When Your Emotions Shift With Your Cycle
- Ellen Lambert
- 2 hours ago
- 5 min read
The Science and the Reality of Living With PMDD
For some people, the days before a period bring mild irritability or low mood. For others, the emotional shift is so intense it can feel like becoming a different person entirely.
Premenstrual Dysphoric Disorder (PMDD) is far more than the occasional premenstrual mood swing. It is a severe, cyclical mood disorder that can disrupt relationships, work, social life, and a person’s sense of self.
PMDD was formally recognised as a mental health diagnosis in 2013, yet it remains significantly underdiagnosed and under-recognised. An estimated 3-8% of people assigned female at birth are affected worldwide, representing millions navigating monthly cycles of instability, often without adequate support, validation, or effective treatment.
I’m Dr Ellen Lambert, a Clinical Research Fellow at King’s College London specialising in PMDD. You may have read my previous article for Inspire the Mind about my personal experience of premenstrual mood changes.
This article brings together scientific evidence with lived experience accounts from an interview with Kim Cormack, Community Outreach Manager at The PMDD Project charity.
What is PMDD?
PMDD symptoms typically emerge in the one to two weeks before menstruation (the luteal, or premenstrual, phase of the cycle), and ease shortly after bleeding begins. While many people experience some premenstrual changes, PMDD is distinguished by the severity of symptoms and the extent to which they interfere with daily life.
The core symptoms required for a diagnosis are emotional and psychological, such as intense irritability or depressed mood. For many, these are accompanied by difficulties with concentration, as well as physical symptoms like bloating or headaches.
The average person experiences around 450 menstrual cycles in their lifetime. For someone with PMDD, even a few days of severe symptoms each cycle can add up to years spent in significant psychological distress.
Kim’s experience reflects this reality. She describes suffering for “weeks out of every month…with the worst being in the luteal week”. She experiences “anger and irritability, paranoia and deep, overwhelming depression”, where suicidal thoughts became the “norm”. In the past, this led to multiple plans and attempts to end her life.
PMDD is not simply “a bad week”. It can disrupt relationships, careers, and a person’s sense of stability and self-trust. As Kim puts it, “Being afraid of your own mind and unable to trust your choices is terrifying”.
When experiences like this go unrecognised or misunderstood, it deepens distress and highlights the urgent need for research that can bridge the gap between lived experience and clinical care.
Why Understanding Emotions Matters in PMDD
One of the most misunderstood aspects of PMDD is that it is not caused by “abnormal” hormone levels. Instead, it likely reflects a heightened sensitivity to normal hormonal changes, affecting brain systems involved in emotion regulation.
In other words, the issue is not the hormones themselves, but how the brain responds to them.
Difficulties managing emotions are seen across many mental health conditions, including depression and anxiety. This led us to ask whether emotion regulation might be central to PMDD, particularly during the luteal phase.
This does not mean PMDD is “just psychological”. Rather, it reflects an interaction between biology and psychology: hormonal changes may increase emotional intensity, while regulation processes shape how those emotions are experienced and managed.
Kim’s experience brings this into sharp focus. She explains that while other factors, such as “comorbid conditions like CPTSD and ADHD”, may play a role, “the dysphoric element of PMDD is overwhelming on its own”.
At her most unwell, Kim describes feeling “hijacked… like there is an intruder in my mind that looks and sounds like me”, convincing her that she is “worthless” and that “nothing will ever change”. In these moments, she feels unable to trust her own thoughts.
Yet this state is not constant. “A few hours later, I could be ‘me’ again”, she explains, returning to a self that is “full of love and compassion and positivity”. This contrast highlights the cyclical nature of PMDD and the disruption it can cause to a person’s sense of identity and control.
Our Systematic Review: Exploring Emotion Regulation in PMDD
To better understand the emotional processes underlying PMDD, a team of researchers and I conducted a systematic review (a structured method to review literature) to look at findings from 22 studies involving over 1,500 participants.
We used a simple framework that looks at how people recognise emotions, choose how to respond, and put those responses into action.
Several clear patterns emerged. People with PMDD showed stronger emotional reactions, found it harder to understand their emotions, and had fewer effective coping strategies. Even when strategies were known, using them often felt much harder, particularly in the late-luteal phase. You can read our full published findings here.
This difficulty resonated with Kim, who explains that although she is usually reflective, “when PMDD is involved, my grasp of reality is entirely warped… my ability to reflect on my emotions and read other people’s is almost impossible”.
People with PMDD were also more likely to dwell on negative thoughts (rumination). Kim recalls feeling “convinced that I was just broken… convinced that I was cursed”, highlighting how overwhelming and confusing these experiences can be.
Even with support, applying coping strategies can remain difficult. As Kim explains, “even with the coping strategies I have learned in therapy, it is so hard to implement them in a luteal crisis,” where “the hijacker can convince you that even things that have helped before will never help again”.
At the same time, appropriate support can make a difference. With specialist therapy, Kim says she has become “more informed and less scared”, although many professionals “have rarely even heard of PMDD”, limiting access to care.
Why This Research Matters
This research has important practical implications.
First, validation: people with PMDD are not “overreacting”. Their experiences are real and grounded in biological sensitivity to hormonal change. As Kim explains, being truly heard by a specialist was “healing” after years of dismissal.
It also highlights the need for menstrual phase-sensitive care. Support should take menstrual cycle timing into account, with skills developed during lower-symptom phases and supported during more difficult periods.
Expanding coping strategies is equally important. Approaches that target emotional intensity and rumination, such as Dialectical Behaviour Therapy (DBT) and Acceptance and Commitment Therapy (ACT), may be particularly helpful.
For Kim, this offers a sense of hope. She explains that if this kind of tailored support were available, she would “do anything to have it”, describing the relief of gaining “skills that are specific to PMDD”.
Ongoing Research: Where We’re Headed
Building on this, we are launching a new study (SPARK-PMDD) examining psychological and biological changes across the menstrual cycle to better understand what drives emotional shifts and symptom severity.
Recruitment begins soon and information can be found on our website.
This research is deeply meaningful for people living with PMDD. For Kim, contributing to research is not only about her own experience, but also about future generations, including her young niece.
She emphasises that “one informed medical practitioner or therapist… can literally save a life”, and that while such support exists, it remains rare. For many, knowing that research like this is happening brings something essential. As Kim puts it, that word is “hope.”
Acknowledgements: The PMDD Project
We are deeply grateful to The PMDD Project, the UK’s first PMDD-specific charity, for funding this research to be published open access. Making the findings freely available ensures that individuals with PMDD, clinicians, and researchers can all access the evidence without barriers.
