Why Does PMDD Make My Trauma Responses Feel Worse?

Have you ever noticed that things which feel more manageable during one part of your menstrual cycle become almost unbearable during another? Perhaps you can usually navigate a conflict in your relationships, but in the days before your period the same situation leaves you feeling rejected, frightened, or overwhelmed. You might find yourself questioning relationships that usually feel secure, or ruminating more on the past, or you might find that critical thoughts feel more convincing. For those living with Premenstrual Dysphoric Disorder (PMDD), these experiences are highly distressing. If you also have a history of trauma it can be difficult to understand what is PMDD, what is trauma, and why the two sometimes seem to intensify one another.

What Is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual Dysphoric Disorder, or PMDD, is a cyclical condition characterised by significant emotional, psychological, physical, and behavioural symptoms and changes that emerge in the luteal phase of the menstrual cycle (starting around 14 days before your period). PMDD is currently understood as a sensitivity to normal hormonal fluctuations, rather than a hormonal imbalance. For some people with PMDD, symptoms include:

• significant mood changes

• irritability or anger

• anxiety or heightened emotional sensitivity

• depressed mood or feelings of hopelessness

• feeling easily overwhelmed

• difficulty concentrating

• changes in sleep and appetite

• physical symptoms such as breast tenderness, bloating, or pain

• increased interpersonal conflict

  
  

PMDD is not the same as PMS. The symptoms of PMDD cause significant distress and interference with work, relationships, everyday functioning, and quality of life. Frustratingly, knowing that this is a cyclical pattern doesn't make the symptoms any less difficult to deal with.

How Can Trauma Shape Our Responses?

When we talk about trauma, we often think about particularly frightening or distressing events. But the psychological impact of trauma is not limited to just the memories of what happened, it also shapes how we feel about ourselves, other people, and relationships. For example, someone who grew up in an unpredictable environment may become particularly sensitive to other people's mood changes, someone who experienced high levels of criticism may grow up afraid to make mistakes, and someone who experienced rejection or abandonment may become distressed when they perceive distance in a relationship. These responses make sense in the environment in which they developed, but when they continue to influence emotional responses in the present day, in the absence of threat, they can become problematic for people.

What Happens When PMDD Interacts With Trauma?

Lets imagine someone who already has heightened sensitivity to rejection due to past relationships. Outside of the luteal phase, they may be able to recognise the fear, reflect on it, and respond in a way that feels manageable.

They might think: My partner seems quiet today. They're probably tired.

But during the luteal phase, the same situation might feel very different.

They might think: They're quiet because they're upset with me. I've done something wrong. They don't love me anymore. The relationship isn't working.

The situation hasn't changed, but the person's emotional experience, interpretation, and capacity to respond has. This doesn't mean that every intense thought during the luteal phase reflects past trauma, but the cyclical changes that occur in PMDD can interact with pre-existing vulnerabilities.

It is worth bearing in mind that the research exploring PMDD and trauma is still developing, and we should be careful not to assume that everyone with trauma and PMDD will respond in the same way.

"I Know It's PMDD, But It Still Overwhelms Me"

This is one of the statements I hear from clients with PMDD all the time. You might know you're in your luteal phase and recognise your patterns, but you still struggle to detach from the impact of PMDD in each luteal phase. This can be frustrating, and can further contribute to negative thoughts and feelings that you have about yourself and your ability to cope. It's important to show yourself compassion, and to remember that whilst awareness of your cycle and patterns is helpful, it doesn't automatically make the experiences any easier to deal with.

Why Relationships Can Be Difficult With Trauma And PMDD

Relationships are often one of the most impacted areas when it comes to PMDD. For some people, the luteal phase brings irritability, sensitivity to perceived rejection, and emotional withdrawal. When someone also has a history of trauma, these experiences can be complicated further. If someone already struggles with feeling safe and secure in relationships, this can be intensified further during the luteal phase. Partners may also struggle to understand PMDD, and be unsure of how to help. This can lead to a cycle of the person with PMDD feeling unsafe or rejected, the partner feeling confused and helpless, and both feeling increasingly distressed.

Is It PMDD, Trauma, Or Both?

PMDD has a characteristic cyclical pattern, with symptoms emerging in the luteal phase and resolving during menstruation. Trauma symptoms, by contrast, are not cyclical, though their intensity may fluctuate. Some people experience trauma symptoms throughout the month that become more difficult just before menstruation. This may represent premenstrual exacerbation (PME), rather than PMDD itself (PME is where pre-existing conditions are intensified during the luteal phase).

Some people, however, may meet the criteria for both PMDD and trauma. The distinctions matter because they impact on assessment and treatment planning. Prospective daily symptom tracking across at least two menstrual cycles is recommended when assessing PMDD, alongside consideration of other mental and physical health conditions.

What Can Help When PMDD And Trauma Overlap?

It's important to remember that supporting yourself with PMDD and trauma will be an individual experience, and not every strategy will work for everyone. I recommend trying one strategy at a time: try each for a couple of days, if you find it helpful, add it to your coping toolbox. If it doesn't work for you, don't try and force it! Try the next strategy.

1) Recognise your individual patterns: Consider tracking the situations that become particularly difficult during the luteal phase. Do disagreements become more threatening? Does self-criticism become more intense? Do particular beliefs feel more convincing? Understanding patterns can help you to distinguish between recurring cyclical changes, and concerns that might need more attention regardless of the stage of menstrual cycle.

2) Create reminders when you have a clearer perspective: Some people find it helpful to set reminders for the luteal phase, that they have written during a less symptomatic part of the cycle. This might include statements such as: I can acknowledge my feelings without acting on every thought immediately; I can revisit non-urgent decisions when I have more perspective; relationships feel especially difficult for me right know, but I know that I am loved and cared for.

3) Reduce unnecessary demands: This would be my top tip for the luteal phase. Look at what can realistically be reduced to give yourself more space and time to manage the difficult days. Maybe you need fewer social events, simpler meals, or more support with practical responsibilities. Ask for help, and push non-urgent tasks and decisions to the following week.

4) Develop a plan for relationship difficulties: If certain patterns repeatedly emerge in relationships during your luteal phase, it may help to discuss them with trusted people when you're feeling more like yourself. These conversations are most helpful when they remain collaborative, rather than making either person responsible for managing all of the other's emotions. Planning for relationships challenges with PMDD should never mean tolerating unsafe or harmful relationships.

5) Safety Plan: Because the risk of self-harm and suicide ideation in PMDD is high, it is so important to have a safety plan to help yourself, and others, safely navigate this. A safety plan should include early warning signs that things are deteriorating, identify trusted people you can reach out to, document helpful coping strategies, reducing access to means of self-harm, and document professional healthcare contact details, such as your GP. If you feel at immediate risk of harming yourself or you don't think you can keep yourself safe, call 999 or attend A&E.

How Can Equilibrium Online Therapy Help Me With Trauma And PMDD?

I'm Dr Emma Rivett, Clinical Psychologist and EMDR therapist, specialising in trauma, complex trauma, and women's mental health.

My work draws on approaches including EMDR, Schema Therapy and Compassion Focused Therapy, with a emphasis on understanding people's difficulties in the context of their experiences and relationships.

I also live with PMDD myself, which makes this an area of particular personal and professional interest. I am currently completing the CYCLES Hormone Informed Practitioner Training, to support this area of my work even more. As well as individual therapy, I run PMDD Support workshops, which can be found here.