PMS and PMDD: Why You Feel So Bad Before Your Period

The week before your period arrives and you become someone you barely recognize.

Maybe it's the irritability that makes you snap at everyone you love. Maybe it's the anxiety that descends like a dark cloud. Maybe it's the depression that makes everything feel hopeless. Maybe it's the bloating, the breast tenderness, the headaches, the fatigue, the cravings that feel impossible to control.

You've been told this is normal. You've been told to take Midol and push through. But when PMS significantly disrupts your life, your relationships, or your ability to function, it's not something to just accept. It's a signal that something is out of balance.

What Is the Difference Between PMS and PMDD?

PMS (premenstrual syndrome) refers to a collection of physical and emotional symptoms that occur in the one to two weeks before menstruation. Most women experience some PMS symptoms at some point in their lives. Mild PMS is common and usually manageable.

PMDD (premenstrual dysphoric disorder) is a severe form of PMS that significantly impairs daily functioning. The emotional symptoms are more intense: severe depression, anxiety, mood swings, anger, and irritability that feel out of proportion and out of control. Research in the Archives of Women's Mental Health estimates that PMDD affects about 3-8% of menstruating women.

The key difference is severity and impact. If your premenstrual symptoms are annoying but manageable, that's likely PMS. If they're disrupting your work, damaging your relationships, making you feel like a different person, or causing you to dread that time of month, you may have PMDD.

Both respond to treatment. Neither is something you simply have to endure.

What Causes PMS and PMDD?

For a long time, PMS was dismissed as hormonal and therefore inevitable. But the reality is more complex.

Women with PMS and PMDD don't necessarily have different hormone levels than women without symptoms. Research in the Journal of Clinical Endocrinology and Metabolism has shown that what's different is how their brains and bodies respond to normal hormonal fluctuations.

After ovulation, progesterone rises and estrogen falls. This shift affects neurotransmitters, particularly serotonin and GABA, which regulate mood, anxiety, and sense of wellbeing. In some women, this normal hormonal shift triggers a cascade of symptoms.

Several factors influence whether you're susceptible:

Neurotransmitter sensitivity. Some women's brains are more sensitive to hormonal fluctuations. The same drop in estrogen that one woman barely notices can significantly affect serotonin function in another woman, triggering depression and anxiety. This sensitivity may be partly genetic, but it's also influenced by factors that affect neurotransmitter function: stress, inflammation, digestive health, and nutrient status.

Inflammation. Research in Brain, Behavior, and Immunity found higher inflammatory markers in women with severe PMS and PMDD. Chronic inflammation affects neurotransmitter function, making the brain more vulnerable to the effects of hormonal shifts.

Stress and nervous system dysregulation. Chronic stress depletes the resources your body needs to navigate hormonal transitions smoothly. It affects progesterone production, neurotransmitter function, and inflammation. Research in Psychoneuroendocrinology has shown that women with high perceived stress have significantly worse PMS symptoms.

Blood sugar instability. Blood sugar swings worsen PMS. When blood sugar drops, it triggers stress hormones and can intensify mood symptoms, cravings, and fatigue. The carbohydrate cravings common in PMS can create a vicious cycle of blood sugar instability.

Nutrient deficiencies. Research in the Journal of Women's Health has linked deficiencies in magnesium, B6, calcium, and vitamin D to worse PMS symptoms. These nutrients are essential for hormone metabolism, neurotransmitter production, and nervous system function.

Digestive health. Your digestive microbiome affects estrogen metabolism. Research in the Journal of Medicinal Food has shown that poor digestive health can lead to estrogen recirculating rather than being eliminated, contributing to estrogen dominance and worsening symptoms.

How Does Chinese Medicine View PMS?

In Chinese medicine, PMS indicates an imbalance, most commonly what we call liver qi stagnation.

The liver in Chinese medicine is responsible for the smooth flow of qi (energy) and emotions. When liver qi stagnates, it creates irritability, frustration, anger, depression, breast tenderness, and headaches, all classic PMS symptoms. The liver also governs the menstrual cycle, so any constraint in liver function shows up most dramatically in the premenstrual phase.

Liver qi stagnation is often caused by stress and emotional suppression, exactly what many modern women experience. When you spend your life managing, performing, and pushing through without space to process emotions, the liver becomes constrained. This pattern is so common in women with demanding lives that we see it in the majority of our PMS patients.

Other patterns can contribute: blood deficiency (causing fatigue, anxiety, and insomnia), spleen qi deficiency (causing bloating, fatigue, and loose stools), and kidney deficiency (causing low back pain and fatigue). Many women have a combination of patterns.

Treatment is individualized based on your specific pattern. This is why two women with PMS might receive different treatments, because what's driving their symptoms is different. We assess your symptoms, your pulse, your tongue, and your overall health picture to determine which patterns are present and which need the most attention.

