If you have PMDD (Premenstrual Dysphoric Disorder), perimenopause may be a particularly challenging time.

The link: PMDD reflects an abnormal sensitivity to normal hormonal fluctuations. Perimenopause brings amplified fluctuations — making women with PMDD history more vulnerable.

Freeman et al. (2006) found that women with prior PMDD had a significantly higher risk of perimenopausal depression. SWAN data confirms that a history of premenstrual symptoms predicts worse mood outcomes during the transition.

Treatment:

  • SSRIs — first-line for PMDD. Can be taken continuously or only during the luteal phase. They may prevent mood worsening in perimenopause
  • Hormonal stabilization — combined hormonal contraception or HRT can smooth out the hormonal fluctuations that trigger mood symptoms
  • CBT — helps develop coping strategies for the transition
  • Tracking — use this app to track mood across your cycle. PMDD symptoms are cyclical; perimenopause depression may not be

Key point: PMDD is NOT "bad PMS." It is a distinct neurobiological condition. Women with PMDD need a different approach to perimenopause care than women without it.