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PMS, PMDD and our relationships - the effects and how to talk about it
Summary
PMS and PMDD can strain relationships through mood shifts, anxiety, irritability, low libido, and fatigue - especially in the luteal phase. This article outlines how symptoms show up between partners, friends, and family, why communication can break down, and practical ways to rebuild connection through empathy, education, and the right support.
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🌿 Key takeaways
PMS, PMDD and relationships: what to know
- Nearly half of people with PMS report an impact on socialising and family relationships
- Partners of people with PMS or PMDD also report lower relationship satisfaction - the impact extends in both directions
- Having a supportive partner who understands PMDD is linked to greater relationship satisfaction and can reduce symptom severity
- Conversations about managing symptoms are most productive when held outside the luteal phase - during the follicular phase when mood is more stable
- Dialectical Behavioural Therapy (DBT) and CBT can help build emotional regulation skills; couples therapy is also a valid option when communication feels stuck
What are PMS and PMDD?
You have probably heard of premenstrual syndrome (PMS), but what it actually means is not always clear. "PMS is a huge umbrella term," explains Dr Tory Eisenlohr-Moul, associate professor of psychiatry at the University of Illinois at Chicago and chair of the clinical advisory board for the International Association of Premenstrual Disorders. "Is it physical or emotional, severe or mild? It's not very specific."
Most people who menstruate experience some level of PMS at some point. Common symptoms include mood swings, anxiety, insomnia, breast tenderness, headaches, and changes in appetite and sex drive.
For 3 to 8% of people who menstruate, symptoms are disruptive enough to meet the criteria for premenstrual dysphoric disorder (PMDD) - a depressive disorder in the DSM-5. Both conditions occur during the luteal phase - after ovulation and before the period - and symptoms typically ease within a few days of menstruation beginning.
🧠 In simple terms: "Although PMDD can include physical symptoms, the emotional symptoms have to be there in order to diagnose the disorder, which isn't true of PMS," says Dr Eisenlohr-Moul. "PMDD is also a way to specify that the condition is very severe."
How PMS and PMDD can affect relationships
In a survey of more than 4,000 people, 35% described PMS as having a moderate-to-severe impact on everyday life. A 2016 study found that 58% of people with severe PMS reported lower productivity; Evelyn's own research showed that 51.7% of people had taken time off work or school because of PMS or PMDD.
Nearly half of people with PMS report an impact on socialising and family relationships. The same study found that half felt less satisfied with their relationship in the lead-up to a period - and partners of people with PMS or PMDD also reported lower relationship satisfaction compared with couples where the individual did not experience PMS.
"The experience of PMDD varies really widely, but for the average person, PMDD has at least some impact on their personal life. It's very typical to experience lost relationships due to the symptoms."
Dr Tory Eisenlohr-Moul, associate professor of psychiatry, University of Illinois at Chicago
For people with PMDD, extreme irritability is a particularly common symptom in relationships. "They're reacting to things in ways that they don't feel in control over," says Dr Eisenlohr-Moul. "Even small acts of interpersonal aggression, like snapping at people, can really have an impact on relationships." Irritability in PMDD is a recognised medical symptom - not a character flaw. But its effects can leave friends and partners walking on eggshells for part of the month.
The good news is that growing awareness of premenstrual disorders means there are more resources than ever before to support everyone involved.
How to talk about PMS and PMDD
Opening up about premenstrual symptoms is not always easy - particularly when it touches on periods and mental health, topics that still carry stigma. Dr Eisenlohr-Moul recommends thinking about how you would approach any other physical health condition.
"Imagine how you would tell a friend that you've been diagnosed with diabetes. PMDD is not completely different. You can say something like: I just wanted you to know that I have this condition, and if you notice that I'm not myself, that might be what's going on."
Dr Tory Eisenlohr-Moul
There is no right or wrong way to start. Being honest about what you are going through helps the people you care about understand and offer meaningful support.
