PMS & PMDD
Overview
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are cyclical conditions that can cause physical, emotional, and behavioural symptoms in the days or weeks 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, and overall well-being.¹ ²
At Tangible Health, we take an individualized, integrative approach to PMS and PMDD care. We take a comprehensive approach to PMS & PMDD treatment, focusing on hormone regulation, metabolic health, and sustainable lifestyle support to help you feel balanced and in control of your body again.
What Is PMS & PMDD?
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are cyclical conditions involving physical, emotional, and behavioural symptoms that typically occur during the luteal phase of the menstrual cycle, after ovulation and before menstruation. Symptoms generally improve once menstruation begins or shortly afterward.¹˒⁴
PMS may cause symptoms such as bloating, breast tenderness, headaches, fatigue, food cravings, irritability, anxiety, or mood changes. Symptoms become clinically significant when they repeatedly interfere with normal activities or quality of life.¹
PMDD is a more severe premenstrual disorder with prominent mood symptoms that can significantly affect work, school, relationships, and daily functioning. Diagnosis involves a specific pattern of symptoms, including at least five symptoms with at least one significant mood-related symptom.²˒⁴
Unlike the idea of a simple “hormone imbalance,” people with PMDD do not necessarily have abnormally high or low hormone levels. Research suggests that PMDD is associated with an increased sensitivity to normal hormonal fluctuations, particularly changes occurring after ovulation and their effects on brain signalling involving serotonin, GABA, and the progesterone-derived neurosteroid allopregnanolone.⁵
Common Symptoms of PMS & PMDD
Symptoms vary from person to person and can change from cycle to cycle.¹˒²˒⁴
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
Sleep disturbances
Gastrointestinal symptoms
Emotional and cognitive symptoms may include:
Irritability or anger
Anxiety or feeling overwhelmed
Low mood or tearfulness
Mood swings
Social withdrawal
Difficulty concentrating or brain fog
Reduced motivation or interest in usual activities
Changes in sleep
Feeling emotionally sensitive or easily triggered
PMDD symptoms may include:
Severe irritability or anger
Significant mood swings
Depression, hopelessness, or despair
Heightened anxiety or tension
Panic symptoms
Feeling overwhelmed or out of control
Significant difficulty concentrating
Loss of interest in relationships or usual activities
Severe emotional symptoms that interfere with work, school, relationships, or everyday life
If emotional symptoms consistently interfere with daily functioning, PMDD should be considered.
Causes & Contributing Factors
The exact causes of PMS and PMDD are not completely understood. Current evidence suggests that several biological and individual factors may contribute.²˒³˒⁵
Hormonal sensitivity
Symptoms occur in relation to the normal hormonal changes that take place after ovulation. In PMDD particularly, the nervous system appears to respond differently to these normal cyclical changes rather than simply having “too much” or “too little” estrogen or progesterone.⁵
Brain and neurotransmitter signalling
Changes involving serotonin, as well as the interaction between allopregnanolone and GABA-A receptors, appear to play an important role in the mood and nervous-system symptoms associated with PMDD.²˒⁵
Individual susceptibility
Not everyone responds to menstrual-cycle hormone changes in the same way. Genetics, nervous system sensitivity, prior mental health history, and other biological differences may influence how symptoms are experienced.
Lifestyle and overall health
Sleep disruption, chronic stress, irregular eating patterns, alcohol or caffeine intake, and other lifestyle factors may influence the severity of premenstrual symptoms. However, they are not considered the sole cause of PMS or PMDD.¹˒³
Other overlapping conditions
Depression, anxiety disorders, migraines, thyroid disorders, irritable bowel syndrome, and other health conditions can overlap with or worsen around the menstrual cycle.¹
Some people experience premenstrual exacerbation (PME), where an existing condition such as depression or anxiety 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
From a naturopathic perspective, PMS and PMDD are approached by looking at the whole pattern of symptoms, including menstrual-cycle timing, nutrition, sleep, stress, nervous-system health, physical symptoms, medications, and other health conditions.
Treatment is individualized and may focus on:
Reducing the severity of physical and emotional symptoms
Improving energy, sleep, and mood throughout the menstrual cycle
Supporting consistent nutrition and healthy lifestyle patterns
Identifying conditions that may be overlapping with PMS or PMDD
Improving resilience during the premenstrual phase
Supporting overall quality of life
For mild PMS symptoms, lifestyle and nutritional strategies may provide meaningful support. For PMDD or significant mood symptoms, we recommend collaborative care with your primary care provider and/or an appropriate mental-health professional when needed. Evidence-based conventional treatments such as SSRIs, cognitive behavioural therapy, and selected hormonal therapies may form an important part of a comprehensive treatment plan.³˒⁴˒⁶
Treatments That May Be Included
Your PMS & PMDD care plan may include a combination of:
Acupuncture as a complementary approach to symptom management
Clinical nutrition to support consistent eating patterns, nutritional adequacy, and overall menstrual health
Botanical medicine when appropriate, taking current evidence, medication interactions, and reproductive goals into consideration
Nutraceuticals & supplements when there is an individualized nutritional or clinical indication
Lifestyle medicine to support movement, sleep, stress management, and sustainable daily routines
Naturopathic counselling to support stress management, coping strategies, and behavioural changes
Collaborative care with your family doctor, gynecologist, therapist, psychologist, psychiatrist, or other healthcare providers when appropriate, particularly for PMDD or significant mood symptoms³ ⁴
Each treatment is selected based on your individual symptoms, health history, menstrual cycle, and goals.
