As women enter their 40s, they often struggle to distinguish between Premenstrual Dysphoric Disorder (PMDD) and perimenopause symptoms. Both conditions affect mood and well-being, but understanding their distinct characteristics will help tell the difference between PMDD and perimenopause.

Dr Lisa Cochrane is a Sunshine Coast GP who’s passionate about helping busy people prevent and manage chronic health conditions through practical lifestyle changes. Combining her medical expertise with real-world solutions, she specialises in supporting those who want to optimise their health naturally, but need guidance that fits into their demanding lives. Currently completing her Fellowship in Lifestyle Medicine, Dr Lisa takes a holistic approach to health and wellbeing. With additional qualifications in medical hypnotherapy and focused psychological strategies, she helps address the lifestyle factors that impact chronic disease – from stress management and sleep to nutrition and movement patterns.

What Is PMDD (Premenstrual Dysphoric Disorder)?

While women are now relatively educated on PMS (premenstrual syndrome), there’s another condition that has similar symptoms but is far more severe.

PMDD isn’t just bad PMS. While it does include some of the same symptoms like bloating and mood swings, the impact it has on a woman’s life, both physically and mentally, is often debilitating.

While PMDD is connected to the menstrual cycle, researchers don’t think it’s caused by a hormone imbalance, but rather triggered by the hormone changes that come between ovulation and menstruation. It can cause extreme mood swings, anger, anxiety, depressed moods, changes in appetite, breast tenderness, joint pain and bloating.

What is perimenopause?

Perimenopause is the period of time leading up to your last period and ends one year after your last period – which is then menopause. It can last up to 10 years, and usually starts in your 40s. The symptoms includes changes in periods (more or less frequent, heavier or lighter, longer or shorter) as well as hot flushes, night sweats, difficulty sleeping, sore joints and breasts.

It’s easy to see why PMDD and perimenopause can get confused, with so many overlapping symptoms!

Breaking the ‘hot flush’ myth

Many women are surprised to discover that perimenopause (which I affectionately call The Peri) often begins in the brain, not with hot flushes. Brain fog and mood changes can appear years before the more commonly known symptoms, catching many women off guard. I’ve had patients tell me they felt like they were losing their minds! You might find yourself misplacing keys more often or feeling unusually anxious before realising these could be your first signs of The Peri.

Understanding the patterns

While PMDD and The Peri share symptoms, they usually differ in their timing. PMDD follows a monthly cycle, with at least five specific symptoms appearing in the final week before your period and disappearing within a few days after your period starts. These symptoms must include one or more mood-related changes like marked irritability, anxiety, depression, or mood swings. Other symptoms might include difficulty concentrating, fatigue, changes in appetite, sleep issues, or physical symptoms like bloating and joint pain.

The Peri doesn’t follow this cyclical pattern. Its symptoms can occur at any time and often persist, though they might vary in intensity. You may notice continuous mood changes, anxiety, or depression rather than the predictable premenstrual pattern of PMDD.

“Living with PMDD as a working mum has been one of the toughest challenges I’ve faced. Some days, the mood swings, sadness, and irritability feel overwhelming, and I struggle to hold it together for my kids and my job. It’s hard to explain the depth of the emotions—how one moment I’m fine, and the next, I’m drowning in sadness or frustration over the smallest things. I often feel guilty when my mood affects my family, but I remind myself that I’m doing the best I can. Through it all, I’ve learned the importance of asking for help, practicing self-care, and forgiving myself on the hard days. PMDD is a heavy burden, but it’s also taught me resilience, and I’m learning to take it one day at a time.”

ssohiey, Mouths of Mums member sharing her PMDD experience.

The genetic connection

Research has revealed something fascinating: women with PMDD have a genetic predisposition that makes them more sensitive to normal hormonal fluctuations. While all women experience changes in oestrogen and progesterone levels during their menstrual cycle, those with PMDD react more intensely to these natural shifts. One of the challenges in differentiating PMDD from.

The Peri is that women who experience PMDD are more likely to experience emotional changes, like depression, related to The Peri compared with women who haven’t experienced PMDD. The emotional difficulties likely stem from their natural predisposition to react more strongly to the very low oestrogen levels in The Peri.

Tracking the clues

Even during The Peri, when periods become less predictable, tracking your symptoms daily provides valuable insights. Consider using a dedicated symptom-tracking app or keeping a simple diary noting your mood, physical symptoms, and cycle dates. This information helps reveal whether you’re experiencing the defined pattern of PMDD or the more unpredictable Peri symptoms. Many of my patients find that two months of tracking is enough to help them spot a pattern in their symptoms.

“I have PMDD and I’m 38. During and after my last 2 pregnancies (5 in total) I found that my PMDD was really horrific. I was so angry postpartum. I’ve never felt so much rage towards everyone and after my outbursts the guilt and the tears would start and I’d beg for forgiveness and try to do better but would inevitably return back to a state of pure anger and irritation. Before my period I have insomnia, rage, hatred and a very short fuse, intertwined with bouts of crying. I try not to go out anywhere around this time of the month and keep to myself as much as possible just to avoid the outbursts. It’s very hard for my family and I don’t think my husband understands. I’ve tried many vitamins to help including vitamin B, DIM and 5htp supplements but nothing has really helped and I don’t want to go on birth control because it messes with my cycle so badly.” – mom497483, Mouths of Mums member sharing her PMDD experience.

Supporting partners

For partners of women experiencing either condition, listening and practical support make a significant difference. Everyone’s experience of PMDD and The Peri differs. Lifestyle changes offer fantastic ways to ease the symptoms of both conditions, but instead of thinking of lifestyle changes as something only the affected person needs to try, consider them an opportunity for shared health improvements. When both partners practice regular exercise, stress management, and healthy eating, it helps manage the symptoms and strengthens the relationship.

The path forward

The good news? PMDD disappears after menopause, and the mental challenges of The Peri tend to settle down after menopause, too. Research shows that, whether dealing with PMDD, The Peri, or both, lifestyle changes can go a long way to easing symptoms and gaining control over your well-being:

• Maintain consistent physical activity: 150 minutes per week of moderate-intensity exercise delivers ideal benefits. Think brisk walking, swimming, or cycling.
• Practice stress reduction techniques: Mindfulness, meditation, yoga, and time in nature can all help reduce symptoms. Even 10 minutes daily makes a difference.
• Focus on nutrition and sleep quality: A plant-predominant, whole-food diet helps with mood and brain fog. Reducing caffeine and alcohol supports better sleep and mood stability.

Remember that while these conditions challenge many women, they respond well to evidence-based management. Working with healthcare providers who understand the complexities of hormonal health will help you develop strategies tailored to your specific situation.

How are you managing symptoms of PMDD and/or perimenopause? Leave a comment below.