Premenstrual-Related Distress
What is premenstrual-related distress?
Premenstrual distress refers to the physical, emotional, and cognitive symptoms that occur in the luteal phase– that is, the days to weeks before a menstrual period.
While premenstrual symptoms (PMS) are common, most menstruating people report only mild symptoms. For some, though, these symptoms are intense, distressing, and disruptive, and significantly impact work, school, health, and/or daily life. When this is the case, a premenstrual disorder (PMD) may be present [1]:
Premenstrual Dysphoric Disorder (PMDD)
Chronic and cyclical symptoms occur during the luteal phase, causing significant distress and impairment, and typically resolve shortly after menses start. Symptoms often include:
Emotional changes
Frequent, intense shifts in emotions
Intense irritability or anger
Increased depression or anxiety
Cognitive & behavioral changes
Difficulty concentrating, “brain fog”
Significant drop in energy
Isolation or withdrawal from daily activities
Increased relationship conflict
Physical changes
Shifts in appetite and eating
Sleep problems
Severe cramps
Increased physical pain
This is just the tip of the iceberg! While these are common experiences, people with PMDD report a wide range of symptoms. Take a deeper dive into PMDD here.
Premenstrual Exacerbation (PME)
More recently, researchers have found some people experience cyclical worsening of pre-existing mental health symptoms in the luteal phase. This is called Premenstrual Exacerbation or PME.
For example, a client experiencing depression may notice that their symptoms are consistently much worse in the days to weeks right before their menses start.
PME has been shown to impact a wide range of mental health concerns, such as:
Anxiety & OCD
Attention-Deficit/Hyperactivity Disorder (ADHD)
Borderline Personality Disorder (BPD)
Eating disorders
Mood disorders
Trauma & Stressor Related Disorders (PTSD)
Substance use
Suicidal thoughts and behaviors
Learn more about PME here.
Evidence-Based Treatments
Evidence-based psychological treatments are interventions that are backed by science. The talk therapies with the most support for PMDD include:
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT), including DBT Skills Training
Frontline treatments for PMDD also include medication or medical interventions. Learn more about the options and the evidence base here.
Readings & Workbooks
The PMDD Phenomenon by Dr. Diana Dell, MD
The Cycle by Shalene Gupta [author with lived experience]
Mastering the Monthly Madness by Nadine Evans [author with lived experience]
Relevant Organizations
The International Association for Premenstrual Disorders (IAPMD)
Find a Provider
I know how important it is to find the right provider.
I work with individuals experiencing emotional distress in reproductive contexts, including PMDs, and offer both CBT and individual DBT skills training. If you think we might be a good fit, learn more about me and my practice, or get in touch to schedule a free, 15-minute consult call.
Looking for something else? There are many ways to find a provider. These directories can help locate providers who focus on reproductive mental health: