Surviving and thriving with premenstrual disorders

How I'm learning to live more aligned in my cycle

While PMDD (Premenstrual Dysphoric Disorder) is now recognized by the DSM and ICD, the diagnosis is considered controversial. Certainly, it’s not always easy to distinguish between PMDD and PME (premenstrual exacerbation or a worsening of symptoms of a different disorder). Furthermore, 80% of women experience premenstrual symptoms, and 50% of women seek medical care for these symptoms.

While PMDD is an important diagnosis, this article is intended for anyone who struggles with symptoms pertaining to hormonal fluctuations. I’ll link to sources, share my experience, and put the most important bits in bold in case you can’t read it all but still need the takeaways.

Foundations to dealing with premenstrual symptoms

Track your cycle!

If you have or suspect you have any premenstrual disorder or symptoms, the first thing you should do is track your cycle. You can do this by hand or using an app.

Tracking your cycle gives you valuable information and empowers you to set up your life in a way that supports your hormonal cycle. It’s the foundation on which everything else rests.

Some women practice what is known as the “fertility awareness method,” tracking basal body temperature and discharge to get a complete picture of their hormonal cycle, but this isn’t necessary. However, some people who track their cycles and don’t do well on birth control also use this as a way of preventing pregnancy (or trying to get pregnant).

If you’re using an app, all you need to do is enter the first day you start bleeding.

Education!

Once you start tracking your cycle, you can read more about the hormonal cycle to make sense of your body. You don’t have to dive in at once (and it’s impossible to do so), but “knowledge is power” is a cliche for a reason.

Historically, as someone who has struggled with ADHD and mental health, I haven't been a fan of the "it's a superpower" approach. However, reading about and understanding my hormones has been empowering.

During our luteal period, we're more introspective and notice more things. That isn't automatically negative and, in fact, can be powerful. The harmful pattern is when we bottle up our negative feelings during our more positive, optimistic follicular phase. We wear our rose-colored glasses and don't want conflict, particularly after brutal PMS. Then, luteal hits, and we don't have the patience. We're dysregulated and find ourselves focused on the negative. Suddenly, we may find ourselves blowing up at a partner based on an unsupportive comment or even an issue from the past.

By learning why certain feelings and patterns are coming up, you can work with them instead of against them.

Mental health support!

“Go to therapy” has become another cliche. Good therapy can be hard to find and expensive. However, once you find someone, it can be worth the money.

It took me a long time to find a therapist that was a good fit for me. I tried many therapists, and there was often a feeling of something not being quite right. I then went back and forth about whether I should look for someone else or if the problem was me not giving them enough of a chance.

My current therapist is a man who was sadly unaware of PMS/PMDD, but I've started speaking to him about it in sessions, and he's been understanding. He was also aware of CPTSD, ADHD, and ROCD, which are highly comorbid with premenstrual disorders.

There are many guides to finding a good therapist or preparing for therapy. I recommend finding someone who is trained in modalities that are considered beneficial for treating trauma, such as Somatic Experiencing or Internal Family Systems. Expressive or creative arts therapy, such as Dance and Movement Therapy, can also be beneficial. There have also been studies on CBT¹ and emotional-focused therapy for PMDD, showing that they may be beneficial.

Most important, however, is finding a therapist you get on with. You should feel that you have a rapport with your therapist: they get what you say and offer positive regard. What’s important to you in a therapist? Consider things like sense of humor and how much you’d like your therapist to disclose about themselves (some clients prefer their therapist to be more of a blank state, while others feel more comfortable sharing with someone they know experienced similar things).

I recommend doing some research and searching for therapists who offer the approaches you feel drawn to. Pick two or three and talk to them on the phone to see if you have an initial connection.

Peer-led support groups can be a low-cost supplement to individual therapy or a great source of support if you can’t access therapy. Journaling and building a real-life support network are also important. 

Build your systems!

Once you’re more aware of your cycle and patterns, have increased your vocabulary and toolkit, and have started building a support system, building systems to support your hormonal cycle will begin to feel natural.

