You’re Not Crazy. Your Hormones Are Not the Enemy: Understanding PMDD and Hormonal Mood Shifts

Have you ever felt like a totally different version of yourself in the week or two leading up to your period? One moment you’re fine, and the next you're tearful, irritable, or overcome with a sense of hopelessness that feels disproportionate — even unrecognizable. Maybe you've been told it's just PMS, to “toughen up,” or worse, that you’re being dramatic.

Let’s be clear: you’re not crazy, and your hormones are not the enemy.What you might be experiencing is something deeper, and very real Premenstrual Dysphoric Disorder (PMDD).

What is PMDD?

PMDD is a severe and chronic medical condition that affects mood, behavior, and physical health in the luteal phase (the one to two weeks before menstruation). It’s classified in the DSM-5 under depressive disorders and is estimated to affect 3–8% of menstruating individuals.

To meet the criteria for PMDD, symptoms must be present in most menstrual cycles and include at least five of the following:

• Marked mood swings (sudden sadness, increased sensitivity to rejection)

• Irritability or anger

• Depressed mood, feelings of hopelessness

• Anxiety or tension

• Decreased interest in usual activities

• Difficulty concentrating

• Lethargy or fatigue

• Appetite changes (overeating or specific cravings)

• Sleep disturbances

• Physical symptoms (breast tenderness, bloating, joint/muscle pain)

These symptoms often begin after ovulation and resolve within a few days after menstruation starts. But during that window, they can feel all-consuming.

PMDD vs. PMS: What's the Difference?

PMS (Premenstrual Syndrome) is common and can involve discomfort — bloating, mild irritability, fatigue — but it doesn't significantly interfere with daily functioning.

PMDD, on the other hand, is debilitating. It can affect your ability to go to work, maintain relationships, make decisions, and feel emotionally stable. It’s like a switch flips and you're not quite yourself, and it happens month after month.

How PMDD Impacts Daily Life

Living with PMDD can feel like leading a double life. For roughly half the month, you might feel grounded and capable. Then, without warning, emotional dysregulation hits — making you doubt yourself, your worth, and your ability to cope. Clients often describe it as:

• Feeling “possessed” by their emotions

• Overreacting to small stressors and later feeling shame or confusion

• Isolating from loved ones out of fear of being “too much”

Over time, this cycle can erode your self-confidence, strain relationships, and make it difficult to feel stable in your identity.

The Diagnostic Gap — Especially for Women and AFAB Folks

Many people with PMDD go years — or even decades — without a proper diagnosis. Why?

Because we’re often taught to dismiss pain or distress related to our cycles as “just part of being a woman.” This cultural minimization, paired with a lack of awareness in the medical field, means PMDD often gets misdiagnosed as anxiety, depression, or even bipolar disorder.

And for those assigned female at birth (AFAB), particularly people of color, trans, and nonbinary folks, the road to validation is even harder. Too often, symptoms are dismissed, minimized, or blamed on personality — not physiology.

The Hormonal Brain: Why It’s Not “All in Your Head”

So, what’s actually happening in the brain?

During the luteal phase of the menstrual cycle, estrogen and progesterone levels fluctuate dramatically. These hormones don’t just regulate reproduction — they also affect neurotransmitters like serotonin, which plays a major role in mood regulation.

In those with PMDD, the brain appears to be more sensitive to these hormonal shifts. This sensitivity creates a cascade effect — impacting mood, cognition, and emotional regulation — without the brain being able to “buffer” those changes effectively.

It’s not weakness. It’s neurobiology.

Where Do You Go From Here?

If any of this resonates, you’re not alone — and you’re not imagining it. Whether you have a formal diagnosis or are just beginning to suspect PMDD, there is support available.

Treatment options include:

• Tracking your cycle and symptoms (apps like Me v PMDD can help)

• Therapy, especially approaches like DBT or ACT that support emotion regulation

• SSRI medications, which can be used continuously or just during the luteal phase

• Hormonal treatments, such as birth control or GnRH agonists

• Lifestyle support, including nutrition, movement, and stress reduction

But more importantly: healing starts with validation and radical self-acceptance. You are not broken. You are not “too emotional.” Your body is communicating with you — and you deserve care that listens.

At Brave You Therapy, we understand the toll that hormone-related mood disorders can take on your life. If you’re navigating PMDD or feel dismissed by the systems around you, therapy can offer a grounding space to understand your symptoms, regulate your emotions, and reclaim your voice.

You don’t have to do this alone. Let’s walk through it together one cycle at a time.