How Does Acupuncture Help PMS and PMDD?

Acupuncture is remarkably effective for PMS and PMDD. Research published in the Journal of Alternative and Complementary Medicine found that acupuncture reduced both physical and emotional PMS symptoms by approximately 50%, often more effectively than conventional treatments.

Acupuncture works by regulating the nervous system, which affects everything downstream. It reduces stress response, supports neurotransmitter balance, decreases inflammation, and promotes smooth flow of qi. Many women notice improvement within one to two cycles.

We typically recommend weekly acupuncture, with treatment timed to your cycle. The week before your period, when symptoms are building, is a particularly important time to receive treatment.

Chinese herbs can also be powerful for PMS. Formulas are customized to your specific pattern. Some women take herbs throughout their cycle; others use them only in the luteal phase. Classic formulas for liver qi stagnation have been used for centuries to address exactly these symptoms.

What Lifestyle Changes Help PMS?

Beyond acupuncture and herbs, we address the underlying factors that make you susceptible to PMS.

Reducing inflammation. Anti-inflammatory diet changes often produce significant improvement. This means reducing sugar, processed foods, alcohol, and inflammatory oils while increasing vegetables, omega-3 fats, and anti-inflammatory foods. Some women notice dramatic changes just from dietary shifts.

Stabilizing blood sugar. Eating regular meals with protein and healthy fat prevents the blood sugar swings that worsen PMS. Reducing refined carbohydrates and sugar is particularly important in the luteal phase.

Supporting nutrient status. Research in Obstetrics and Gynecology found that magnesium supplementation reduced PMS symptoms significantly. B6 supports progesterone production and neurotransmitter function. Calcium and vitamin D also show benefit in studies. We assess what you might be deficient in and address gaps.

Managing stress. This is often the hardest but most important factor. If you're running on stress constantly, your body doesn't have the resources to navigate hormonal shifts smoothly. Whatever helps you regulate, whether that's acupuncture, movement, breathing practices, or making changes in your life, matters for PMS.

Supporting digestive health. If you have digestive symptoms, addressing digestive health often improves PMS. Better estrogen metabolism, reduced inflammation, and improved nutrient absorption all contribute.

What Should I Expect from Treatment?

Improvement is usually gradual. You may notice some changes in your first cycle, but significant and lasting improvement typically takes two to three cycles of consistent treatment.

The goal isn't perfection. Most women still notice their cycles, still have some awareness of the premenstrual phase. But the symptoms become manageable. You stop dreading that time of month. You stop feeling like a different person. You stop damaging relationships with words spoken from hormonal reactivity.

Some women find that as their PMS improves, other aspects of their health improve too. Sleep gets better. Anxiety outside the premenstrual phase decreases. They feel more even overall. This makes sense, because the factors that cause PMS affect health more broadly.

What Does Treatment Look Like?

A 34-year-old patient came to us with severe PMDD. For ten days before her period, she experienced crushing depression, explosive anger, and anxiety so intense she sometimes couldn't leave the house. She'd damaged friendships. Her relationship was strained. She'd tried antidepressants, which helped somewhat but caused side effects she couldn't tolerate.

When we assessed her, several things were clear. She was running on stress, sleeping poorly, eating irregularly. Her digestion was off, with bloating and constipation. She drank wine most nights to take the edge off. In Chinese medicine terms, she had severe liver qi stagnation with underlying blood deficiency.

We started with weekly acupuncture, timed so she always had a session in the week before her period. We prescribed Chinese herbs tailored to her pattern. We addressed her blood sugar with regular meals and protein. We reduced inflammation by cutting alcohol, which was also disrupting her sleep and worsening anxiety. We worked on her sleep.

Her first cycle was only slightly better. Her second cycle, she noticed a real difference. The depression was less crushing. She had more capacity to notice her irritability before acting on it. By her fourth cycle, she said she felt like herself again during that time of month. Not perfect, not symptom-free, but like a normal person having a harder week rather than someone completely overtaken by her hormones.

She continued monthly maintenance acupuncture and stayed on the herbs during her luteal phase. A year later, she still has some PMS, but it's manageable. She no longer dreads that time of month.

Your Next Step

If PMS or PMDD is significantly affecting your quality of life, you don't have to accept it. This is treatable. The symptoms you're experiencing have causes, and those causes can be addressed.

You're not crazy. You're not weak. You're not just "hormonal" in a way that nothing can help. Your body is telling you something is out of balance, and balance can be restored.

If you're suffering from PMS or PMDD and want real relief, we can help. We'll assess your specific pattern and create a treatment plan that addresses the root cause of your symptoms.

Learn more about our Fertility & Health path or contact us at 212.432.1110 or info@fafwellness.com.