How Therapy Can Support You Through PMDD: A Somatic, Relational, and Nervous System-Based Approach
It was a random weeknight. And I was wandering around my living room in a frenzy. “Where the f&%k is my phone?!” I kept repeating out loud, looping in and out of rooms feeling out of my body.
Losing my phone in the house is a daily occurrence. I really should put a tracker on it. But losing my phone and then collapsing to the floor in heavy, loud sobs? That… does not usually happen. I was deep in my luteal phase, and in that moment, not being able to find my phone felt like proof that I was failing and that something was wrong with me.
My partner walked in and found me splattered across the carpet, crying hard. I was embarrassed. But I also couldn’t stop.
If you’ve experienced intense mood shifts, irritability, shame, or emotional dysregulation in the days leading up to your period, you might be facing more than PMS.
Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-related mood disorder that can deeply impact your sense of identity, relationships, and quality of life. And while many women are told to “just track your cycle” or are handed SSRIs or birth control as a one-size-fits-all fix, those suggestions often bypass the lived experience of PMDD — which is actually deeply somatic, relational, and often layered with nervous system dysregulation and unprocessed trauma.
In my therapy practice, I work with high-achieving, self-aware women who are exhausted by this monthly emotional rollercoaster. They’ve read the books and tried the meds. They can articulate exactly what’s happening… and still feel hijacked by a version of themselves they barely recognize for half the month.
This post is for them! And for you, if you relate.
I want to walk you through three therapeutic modalities I use to help clients manage PMDD, reconnect with their sense of self, and approach their cycles with more compassion, not more shame.
A Brief Note on Diagnosis and Support
Before diving in: PMDD is a clinical diagnosis, and if you haven’t already, it’s helpful to track your symptoms daily for at least two full menstrual cycles. Tools like the Daily Record of Severity of Problems (DRSP) or apps like Me v PMDD and Clue can support this process. I also offer a symptom tracker that can be integrated into our therapy work together.
You don’t need a formal diagnosis to benefit from therapy though. If your cycle leaves you feeling unrecognizable every month — like your emotions hijack your nervous system — therapy can help you feel more regulated, understood, and in control.
Modality 1: Internal Family Systems (IFS) – Mapping the Parts Affected by PMDD
PMDD often triggers intense inner conflict. There may be a highly self-critical part that takes over when you're irritable, a caretaking part that feels guilty for being less available to others, or an angry part that finally explodes after weeks of suppressing your needs.
IFS therapy helps you:
Identify and befriend the parts that show up during your luteal phase (e.g., rage, despair, anxiety)
Reduce internal shame by understanding these parts are trying to protect you, even when their methods feel destructive
Access more Self-energy (calm, curious, compassionate) so you're not flooded by emotional intensity
In PMDD, emotional responses are amplified by hormonal shifts, but they’re often shaped by older wounds. A part that panics about being alone might have roots in childhood neglect. A part that spirals into self-loathing might be trying to motivate you the only way it knows how. When we understand these parts, we can meet them with compassion rather than resistance.
IFS mantra for PMDD: “All parts are welcome. Especially the messy ones.”
Modality 2: Polyvagal Theory + Somatic Work – Nervous System Regulation for the Luteal Storm
The luteal phase (roughly 7–10 days before your period) is when PMDD symptoms typically peak. From a nervous system perspective, you might flip-flop between:
Sympathetic activation: racing thoughts, rage, anxiety, over-functioning
Dorsal vagal shutdown: numbness, hopelessness, fatigue, disconnection
Ventral vagal calm: harder to access, but therapy helps you build this as a homebase
Using the Polyvagal Theory lens, we normalize these shifts and work on increasing your window of tolerance, the zone in which you can feel big emotions without becoming overwhelmed. Somatic therapy tools like grounding, orienting, and body scanning help you track your internal state and offer your body cues of safety when you’re dysregulated.
You’ll also learn how to:
Recognize early signs of dysregulation in your body (tight jaw, buzzing chest, collapsed posture)
Use micro-regulation tools like breathwork, vagal toning, or movement breaks
Create rituals of co-regulation with loved ones (or pets!) that nourish your nervous system
In short, we teach your body how to ride the wave without crashing.
Favorite grounding tool for PMDD clients: Slow, deep breaths while repeating a self-soothing phrase: “I’m here. I’m safe. This will pass.”
Modality 3: EMDR Therapy – Processing the Roots of Cycle-Activated Triggers
PMDD doesn’t just cause emotional reactivity, it often activates unprocessed pain. Many of my clients tell me:
“It’s like I have access to a whole other emotional realm the week before my period. I cry about things I didn’t even know were bothering me.”
This isn’t irrational. It’s biology meeting your body’s long-held story.
EMDR (Eye Movement Desensitization and Reprocessing) helps clients process the unhealed experiences that resurface in their luteal phase. With gentle bilateral stimulation (like eye movements or buzzers), we target memories and beliefs such as:
“I’m too much.”
“I’m not allowed to have needs.”
“I’m unlovable when I’m emotional.”
EMDR allows the nervous system to reprocess these memories so they no longer hijack your body during hormonal shifts. Over time, clients find that their emotional reactions lessen in intensity — not because the hormones change, but because the old wounds no longer light up.
Positive cognition we might land on (there are several different cognitions that could emerge here!): “I am safe to feel my emotions.”
A Note on Internalized Capitalism and PMDD
A deeper layer I often work with in therapy is how internalized capitalism intersects with PMDD. So many clients judge themselves for being "lazy" or “irrational” during their luteal phase, especially if they can’t perform at their usual high-achieving level. But what if your worth wasn’t based on how productive, happy, or easy-to-be-around you are?
Therapy invites you to challenge the belief that your emotional or physical needs are a problem to be fixed. It creates space for a more cyclical, humane way of living — one where your rest, irritability, or sensitivity isn’t a moral failure. It’s just information.
What This Might Look Like in a Real Session
Every session is tailored to what your system needs most that day, but some things we might explore include:
Gently mapping the parts of you that show up during different phases of your cycle (IFS)
Using body-based awareness to track your nervous system state (Polyvagal/Somatic)
Reprocessing a moment of cycle-triggered shame or overwhelm (EMDR)
Practicing language for asking for what you need, especially during your luteal phase
Creating a self-compassion ritual for tough days (like journaling, using a warm compress, or soothing your inner dialogue)
No two sessions are exactly alike, but all of them center your autonomy, your pacing, and the wisdom your body already holds.
Journal Reflection for You
If you’re reading this and wondering if therapy might help your PMDD, try reflecting on the following prompts:
What parts of myself do I feel ashamed of during my cycle?
How do I talk to myself when I’m struggling in my luteal phase?
What’s one compassionate ritual I could try to support myself next month?
You don’t have to wait until things feel unbearable again. There’s support available for the whole you, not just the “stable” version.
Final Words
PMDD is real. It’s not a character flaw or a personal failure. It’s a cyclical neurobiological condition, one that often intersects with unhealed trauma, nervous system sensitivity, and the unrealistic expectations placed on women to be stable and selfless at all times (ugh).
Therapy won’t “cure” your PMDD, but it can give you tools, language, and support to meet your cycle with more self-compassion and less chaos.
If you’re curious about what this kind of support might look like, I offer 15-minute intro calls. Whether or not we work together, I hope you leave this post knowing: You are not alone. And you are not too much.
