Premenstrual Dysphoric Disorder - PMDD

Psychologist Central Coast and Galston supporting with hormone related mood disorders

If you've ever cried literally over spilled milk, picked a fight you didn’t mean to start, or felt like your body was hosting a completely different version of you once a month— you might be in PMDD territory.

I know it well. Not just professionally, but personally.After having my daughter, I began to notice my hormone shifts so much more. After over a year of relative mood stability during pregnancy and postnatal, going back to cyclical changes and with a new baby was too much to cope with alone —tears, rage, dread, the whole dramatic arc. And I remember thinking, This cannot just be PMS. Spoiler: it wasn’t.

Thankfully, I had a wonderful GP who took my concerns seriously and helped me start connecting the dots. For anyone navigating similar terrain, I often recommend the team at WHRIA (Women’s Health and Research Institute of Australia), who specialise in hormone-sensitive mood disorders and truly understand PMDD.

So, What Is PMDD?Premenstrual Dysphoric Disorder (PMDD) is a severe, cyclical mood disorder triggered by sensitivity to the natural hormonal fluctuations of the menstrual cycle. It affects an estimated 3–8% of menstruating people worldwide (Halbreich et al., 2003). Neurodivergent women—including those with ADHD or autism—are significantly more likely to experience PMDD and often report more intense symptoms than their neurotypical peers (Green & Griffiths, 2021).

It’s not caused by a hormone imbalance, but by how the brain responds to hormones—especially progesterone and its metabolites like allopregnanolone (Rapkin & Winer, 2009).

For two weeks, you might feel grounded, creative, and full of drive.

And then suddenly:You hate your job.Your relationship feels unbearable.The sound is too hot. Your clothes are too loud.Your skin is crawling. Your thoughts spiral.And just like that, you’re drowning in a version of yourself you don’t recognise.

Then your period comes, and the fog lifts. Until next month.

Why So Many of Us Miss It

Part of what makes PMDD so hard to piece together is how late it was officially recognised. PMDD was only included as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 (APA, 2013). Before that, it was often mislabelled as “severe PMS” or ignored entirely.

Research into women’s hormonal mental health has long been underfunded and undervalued (Martin et al., 2017). Which means many women—and many health professionals—are still catching up.

The Unspoken Risk

PMDD is not just inconvenient or emotional. It is deeply distressing and often dangerous.

Around 30% of individuals with PMDD report suicidal ideation, with some studies suggesting even higher rates during high-symptom phases (Pearlstein et al., 2005; Epperson et al., 2012).

And yet, it’s still not routinely screened for in mental health or general practice settings.

Perimenopause—a time of intense hormonal fluctuation—is the stage of life with the highest suicide rate among women (Rendell et al., 2022). I can’t help but wonder how many of those women may have lived for years with undiagnosed or untreated PMDD, never knowing that help was possible.

What a Psychologist Can Do (Besides hand you a hot water boottle,punching bag and some tissues)

You might wonder what a psychologist has to do with hormones.The answer? A lot.

While we can’t stop the hormonal shifts, we can absolutely work with your brain’s response to them. In therapy, we might:

• Map your cycle and track symptoms to identify patterns and build predictability

• Use ACT and DBT strategies to manage overwhelming emotions and distress

• Support nervous system regulation and emotional recovery

• Explore identity, relationships, and self-worth impacts of cyclical mental health

• Help you prepare for high-symptom weeks with practical, compassionate plans

• Clarify your treatment needs and work collaboratively with your medical team to ensure you receive appropriate and timely care—whether it includes psychological support, medication, hormonal treatment, or nutritional interventions.

A Holistic Lens: Support at Eatsense in Erina

I currently see clients at Eatsense, an integrative health practice in Erina, where we treat mental health with a whole-person approach. If you’re experiencing emotional, cognitive, or relational upheaval linked to your cycle, you are not imagining it—and you’re not alone.

We also understand that PMDD doesn’t only show up in your mood. Many women experience physical symptoms—bloating, inflammation, digestive issues, and changes in appetite. The dietitians at Eatsense often work alongside us to support women with hormonal weight fluctuations, inflammation, and food sensitivities that worsen during the luteal phase.

Together, we support your mind and body through every phase of your cycle.

You Deserve to Be Taken Seriously

You are not dramatic. You are not “too much.” You are not fragile or broken.You are responding to a neurobiological condition that deserves compassionate care.

📍 I’m currently accepting new clients at Eatsense in Erina.

✨ If you’re curious whether PMDD might be part of your story—or you’re just ready to feel more steady across the month—please reach out to book a session or learn more: https://eatsense.com.au/services/psychology-services/

Let’s name it. Let’s talk about it. Let’s get you the support you deserve.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Epperson, C. N., Steiner, M., & Hartlage, S. A. (2012). Premenstrual dysphoric disorder: Evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465–475.

Green, T. L., & Griffiths, S. (2021). Neurodiversity and the menstrual cycle: The overlapping challenges of PMDD and autism/ADHD. Archives of Women's Mental Health, 24(4), 651–659.

Halbreich, U., Borenstein, J., Pearlstein, T., & Kahn, L. S. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder. Psychoneuroendocrinology, 28, 1–23.

Lustyk, M. K. B., Gerrish, W. G., Shaver, S., & Keys, S. L. (2004). Cognitive-behavioral therapy for premenstrual disorders: A review. Journal of Obstetric, Gynecologic & Neonatal Nursing, 33(6), 655–665.

Martin, V. T., Pavlovic, J. M., & Fanning, K. M. (2017). Women's hormonal health: Barriers to diagnosis, treatment, and research. Current Pain and Headache Reports, 21(7), 29.

Pearlstein, T., et al. (2005). PMDD and risk for major depressive disorder. Journal of Clinical Psychiatry, 66(2), 159–165.

Rapkin, A. J., & Winer, S. A. (2009). Premenstrual dysphoric disorder: Neuroendocrine findings and treatment. Current Psychiatry Reports, 11(6), 453–461.

Rendell, P. G., Simons, M., & Henry, J. D. (2022). Suicide and perimenopause: A public health blind spot. Journal of Women's Health, 31(3), 313–319.