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PMDD and Perimenopause: When Hormones Hijack Your Mental Health

Reviewed by Dr. Kenton Bruice, MD

Reading time: four minutes

Many women entering perimenopause experience a shift in their mood, energy, and emotional resilience. For some, this shift brings back, or introduces, symptoms that mirror an extreme form of PMS. This is where PMDD, or Premenstrual Dysphoric Disorder, comes in.

PMDD is a severe hormonal mood disorder characterized by debilitating emotional and physical symptoms that occur in the luteal phase of the menstrual cycle. Unlike PMS, PMDD disrupts daily life with psychological symptoms such as severe irritability, depression, anxiety, and feeling overwhelmed. 

This blog explains the link between PMDD and perimenopause and helps you understand why emotional symptoms can intensify during this hormonal transition.

Key Takeaway

PMDD and perimenopause often collide, creating severe symptoms driven by hormone fluctuations. With proper testing and personalized care, you can reduce emotional and physical symptoms, regulate your hormone levels, and restore your quality of life.

What We Offer

Dr. Kenton Bruice helps women navigate the emotional and physical toll of PMDD and perimenopause. Our care is tailored, research-backed, and focused on restoring balance and improving your quality of life.

We offer:

Schedule a consultation with Dr. Bruice to get clear answers and expert care for your hormonal symptoms.

What Is PMDD?

PMDD stands for Premenstrual Dysphoric Disorder. It is a form of depressive disorder linked to hormonal shifts during the luteal phase. Symptoms usually start a week or two before your period and include:

  • Severe irritability and mood symptoms
  • Anxiety or panic attacks
  • Depressive symptoms, including suicidal ideation or depressed mood
  • Sleep problems and brain fog
  • Trouble concentrating on daily activities
  • Physical symptoms like bloating, breast tenderness, and joint pain

PMDD affects up to 8% of women during their reproductive years. Those with a history of depression, bipolar disorder, or other mental disorders may be more vulnerable. Some women see their symptoms worsen as they enter the perimenopausal stage.

Why PMDD Can Flare During Perimenopause

Perimenopause is a hormonal freefall. Estrogen and progesterone levels fluctuate wildly, sometimes dropping sharply, other times spiking unpredictably. These hormonal shifts disrupt your brain’s neurotransmitters like serotonin, which regulate mood.

If you have struggled with premenstrual disorders or PMDD earlier in life, you may notice more intense perimenopausal symptoms now. Even women who never had premenstrual symptoms before may develop mood symptoms during this time.

Can Perimenopause Cause Depression?

Perimenopause can cause depression, even if you have never had mental health struggles before. It is not just “feeling off.” You may experience:

  • Persistent sadness or hopelessness
  • Loss of interest in daily life and normal routines
  • Trouble sleeping or oversleeping
  • Changes in appetite or weight
  • Feelings of worthlessness or guilt

Traditional antidepressants do not always help because the root cause is hormonal, not just psychological.

Understanding the Hormone-Mood Connection

Hormones do not just affect your period, they regulate your brain chemistry, sleep cycles, and stress response. Estrogen supports serotonin levels and dopamine activity. When it plummets, your mood does too.

Common signs that hormone imbalances are behind your mood symptoms:

  • Mood crashes that sync with your menstrual cycle
  • Worsening symptoms in your 40s
  • Physical changes like hot flashes, vaginal dryness, or irregular bleeding
  • Symptoms that do not respond well to SSRIs or anxiety medications

Learn more about the connection between anxiety and perimenopause in this blog: Does Perimenopause Cause Anxiety?

Treatment Options That Actually Work

You do not have to white-knuckle your way through menopause symptoms. At the Denver Hormone Institute of Colorado, Dr. Kenton Bruice takes a root-cause approach to treatment by targeting the underlying hormone imbalance.

Here is what works:

  • Hormone testing: A full lab panel helps identify where your hormone levels are fluctuating, especially estrogen and progesterone.
  • Bioidentical hormone replacement therapy (BHRT): Restores balance with customized doses that mimic your body’s natural hormones.
  • Nutritional and lifestyle support: A well-balanced diet, regular exercise, and targeted supplements help support hormone balance and serotonin levels.
  • Sleep and stress management: Guided plans to stabilize cortisol, improve sleep, and reduce inflammation.

When to Seek Help

If you have noticed any of the following, it is time to take action:

  • Mood swings that interfere with relationships or work
  • Emotional or depressive symptoms that feel out of proportion
  • Worsening PMS or PMDD symptoms in your late 30s or 40s
  • Difficulty concentrating, brain fog, or feeling overwhelmed

Schedule Your Consultation Today

If you are struggling with mood changes, PMDD symptoms, or perimenopausal hormone shifts, schedule a consultation to explore your treatment options.

To book an appointment at the Denver Hormone Institute of Colorado, call (303) 957-6686 or complete the online inquiry form. We are located at 55 Madison Street, Suite 575 Denver, CO.

📍Other locations:

St.Louis Hormone Institute of Missouri

9909 Clayton Rd, Suite 225 , St. Louis, MO.

📞(314) 222-7567

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