Practical tips for the conversation
- Think about where you want to talk - somewhere private, or somewhere relaxed like a café
- Prepare what you want to say - specific examples or information that would help the other person understand
- Have resources ready - the IAPMD toolkit is a brilliant overview for patients and their families
- Be clear about what you are hoping for - empathy, practical help, or something specific
- If the person does not react as hoped, give them space - understanding may come with time
If you are talking to children, use self-empowering language - like explaining that you are doing everything you can to understand your body and get the support you need. You can still be honest, but framing it this way helps children feel safe and reassured.
🔗 Our 70-page guide offers scripts, advice for friends and family, and tools for connection
How to support someone with PMDD
Learning about the condition is one of the most important things you can do. There is evidence that having a supportive partner who understands PMDD leads to greater relationship satisfaction and can even reduce the severity of symptoms.
One study found that individuals in same-sex relationships managed PMS symptoms more effectively than those in comparable opposite-sex relationships - with participants pointing to open communication and mutual awareness as key strategies.
"Some partners know that their partner's brain is sensitive to these cyclical hormone fluctuations and so they're trying their best to anticipate and give support. That's a very different experience than someone who is completely unaware of what's happening and just experiences their partner as very unpredictable."
Dr Tory Eisenlohr-Moul
A good understanding of PMS and PMDD means you can work on strategies together. That might mean discussing how to support each other during difficult phases, or finding ways for both partners to practise self-care.
🌿 A simple starting point: "Have a conversation about what's helpful," says Dr Eisenlohr-Moul. "Do you need to go away and not be bothered for a day, or do you want more affection and support? Depending on the person, that's going to differ so much." Knowing in advance removes the guesswork when symptoms arrive.
Practical support can also make a real difference - including attending medical appointments together, or offering extra help with childcare during the luteal phase.
Reducing tension in your relationship
Research shows that PMS makes communication between partners harder - and the more severe the symptoms, the greater the impact. But effective communication is not impossible. It may just take some timing and extra effort.
Dr Eisenlohr-Moul recommends having conversations about managing tensions during the follicular phase - the part of the cycle when symptoms are absent - rather than trying to address them during the luteal phase when emotions are already heightened.
When raising concerns during a symptomatic period, framing matters. Saying "you don't seem like yourself" is far more constructive than "you're acting weird." "When you frame it as 'not yourself', there's an understanding that something is going on in their brain that's different from what's normal for them," says Dr Eisenlohr-Moul.
DBT and CBT
Because PMDD was only added to the DSM in 2013, large trials on psychotherapies for relationship impacts are still limited. But Dr Eisenlohr-Moul suggests that some people with PMDD may benefit from Dialectical Behavioural Therapy (DBT) - a skills-based talking therapy built on CBT, designed for people who experience intense emotions. DBT teaches how to identify and understand difficult emotions and develop tools to manage them without acting on them impulsively.
🧪 In Dr Eisenlohr-Moul's words: "We're not saying you need to learn these skills to manage irritability because the irritability is your fault. The irritability comes from a biological place. But we do want people to feel empowered to learn skills that can reduce the impact on relationships."
Couples therapy is also worth exploring if communication remains difficult - having a neutral professional to facilitate conversation can help both partners feel heard.
What help is available?
If PMS or PMDD is affecting your relationships, speaking to your GP is a good first step. Your GP may recommend lifestyle changes, combined oral contraceptives, or SSRIs - which provide effective symptom relief for up to 70% of people with PMDD.
The National Institute for Health and Care Excellence has detailed clinical guidelines on diagnosis and NHS treatment options. The National Association for Premenstrual Syndromes is a UK charity with further information and support.
You are not too much.
You are worthy of friendship - even when you are quiet, even when you cancel, even when you disappear.
Evelyn exists to help you own your cycle - not be defined by it.
Further reading
- Navigating friendships with PMDD: boundaries, one-liner explanations, and real talk
- PMDD and your mental health at work
- Life with PMS and PMDD: the emotional, social, and work realities
Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.
