Is anxiety, PMDD, or both making your menstrual cycle worse?

If you’ve never heard of premenstrual dysphoric disorder (PMDD), you’re not alone. PMDD has existed for years but was only recently recognized as a depressive disorder. In the past, many women with PMDD were misdiagnosed as having depression or PMS.  

Women with PMDD experience an intensified sensitivity to normal hormonal shifts — particularly fluctuations in estrogen and progesterone levels. Since its addition to the International Classification of Diseases in 2022, healthcare providers now recognize PMDD as a legitimate medical diagnosis, allowing them to diagnose, monitor, and manage PMDD with more precision.

Although an anxiety disorder is a separate mental health condition, it can share overlapping symptoms with PMDD. You can also be diagnosed with both. Understanding the differences between PMDD and anxiety can help you get a correct diagnosis and find the most effective treatment for your needs. 

Untangling symptoms of PMDD and anxiety

Anxiety affects over 40 million Americans. So when someone visits their doctor with symptoms like fatigue, irritability, and excessive fear and worry, a diagnosis like generalized anxiety disorder (GAD) may be the first consideration.

The primary difference between PMDD and an anxiety disorder is the timing of symptoms. With GAD, anxiety is present nearly every day, persisting for six months or more, and is unrelated to the menstrual cycle. 

PMDD, on the other hand, triggers intense anxiety and other symptoms only during the two weeks before menstruation, known as the luteal phase. These symptoms ease a few days after menstruation begins, creating a recurring pattern with each menstrual cycle.

Some of the symptoms of PMDD and anxiety overlapping include:

• Panic attacks
• Trouble sleeping
• Persistent feelings of irritability 
• Difficulty concentrating

Symptoms unique to PMDD include:

• Severe mood swings: Although mood swings can occur with anxiety, they’re less intense and resolve quickly. With PMDD, mood swings are more intense and can quickly shift from anger to sadness.
• Feelings of intense sadness or hopelessness: These feelings are common in PMDD but not typical of anxiety. 
• Severe physical symptoms: Breast tenderness, bloating, and joint pain are common with PMDD. 
• Hypersensitivity to criticism: Although anxiety can cause heightened sensitivity, women with PMDD often report extreme emotional reactions to criticism. 

Can anxiety mask what’s really PMDD?

Sometimes, anxiety can become so intense that it overshadows the mood swings of PMDD. This can make getting a correct diagnosis challenging. One study found that women with PMDD reported a higher rate of generalized anxiety disorder and those experiencing both conditions faced more severe anxiety symptoms than women without GAD.

Because many people with PMDD also experience anxiety and depression, tracking your symptoms and discussing them with your healthcare provider is essential. Remember, timing is of the essence: PMDD symptoms only appear in the two weeks leading up to your period and ease once it begins. In contrast, anxiety disorder symptoms are longer-lasting and don’t follow your menstrual cycle. 

Health effects of living with PMDD and anxiety

PMDD symptoms can be debilitating, as mood swings and physical symptoms can affect relationships, parenting, and your profession. Studies suggest that women with PMDD may face an increased risk of suicidal thoughts.*

Anxiety can impact your day-to-day life, too. It might make you feel like you can’t enjoy activities you love or develop healthy relationships with others. It has been associated with heart disease, migraines, digestive problems, and other medical conditions.

With the right treatment, many find lasting relief from PMDD and anxiety, reclaiming their joy and well-being.

*A note on safety: If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If it’s an emergency, call 911. 

Strategies for managing PMDD and anxiety together

Navigating PMDD and anxiety typically involves a combination of talk therapy, lifestyle changes, and medication. Here are some strategies that can help relieve symptoms of both PMDD and anxiety. 

• Finding a therapist: Cognitive behavioral therapy (CBT), a form of talk therapy, can help you to identify and change the patterns of thinking and behavior that contribute to anxiety. It can also help you develop skills to cope with the emotional and physical symptoms of PMDD. Dialectical behavioral therapy (DBT), another approach to talk therapy, can help you manage and regulate the intense emotions that come with your cycle. 
• Practicing relaxation techniques: Managing stress effectively can make a big difference in relieving PMDD symptoms like anxiety and irritability. By practicing mindfulness through deep breathing, guided imagery, and meditation, you can support your emotional health and ease PMDD symptoms.
• Tracking your symptoms: Identifying when your PMDD symptoms begin empowers you to reschedule stressful tasks and prioritize relaxing activities that lift your mood.
• Exercising regularly: Exercise boosts serotonin in your brain, your body’s natural mood-lifter, helping to combat anxiety and depression. Whenever you can, take a walk or hike in nature, which research shows can lower stress and anxiety.
• Prioritizing sleep: Consistently getting a good night’s sleep is vital for overall health, as sleep issues can intensify anxiety. Bright-light therapy used during the luteal phase — the two weeks prior to menstruation — has been shown to reduce depression, tension, and stress for people with PMDD and encourages a healthy sleep cycle.
• Finding a support network: Connecting with others who understand PMDD and sharing effective symptom-relief tips can make a real difference. The International Association for Premenstrual Disorders (IAPMD) offers online peer support and links to online support groups, making it easy to find community online.
• Adjusting your diet: Boosting your intake of complex carbohydrates (beans, whole grains, and vegetables) and eating frequent snacks or meals, while cutting back on refined sugars, artificial sweeteners, and caffeine, has been shown to help relieve PMDD symptoms. 

Find care with Rula

If you’re noticing intense emotional and physical symptoms that align with your menstrual cycle, talk to your doctor about a PMDD assessment. Both PMDD and anxiety are highly treatable, and, with the support of a mental health professional, you can reduce symptoms through a personalized plan often including talk therapy and lifestyle changes. 

At Rula, we can connect you with a mental health professional trained in treating both PMDD and anxiety. With our extensive network of over 10,000 therapists, you can find the right provider in less than a minute and meet with them via live video as soon as tomorrow. 

Find a therapist with Rula