard, and it makes sense.
It’s okay for me to feel this way
I’m going to give myself grace.
I can adjust my expectations without judgment.
My nervous system is just responding to hormonal changes.
I am going to honor my needs and communicate them.
Ways to Cope
Track Cycle and Symptoms
Awareness can help people notice patterns and know how to be proactive with their cycle.
Tracking mood, energy levels, sleep, thoughts, and severity can help with diagnosis and treatment planning.
You can track by journaling or through mobile apps, such as Clue, Flo, Natural Cycles, and more.
Adjust Expectations
When you’re in your luteal phase, it might help to adjust expectations and work with your body rather than against it.
Reduce your workload
Limit social commitments
Communicate your needs ahead of time
Make time for rest
Emotional Regulation Skills
Below are some coping skills for emotions:
Naming emotions (“I feel ____”)
5-4-3-2-1 grounding technique
Diaphragmatic breathing
Meditation
Increasing distress tolerance for discomfort (riding the wave of these emotions)
Self-care (blankets, music, calming shows)
Living according to one’s values
Reframing negative thoughts
Giving yourself compassion
Somatic Skills
Coping involves connecting with and supporting your physical body.
This includes gentle movement (yoga, stretching, walking), eating nutritious food, getting adequate sleep, limiting caffeine and alcohol, and hydrating consistently.
Medical and Therapeutic Support
Connect with your gynecologist and therapist to learn more about ways to manage. Whether it’s coping skills, therapy, medication, or hormonal interventions, talking to these professionals can help you weigh your options.
Final Thoughts
Coping with PMS and PMDD is a journey that requires curiosity, compassion, and support. There’s nothing wrong with you. Give yourself and those you care about grace and support. Hormones are not the enemy; they are messengers. Try to listen with compassion.
This information is useful not only for those who experience PMS or PMDD, but it’s also for loved ones or anyone wishing to learn more about it these hormonal changes in general. Connect with your therapist, medical provider, or gynecologist if you are curious about learning more or want more support.
Sources
Clay, R. A. (2023, July 31). PMS vs. PMDD: What’s the difference? American Psychological Association. https://www.apa.org/topics/women-girls/pms-vs-pmdd
Mayo Clinic. (2024, January 19). Premenstrual dysphoric disorder: Different from PMS? https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
Radytė, E. (2025, August 15). Hormonal fluctuations and their role in PMS & PMDD. Hormonal Fluctuations and Their Role in PMS & PMDD. https://www.samphireneuro.com/en-us/blog/how-hormones-work-pmdd-pms?srsltid=AfmBOoqYiPVz3ZJHAWpR8DR4ByxtT6wnkVu7Fv-_Fxxcqb1_ZhAsAX8s
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