PMS & PMDD

Hormone CareEnergy, Sleep & Stress Care
Written By Jennifer Tang

Overview

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are cyclical conditions that can cause physical, emotional, and behavioural symptoms before menstruation. PMS can range from mild to disruptive, while PMDD involves more severe mood-related symptoms that can significantly affect daily life, relationships, work, school, and overall well-being.¹˒²

At Tangible Health, we take an individualized approach to PMS and PMDD care. We look at your menstrual-cycle pattern, symptoms, mood, nutrition, sleep, stress, medications, lifestyle, and overall health to develop practical strategies that support how you feel throughout your cycle.

What Is PMS & PMDD?

PMS and PMDD involve symptoms that typically occur during the luteal phase, after ovulation and before menstruation, and improve once menstruation begins or shortly afterward.¹˒²

  • PMS can involve a combination of physical and emotional symptoms such as bloating, breast tenderness, headaches, fatigue, food cravings, irritability, anxiety, or mood changes.

  • PMDD is a more severe premenstrual disorder in which mood and behavioural symptoms significantly interfere with everyday functioning. Diagnosis involves a specific pattern of symptoms, including at least five symptoms with at least one prominent mood-related symptom.²˒⁴

PMDD is not simply caused by having “too much” or “too little” estrogen or progesterone. Research suggests that some people are more sensitive to the normal hormonal changes that occur after ovulation and to their effects on brain signalling involved in mood and emotional regulation.⁴˒⁵

Common Symptoms of PMS & PMDD

Symptoms vary from person to person and may change from cycle to cycle.¹˒²

Physical symptoms may include:

  • Breast tenderness or swelling

  • Bloating or fluid retention

  • Headaches or migraines

  • Fatigue or low energy

  • Changes in appetite or food cravings

  • Abdominal discomfort or cramping

  • Joint or muscle aches

  • Changes in sleep

Emotional and cognitive symptoms may include:

  • Irritability or anger

  • Anxiety or feeling overwhelmed

  • Low mood or tearfulness

  • Mood swings

  • Difficulty concentrating or brain fog

  • Social withdrawal

  • Reduced interest or motivation

With PMDD, these emotional symptoms are more severe and may include significant depression, hopelessness, anxiety, anger, feeling out of control, or difficulty functioning at work, school, or in relationships.²

Causes & Contributing Factors

The exact causes of PMS and PMDD are not completely understood. Symptoms appear to result from a combination of normal menstrual-cycle hormone changes and individual differences in how the brain and body respond to those changes.²˒⁴˒⁵

Hormonal Sensitivity
PMS and PMDD occur in relation to normal hormonal changes after ovulation. Particularly in PMDD, symptoms appear to reflect increased sensitivity to these fluctuations rather than simply abnormal hormone levels.⁴˒⁵

Brain & Neurotransmitter Signalling
Serotonin and the interaction between the progesterone-derived neurosteroid allopregnanolone and GABA-related brain signalling appear to play a role in PMDD symptoms.⁵

Individual Susceptibility
Genetics, nervous-system sensitivity, previous mental-health conditions, and other individual biological differences may influence how strongly someone responds to menstrual-cycle changes.²˒⁵

Lifestyle & Overall Health
Sleep disruption, stress, irregular eating patterns, alcohol, caffeine, and other lifestyle factors may influence the severity of premenstrual symptoms, although they are not considered the underlying cause of PMDD.¹˒³

Overlapping Conditions
Conditions such as depression, anxiety, migraines, thyroid disorders, and irritable bowel syndrome may overlap with premenstrual symptoms or become worse before menstruation.

Some people experience premenstrual exacerbation (PME), where an existing condition such as anxiety or depression is present throughout the month but becomes significantly worse before menstruation. PME is different from PMDD and may require a different treatment approach.⁸

Our Approach to PMS & PMDD

At Tangible Health, we look at the whole pattern of your symptoms and menstrual cycle rather than treating every premenstrual symptom the same way. For PMDD or significant mood symptoms, naturopathic care is used alongside appropriate medical and mental-health care when needed.

Your Cycle & Symptoms
We look at when your symptoms begin, how they change throughout your menstrual cycle, and whether they improve after menstruation. Understanding this pattern helps distinguish PMS or PMDD from conditions that may be present throughout the month.

Your Mood, Sleep & Overall Health
We consider mood, anxiety, sleep, stress, energy, nutrition, movement, medications, hormonal contraception, and other health conditions that may influence how you feel throughout your cycle.

Your Goals
Your priorities may include reducing mood changes, improving energy or sleep, managing physical symptoms, feeling more like yourself before your period, understanding your cycle, or finding an integrative treatment approach that works alongside medication or hormonal therapy. Your care plan is developed around the outcomes that matter most to you.