What to Expect
Initial Assessment
We start by taking a comprehensive look at 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.
Targeted Testing
Testing is recommended based on your individual presentation rather than using the same panel for everyone. There is currently no blood test or hormone panel that can diagnose PMDD. Diagnosis is based primarily on the timing, severity, and pattern of symptoms throughout the menstrual cycle. For suspected PMDD, prospective daily symptom tracking for at least two menstrual cycles is commonly recommended to help confirm the cyclical pattern.² ⁴
Additional laboratory testing may be recommended when clinically appropriate to investigate other conditions that could contribute to or resemble certain symptoms, such as thyroid dysfunction, anemia, or nutritional deficiencies.
Personalized Plan
Your care plan is developed around your symptoms, menstrual cycle pattern, clinical findings, health history, and goals. There is no single PMS or PMDD protocol, and recommendations are selected according to your individual needs.
Ongoing Support
PMS and PMDD symptoms can change over time and may be influenced by different stages of life, stress, medications, and other health factors. Follow-up allows your care plan to evolve based on your symptoms, response to treatment, changing goals, and other medical or mental-health care.
When to Seek Support for PMS & PMDD
You do not need to wait until your symptoms become severe before seeking support.
Consider speaking with a healthcare provider if:
Premenstrual symptoms interfere with work, school, relationships, or daily activities
Irritability, anxiety, depression, or mood swings become difficult to manage
You regularly feel unlike yourself before your period
Symptoms appear consistently during the same phase of your menstrual cycle
Symptoms are becoming more severe over time
Your symptoms continue throughout the entire month rather than resolving after your period
You are unsure whether you have PMS, PMDD, depression, anxiety, or premenstrual exacerbation
Lifestyle changes alone are not providing enough relief
You would like support navigating medications, hormonal contraception, supplements, or integrative treatment options
Major medical organizations emphasize that early recognition and timely treatment matter, as long delays in diagnosis are common and can negatively affect quality of life. An integrative approach, working with a gynecologist alongside a naturopathic doctor, may provide more comprehensive support. ²
Frequently Asked Questions
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PMS can cause physical and emotional symptoms before your period, while PMDD is a more severe form that can significantly affect mood, relationships, work, school, or daily life.²˒⁴
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Common PMDD symptoms include severe irritability, mood swings, anxiety, depression, feeling overwhelmed, low energy, and difficulty concentrating. Symptoms usually appear before your period and improve after menstruation begins.²
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The biggest clues are when your symptoms happen and how much they affect your life. PMDD symptoms are usually more severe and follow a clear pattern before your period.²˒⁴
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PMDD is diagnosed based on your symptoms, their timing during your menstrual cycle, and how much they interfere with daily life. Tracking symptoms every day for at least two menstrual cycles can help confirm the pattern.⁴
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No. There is currently no blood test or hormone test that can diagnose PMDD. Testing may still be used to rule out other conditions that can cause similar symptoms.¹˒⁴
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Some people are more sensitive to the normal hormonal changes that happen after ovulation. These changes can affect brain systems involved in mood, stress, and emotional regulation.²˒⁵
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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 gets worse before your period.⁸
Related Care
PMS and PMDD can affect multiple areas of health. You may also benefit from:
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American College of Obstetricians and Gynecologists. Premenstrual Syndrome (PMS).
https://www.acog.org/womens-health/faqs/premenstrual-syndromeOffice on Women’s Health, U.S. Department of Health and Human Services. Premenstrual Dysphoric Disorder (PMDD).
https://womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmddAmerican College of Obstetricians and Gynecologists. Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. December 2023.
https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/12/management-of-premenstrual-disordersBiggs WS, Romeu JM, Gaudard T. Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Common Questions and Answers. American Family Physician. 2025;111(4):345–350.
https://www.aafp.org/pubs/afp/issues/2025/0400/premenstrual-syndrome-premenstrual-dysphoric-disorder.htmlHantsoo L, Epperson CN. Allopregnanolone in Premenstrual Dysphoric Disorder (PMDD): Evidence for Dysregulated Sensitivity to GABA-A Receptor Modulating Neuroactive Steroids Across the Menstrual Cycle. Neurobiology of Stress. 2020;12:100213.
https://pubmed.ncbi.nlm.nih.gov/32435664/Jespersen C, Lauritsen MP, Frokjaer VG, et al. Selective Serotonin Reuptake Inhibitors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Cochrane Database of Systematic Reviews. 2024.
https://pubmed.ncbi.nlm.nih.gov/39140320/Nutrients. Effect of Nutritional Interventions on the Psychological Symptoms of Premenstrual Syndrome in Women of Reproductive Age: A Systematic Review of Randomized Controlled Trials. 2024.
https://pubmed.ncbi.nlm.nih.gov/38684926/Kuehner C, Nayman S. Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps. Current Psychiatry Reports. 2021;23(11):78.
https://pubmed.ncbi.nlm.nih.gov/34626258/
This information is intended for educational purposes and is not a substitute for individualized medical advice, diagnosis, or treatment.
