When PMS Isn’t Mild: Living With PMDD and Not Knowing It

By Dr. Aninda Sidhana

This article is part of That Time of the Month — a four-part series by The Lipstick Politico × HealCycle, exploring the stereotypes, science, and systemic silence around menstrual health.

In this installment, Dr. Aninda Sidhana, a psychiatrist specializing in women’s mental and psychosexual health, unpacks what happens when hormonal shifts turn from manageable to unlivable, and why millions of women mistake a treatable disorder for personal failure.

Every month, without fail, Neeharika would call me in tears.  She would spiral into despair over something small;  a missed text, a forgotten errand, convinced her marriage was falling apart.  Her husband became the villain of her life story.  Two days later, he was back to being the most charming, loving, and perfect husband one could dream of. The pattern repeated itself like clockwork.

As women, we are rarely taught to map the line between hormonal and emotional pain. 

Friends called her “too emotional.” Some joked, “You must be PMSing.” But this wasn’t moodiness. It was a monthly emotional collapse that came on cue, wrecked her peace, and left her wondering who she was.

When I asked Neeharika  to track her symptoms,, the pattern was impossible to miss. It wasn’t chaos; it was PMDD. Finally  the pain of being called  "crazy"  had a name.

What’s Really Going On

Premenstrual Dysphoric Disorder (PMDD) isn’t “just PMS.” It’s a neuroendocrine disorder where  your brain and body react violently to normal hormonal shifts. It hijacks your emotional regulation system every month.

Imagine feeling suicidal, paranoid, or consumed by rage, only to wake up a few days later feeling like yourself again and wondering what just happened.

PMDD Symptoms range from panic attacks and hopelessness to crushing fatigue and physical pain. They appear during the luteal phase (the week or two before a period) and vanish once bleeding begins.

To be diagnosed, these symptoms must:

 * Occur in the luteal phase (before menstruation)

 * Disappear after bleeding begins

 * Disrupt daily life, relationships, or work

 * Be tracked over at least two cyclesPMDD affects an estimated 1 in 20 menstruating women, yet most have never heard of it.

Invisible, Misdiagnosed, and Dismissed

PMDD is often underdiagnosed because there is no blood test or CT scan that can confirm it. Symptoms often mimic other disorders like anxiety, depression, or bipolar illness, leading to years of misdiagnosis.  Even doctors are not sensitized enough to label it as PMDD, and they often minimize or dismiss it. Others simply don’t believe it’s real.

The result is medical gaslighting: the quiet, systematic invalidation of women’s pain, delivered with a smile and a prescription for yoga or antidepressants.

Sound familiar?

The Power of Cycle Tracking 

Cycle tracking isn’t just a wellness fad, it’s a tool to reclaim control over a body long policed and pathologized.

In cultures where menstruation is not talked about and is whispered about like a scandal, learning to track your cycle becomes a way to reclaim agency over one's body. 

We still buy sanitary pads secretly and hide them in black plastic bags. We still apologize for pain. And we still get told to “snap out of it.”

Cycle tracking  is not just about predicting periods. It’s about decoding mood swings, naming pain, and and identifying conditions like PMDD, PCOS, or thyroid dysfunction.

But tracking isn’t accessible to everyone. Many rely on memory alone. Most period apps don’t include robust mood-mapping. And even when women show up with data, their doctors often shrug.

The Intersectional Reality

Hormones don’t operate in a vacuum and neither does healthcare. Race, caste, neurodivergence, gender identity, and cultural norms all influence who is heard and who is dismissed.

Caste and Race:  Dalit, Adivasi, and Black women are often disbelieved when they report distress. Their pain is either exaggerated or invisible and is rarely validated.I

Neurodivergence: emotional dysregulation is dismissed as a personality trait, not a biological issue.

Gender Identity: Trans and non-binary menstruators are often erased by cisnormative systems. If you don’t fit the form, you don’t get the diagnosis. Hormonal distress in queer bodies remains unrecognized and untreated.

“Don’t wear lipstick, you’ll have an affair. Don’t wear jeans, you’ll create a scandal. Don’t breathe—your heaving chest will attract attention.”

— Rehana, from the movie Lipstick Under My Burkha

This isn’t just a dialogue, it’s a lived reality. 

In cultures where even breathing is policed, how do we expect women to name their pain? Women are always told to shrink themselves.

The Cost of Silence

PMDD is like an invisible illness that comes with mood swings, memory lapses, and a monthly identity crisis.

In South Asian contexts, this invisibility is compounded by cultural silence, caste bias, and gendered expectations of emotional control.

Many spend years misdiagnosed with depression, anxiety, or bipolar disorder. The result? Wrong medications, wrong labels, and a lingering sense of being “broken.”

Women are expected to be stable, nurturing, and resilient. When PMDD disrupts that, they’re called “too sensitive” or “too dramatic.” The pressure to perform normalcy leads many to mask their symptoms and internalize shame.

How We Fix This

To break the cycle of invisibility:

• Train clinicians to ask about menstrual mental health 

• Integrate emotional literacy in schools and homes

• Normalize discussions of hormonal mood disorders

PMDD isn’t rare. It’s just rarely recognized.

Apps like HealCycle are building that bridge and turning hormonal data into insight and care.

What Helps

Tracking: Your First Line of Defense

The first tool of awareness. Apps like HealCycle or even a basic journal can help map emotional changes against hormonal shifts.

 Look for patterns: Does the rage arrive seven  days before your period? Does the fog lift by day two of bleeding? That’s your hormonal fingerprint.

 “Tracking my cycle didn’t just help me understand my moods, it gave me back my dignity.”

 — PMDD survivor

Therapy: Rewiring the Emotional Circuit

PMDD isn’t just biochemical, it’s biopsychosocial. Therapy helps you navigate the emotional terrain like: 

•  CBT (Cognitive Behavioral Therapy): Especially effective when tailored to hormonal mood disorders.

• Trauma-informed care: Crucial for those whose PMDD is amplified by past emotional wounds.

• Online therapy platforms Healcycle   PMDD-aware support.

Therapy helps you build emotional literacy, set boundaries, and stop apologizing for your biology.

Treatment: Science Meets Self-Compassion

There’s no one-size-fits-all, but here’s what works for many:

•  SSRIs (Selective Serotonin Reuptake Inhibitors): Can be taken daily or only during the luteal phase.

• Hormonal treatments: Birth control pills, GnRH agonists, or progesterone therapy—depending on your cycle and symptoms.

•  Lifestyle support: Magnesium, B6, anti-inflammatory diets, movement, and sleep hygiene.

• Alternative care: Acupressure, yoga, and meditation.

Reframing Pain

PMDD exposes the gap between how women experience pain and how the world responds to it. It’s not a character flaw. It’s a biological condition that demands recognition, research, and respect.

You are not broken. You are not “too much.” You are hormonal and that is not a crime.

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This article is part of That Time of the Month — a TLP × HealCycle collaboration unpacking the myths, medicine, and mental load of menstrual health.