Treatments That May Be Included

Your individualized PMS or PMDD care plan may include:

  • Clinical Nutrition to support consistent eating patterns, nutritional adequacy, and overall menstrual health

  • Lifestyle Medicine to support movement, sleep, stress management, and sustainable daily routines

  • Nutraceuticals & Supplements when there is an individualized nutritional or clinical indication; evidence for specific nutrients and supplements varies³˒⁷

  • Botanical Medicine when clinically appropriate, with consideration of current evidence, medications, and reproductive goals

  • Acupuncture as a complementary component of symptom management when appropriate

  • Naturopathic Counselling to support stress management, coping strategies, and behavioural changes

For PMDD or more severe symptoms, collaborative care may also include a family doctor, gynecologist, therapist, psychologist, psychiatrist, or other healthcare provider. Evidence-based conventional options may include SSRIs, psychological therapies, and selected hormonal treatments.²˒³˒⁶

What to Expect

Initial Assessment
We start with a comprehensive review of your premenstrual symptoms, menstrual cycle, symptom timing, mood and mental health, health history, nutrition, sleep, stress, medications, supplements, hormonal contraception, reproductive goals, and overall well-being.

Cycle & Symptom Tracking
Because PMS and PMDD are defined by when symptoms occur during the menstrual cycle, tracking symptoms over time can be an important part of assessment. For suspected PMDD, daily symptom tracking across at least two menstrual cycles is commonly recommended to help confirm the pattern.²˒⁴ There is no blood test or hormone panel that can diagnose PMDD, although other testing may sometimes be appropriate to investigate conditions such as thyroid dysfunction, anemia, or nutritional deficiencies.

Personalized Plan
You’ll receive a personalized care plan designed around your specific symptoms, menstrual-cycle pattern, health history, current treatments, and goals.

Ongoing Support
PMS and PMDD symptoms may change over time and with different stages of life, medications, stress, and other health factors. Follow-up allows us to monitor your symptoms, adjust your plan, and coordinate care with other healthcare providers when needed.

When to Seek Support for PMS & PMDD

You do not need to wait until symptoms become severe before seeking support.

Consider speaking with a healthcare provider if:

  • Premenstrual symptoms interfere with work, school, relationships, or everyday activities

  • Irritability, anxiety, depression, or mood swings become difficult to manage

  • You regularly feel unlike yourself before your period

  • Symptoms consistently appear during the same part of your menstrual cycle

  • Symptoms are becoming more severe

  • Mood symptoms continue throughout the month rather than improving after your period

  • You are unsure whether you are experiencing PMS, PMDD, depression, anxiety, or PME

  • Lifestyle changes alone are not providing enough relief

  • You would like support navigating medication, hormonal contraception, supplements, or integrative treatment options

PMDD can involve severe depression, hopelessness, or thoughts of self-harm. If you feel that you may harm yourself or someone else, seek urgent medical or mental-health care.²

Book An Appointment

Frequently Asked Questions

  • PMS can cause physical and emotional symptoms before your period, while PMDD causes more severe mood-related symptoms that significantly interfere with everyday life, relationships, work, or school.¹˒²

  • Common symptoms include severe irritability, mood swings, anxiety, depression or hopelessness, feeling overwhelmed, low energy, difficulty concentrating, and changes in sleep or appetite.²

  • Diagnosis is based on your symptoms, when they occur during your menstrual cycle, and how much they affect daily life. Daily symptom tracking for at least two menstrual cycles is commonly used to confirm the pattern.²˒⁴

  • No. There is currently no blood or hormone test that can diagnose PMDD. Testing may still be appropriate to rule out other conditions that can cause similar symptoms.

  • Some people are more sensitive to the normal hormonal changes that occur after ovulation. These changes can influence brain systems involved in mood and emotional regulation.⁴˒⁵

  • With PMDD, symptoms are mainly cyclical and improve outside the premenstrual phase. With premenstrual exacerbation (PME), an existing condition such as anxiety or depression is present throughout the month but becomes worse before menstruation.⁸

  • Treatment depends on symptom severity and may include lifestyle and nutritional strategies, psychological therapies, SSRIs, hormonal treatments, or a combination of approaches.²˒³˒⁶

  • Naturopathic care can support nutrition, sleep, stress management, lifestyle habits, appropriate supplementation, and symptom tracking. For PMDD or severe mood symptoms, it is best used alongside appropriate medical and mental-health care.

 

Related Care

PMS and PMDD can affect multiple areas of health. You may also benefit from:

Jennifer Tang
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