PMDD
It's not just bad PMS.
And it's not in your head.
Premenstrual dysphoric disorder is a real, recognized condition and one that is routinely minimized, misdiagnosed, or missed entirely. If your symptoms arrive like clockwork in the weeks before your period and disrupt your work, your relationships, and your sense of self, you deserve a provider who takes that seriously.
Most people with PMDD spend years being told it's normal.
The average time between symptom onset and PMDD diagnosis is over a decade. In that time, many are told they're too sensitive, offered antidepressants without explanation, or made to feel that what they're experiencing is simply part of having a cycle.
PMDD is a distinct clinical condition driven by an abnormal sensitivity to normal hormonal fluctuations, not a personality trait, not a stress response, and not something to simply push through every month.
Effective treatment exists. Getting there starts with being believed.
Not sure if what you're experiencing is PMDD?
The International Association for Premenstrual Disorders offers a free, validated self-screener that can help you identify whether your symptoms follow the pattern consistent with PMDD.
Take the IAPMD Self-ScreenerWhatever your results, a visit with us can help make sense of what you're experiencing. You don't need a diagnosis to make an appointment, just a pattern of symptoms that feels like too much.
What we address
We provide individualized, evidence-based PMDD care including:
Your providers
Sarah Stetina, MSN, CNM, APRN-FPA, MSCP
Sarah brings a whole-person, evidence-based approach to PMDD care, with the clinical depth to navigate complex hormonal presentations and the time to actually listen to what you've been experiencing.
Maria Escamilla, DNP, CNM, APRN-FPA
Maria provides compassionate, individualized PMDD care with a focus on accurate diagnosis, honest treatment conversations, and making sure clients leave with a plan that actually addresses what they're going through.
Your questions, answered
What is PMDD and how is it different from PMS?
Premenstrual syndrome (PMS) involves mild to moderate physical and emotional symptoms in the week before menstruation. PMDD is a more severe condition characterized by significant mood disturbance, including depression, anxiety, irritability, or anger, that causes significant impairment in daily functioning. The defining feature is that symptoms follow a predictable pattern: they emerge in the luteal phase (typically 1–2 weeks before your period), and resolve within a few days of menstruation beginning. PMDD is recognized as a depressive disorder.
How is PMDD diagnosed?
Diagnosis is based on symptom tracking over at least two menstrual cycles. There is no single lab test for PMDD, it is a clinical diagnosis. We'll review your symptom history, rule out other contributing conditions, and may ask you to track your cycle and symptoms before or between visits. The pattern of symptoms, specifically their timing relative to your cycle, is the most important diagnostic factor.
What causes PMDD?
PMDD isn't caused by having the wrong hormone levels. In fact, your labs may look completely normal. PMDD happens because your brain is more sensitive than average to the natural hormone shifts of your cycle. That sensitivity affects your mood chemistry, which is why certain medications and treatments can make a real difference.
What are the treatment options for PMDD?
Treatment is individualized and may include SSRIs or SNRIs taken continuously or only during the luteal phase, hormonal options to suppress ovulation, dietary and lifestyle modifications, targeted supplementation such as calcium and vitamin B6, and in some cases coordination with a mental health provider. Most women with PMDD see meaningful improvement with appropriate treatment. The goal is to find the right combination for you.
I've been told my hormone levels are normal. Does that mean I don't have PMDD?
Not at all. Normal hormone levels do not rule out PMDD. The condition is about sensitivity to hormonal changes, not the levels themselves. If your symptoms follow a cyclical pattern and resolve with menstruation, that is the most important clinical signal.
Can PMDD be confused with other conditions?
Yes, frequently. PMDD is often mistaken for generalized anxiety, depression, bipolar disorder, or ADHD because the symptoms overlap significantly. Sometimes PMDD and perimenopause symptoms overlap as well. The distinguishing factor is always timing. If your symptoms are consistently worse in the week or two before your period and improve after it starts, PMDD warrants serious consideration even if another diagnosis has already been made.