Ask yourself what your main challenges and barriers are. For example, I would get overwhelmed during my luteal period and irritated with people. I started venting to others before I spoke to the person I was angry about. This was tricky because I needed to learn who to talk to first. I have made the error of venting about my (now ex) boyfriend to people who would reply that I needed to break up with him. They missed the broader context of my issues.

I now try to vent to people with the right context who will listen and validate without offering advice. It's also important to share with people who know how to set boundaries if they're not in a place to listen.

If you have kids, you may work with your support system to find ways of managing that work for you. Maybe you take the kids to a fun activity while in follicular and plan movies for your low-energy luteal days. You may do more cooking and cleaning during follicular while your partner takes over when you’re in luteal.

Living according to your cycle

After reading about how the world is structured according to a 24-hour clock while women operate on a 28-day clock, I started changing how I approach my time.

I use a cycle tracking app and spend much more alone time in luteal. During my luteal, I practice listening to my needs. I watch stand-up comedy, rest, and sweat by going to a sauna or hot bath instead of strenuous exercise. I make sure to have healthy and unhealthy snacks in the house. I write down my feelings. I remember that whatever comes up is valid. I listen to myself. I get more hours of sleep. I lie on my couch (or floor) for hours, just thinking, ideally with music.

This started by necessity—I would crash during my luteal period, so I had to prepare in advance. However, in my last few cycles, I began considering what working in a 28-day vs. 24-hour clock means.

Many of my symptoms were, I believe, precisely because I tried to force myself to operate on a 24-hour timeline: get a lot of stuff done during the day, rest in the evening, and be consistent week by week.

Once I started giving myself time off during my luteal period, I found myself creative. I had many ideas and goals, which I fleshed out during this period and implemented during the follicular period.

Now, I see my follicular phase as my “getting stuff done” time: I research, exercise, and socialize. I also make sure to set myself up for luteal by buying healthier snacks in advance (I know I’m going to snack, so it’s better for me to have dark chocolate or chocolate-covered banana chips rather than buy a ton of ultra-processed chocolate and cookies in a major craving mode).

I now see that the tough stuff that comes up during luteal is also important. Having the urge to leave my life behind doesn’t mean I should do that, but it’s information that maybe something in my life needs adjusting.

Instead of viewing your luteal and follicular selves as separate entities at war, try seeing them as partners who want the best for you but have different skills and needs.

Exercise according to your cycle!

While this is part of living according to your cycle, it’s a big enough topic to require a separate section.

Studies show that we’re better at building muscle in our follicular phase. Progesterone also has a negative impact on muscle repair. Also, progesterone affects our heart rate, body temperature, and breathing rate. That means a workout that felt OK when you were ovulating can feel like a more significant strain on the body just a few days later. Some women experience tender breasts or bloating during the luteal period, meaning that workouts that call for a lot of running or jumping may be more unpleasant.

Considering all this, many recommend practicing yoga, walking, and dancing during the luteal and early menstrual phases. Most importantly, listen to your body.

During luteal, not only do I have less energy, but I’m also less motivated. Knowing this about myself (by tracking my cycle and symptoms, of course), one small system I built is a workout video playlist on YouTube. When I’m in my follicular phase, I’m more likely to get myself to run on a treadmill or go to an intense workout class (Muay Thai is my favorite).

I curated a list of exercise videos on YouTube that I can use in my luteal period. I added several kinds of videos, focusing on the things I know work best for me:

• An angry dance workout or low-energy dance workout for when I have specific emotions to work through

• Stretching videos

• I search for things like “yoga for PMS” and add those

• Dance workouts from different genres to keep things interesting or short, one-song workouts.

• Or just putting on headphones and letting my body move however it wants.

I make sure the playlist has videos of different styles and lengths to always have something that matches my mood and energy levels.

Diet and supplements!

While some women swear by seed cycling or eating according to their cycle, I don’t yet have this part figured out. However, studies show that our nutritional needs differ as our hormones fluctuate, and several herbs and supplements can help with symptoms.

I found success in using Vitex/Chasteberry² for mood swings³ and Vitamin E and B6 for tender breasts⁴. I bought a bunch of teas alleged to be beneficial for hormonal regulation, such as red raspberry leaf and hibiscus, and I try to remember to drink them during luteal when I’m having a cozy night.

