I went to cognitive behavioural therapy (CBT) for about 5 months and learned so much about PMS and PMDD, I wrote a bunch of it down so I thought I would share what I learned here.

It was a game changer for me to learn about what goes on in my body. Now, when I have a PMDD episode, instead of saying "I feel f-ing crazy", I can say "The breakdown of progesterone in my body affects my calming system, making me more sensitive and emotional."

What is PMS/PMDD?

Researchers believe PMS might be related to how the hormone progesterone is broken down. Progesterone increases during ovulation, preparing the body for pregnancy and breaks down before menstruation if there is no fertilisation (amazing how the female body works). When progesterone breaks down, byproducts are formed. One of these byproducts is called allopregnanolone.

Allopregnanolone affects the intensity of emotions and our ability to manage them by disrupting the central nervous system, in particular the Gamma-aminobutyric acid (GABA) area. GABA is known for producing a calming effect. It’s thought to play a major role in controlling anxiety, stress and fear. 

This disruption of the calming system, impares the ability to regulate emotions and remain composed in emotionally charged situations. So during PMS, GABA, the calming and regulating system doesn’t function as effectively as it usually does, leading to emotions being “misaligned” or simply stronger than usual. The person experiencing PMS or PMDD thus has a heightened sensitivity to emotions because of the calming aspect of the nervous system being disrupted by the progesterone breaking down.

PMDD is not about having more progesterone than anyone else, rather it is a hyper sensitivity to this process. Two individuals with the same levels of progesterone might experience different symptoms depending on how sensitive they are to the hormone and its breakdown product allopregnanolone.

Understanding emotions

Emotions have three primary functions:

1. They provide information about our needs. For example, if you feel fear walking in a dark alley, it signals you should leave. If you feel joy when socializing, it indicates a need for connection.
2. They prepare us to act. Emotions carry impulses, like preparing for fight or flight in threatening situations.
3. They communicate our needs to others. Emotions influence body language and facial expressions, enabling us to signal our feelings and read others’ emotions.

Emotions can also be divided into primary and secondary emotions:

• Primary emotions arise first and are directly linked to an immediate event. They provide information about your needs, necessary actions, and how to communicate with others. A primary emotion is inherently short-lived, lasting seconds to a few minutes, and constantly changing.
• Secondary emotions stem from interpretations of primary emotions based on thoughts about yourself or the emotions. For example, the primary emotion might be fear, but the secondary emotion could be shame about feeling the fear.

Emotions are natural, and no emotion is inherently “good” or “bad.” Social norms might teach us to label certain emotions as good or bad, but all emotions must be felt for you to thrive.

An analogy for emotions is a beach ball. Imagine you’re in the water with a beach ball representing all the emotions you don’t want to feel. You push the ball under the surface to get rid of them, but it takes effort and focus to keep it submerged. Instead, if you let the ball float and observe it as it moves on the water’s surface, it requires less effort. This is called emotional acceptance. With this approach, it becomes easier to choose helpful ways to manage your emotions.

“Emotions are visitors; let them come and go.”

Negative thoughts and thinking traps

A thinking trap is a skewed perception of reality in your mind - exaggerated or irrational negative thought patterns that can lead us to believe things that aren’t necessarily true, which can lead to a spiral of negative thinking patterns. Examples include:

• Drawing conclusions without evidence (e.g., assuming your feelings are facts).
• Expecting the worst.
• Black-and-white thinking.
• Emotional reasoning (e.g., “If I feel this way, it must be true.”).

Remember, perspective is everything, and negative thoughts are just one possible interpretation. A flexible mindset allows for more perspectives.

PMS/PMDD can exacerbate thinking traps, When this happens:

• Acknowledge that you have PMDD which causes above.
• Question your thoughts.
• Give yourself extra love and say kind words aloud to remind yourself that what you feel and think is a thinking trap and not neccesarily true.

If this doesn’t work, acceptance is key. Acknowledge your thoughts and allow them to exist without dwelling on them, believing them, or liking them. Simply recognize their presence. Then ask yourself: “How can I best support myself?” Maybe eat some ice cream, take a nap, meditate for five minutes, or refer to your PMS relief list.

Alternative behaviors

While you can’t choose your emotions, you can choose your behaviors. Be mindful of your choices and focus on what makes you feel good. Spend time with friends instead of isolating yourself, treat yourself kindly, and talk to yourself as you would talk to a friend. Don’t act impulsively on strong emotions; instead, choose alternative behaviors.

Be in the moment:

• Observe: Pay attention to what your senses are telling you here and now. What do you see, hear, feel, smell, and taste? Experience it without labeling or judging.
• Describe: If you feel tightness in your chest and tension in your shoulders, describe it precisely instead of labeling it as stress. For example, “I feel tightness in my chest and tension in my shoulders.”
• Participate: Allow yourself to be here and now, immerse yourself in the experience of right now.

Pause and ask yourself: How do I feel right now?

Tune in. If you feel discomfort, pause and breathe into the area that feels most uncomfortable. Follow the feeling for a moment—this is called “emotion surfing.”

Breathing
Breathe in through your nose for three seconds and out through your nose for five seconds. Repeat this several times. Then try breathing in for four seconds and out for six. Continue until you find a comfortable rhythm. Notice the small pause between inhalation and exhalation.

Factors influencing PMDD and how to cope
Stress, low self-acceptance, caffeine, nicotine, alcohol, lack of support from others or from within oneself, lack of exercise, and inadequate sleep can all contribute to the severity of PMS symptoms. Identifying and addressing these factors can help you better manage your symptoms. For example, incorporating regular physical activity, practicing relaxation techniques, maintaining a balanced diet, and seeking emotional support can make a significant difference.