Other supplements that may help are magnesium, B6⁵ or a multi-B vitamin, calcium, and Vitamin D. Please research before trying any supplements, as they may interact with others, cause adverse effects, or have specific instructions.

Diet-wise, cutting out alcohol and ultra-processed foods is always a good idea (alcohol and particularly heavy drinking is considered a risk factor for PMDD)⁶. I just Googled “ultra-processed foods” to find a third example after the first two that popped into my head: donuts and hot dogs. Here we go: breakfast cereals, fruit-flavored yogurt, and mass-produced bread. Some women do well by cutting out soy and/or dairy as well, whether it’s because they’re some of the most common food intolerances/sensitivities or intolerances or due to phytoestrogens (which flax and sunflower seeds, part of the seed cycling system that some women find helpful, also have).

Others swear by more extreme diets like “carnivore,” but I would encourage you to try less extreme methods. Cutting out mass-produced bread is probably easier and healthier than cutting out all carbohydrates that could be good for you, like sweet potato, millet, and oats. In addition to complex carbohydrates, eating smaller, more frequent meals may help reduce bloating and maintain stable blood sugar levels.⁷

Further resources

Podcast/substack post

Hormone-Health Myths and Facts with Endocrinologist Gregory Dodell

Books

When The Body Says No by Gabor Mate

While this book doesn’t mention premenstrual disorders specifically, there is a lot of valuable information about the body-brain connection and how trauma and suppressed emotions correlate with physical issues.

Period Power: Harness Your Hormones Get Your Cycle Working For You by Maisie Hill

and/or

Hormonal: The Hidden Intelligence of Hormones -- How They Drive Desire, Shape Relationships, Influence Our Choices, and Make Us Wiser by Martie Haselton

Or any book about female hormones, but these are the two I read.

Period Power focuses on menstruation, while Hormonal focuses more on why and how our hormones affect things like how we feel about our partners and other preferences.

How to Keep House While Drowning by K.C Davis

The book offers short and compassionate advice about managing care tasks when things are hard.

Start Where You Are by Pema Chodron

This book helped me learn to see my struggles in life as avenues for growth and change. Pema Chodron is great at adapting Buddhist philosophy in a short, simple, and compassionate way.

Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions by Johann Hari

Focusing on depression, Johann Hari lays out how the way most of us are living these days does not support mental health and lays out the areas in life we need to stay mentally and emotionally healthy.

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For more book recommendations, check out my article on recovery books that won’t trigger you.

1. Lustyk, M. K. B., Gerrish, W. G., Shaver, S., & Keys, S. L. (2009). Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of Women’s Mental Health, 12(2), 85–96. https://doi.org/10.1007/s00737-009-0052-y

2. Rapkin AJ, Lewis EI. Treatment of Premenstrual Dysphoric Disorder. Women’s Health. 2013;9(6):537-556. doi:10.2217/WHE.13.62

3. Döll M. (2009). Das prämenstruelle Syndrom. Wirksamkeit von Vitex agnus castus [The premenstrual syndrome: effectiveness of Vitex agnus castus]. Medizinische Monatsschrift fur Pharmazeuten, 32(5), 186–191.

4. Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):723-7. doi: 10.4103/1735-9066.170003. PMID: 26793260; PMCID: PMC4700694.

5. Kashanian, M., Mazinani, R., Jalalmanesh, S., & Babayanzad Ahari, S. (2007). Pyridoxine (vitamin B6) therapy for premenstrual syndrome. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 96(1), 43–44. https://doi.org/10.1016/j.ijgo.2006.09.014

6. Naik, S. S., Yadav Nidhi, Kumar, K., & Grover, S. (2023). Diagnostic validity of premenstrual dysphoric disorder: revisited. Frontiers in Global Women’s Health, 4. https://doi.org/10.3389/fgwh.2023.1181583

7. Oboza P, Ogarek N, Wójtowicz M, Rhaiem TB, Olszanecka-Glinianowicz M, Kocełak P. Relationships between Premenstrual Syndrome (PMS) and Diet Composition, Dietary Patterns and Eating Behaviors. Nutrients. 2024 Jun 17;16(12):1911. doi: 10.3390/nu16121911. PMID: 38931266; PMCID: PMC11206370.