We do not have a definitive answer yet as to why this happens or what the initial ‘trigger’ is to PMDD developing/starting. While some people find that PMDD occurs from their first period, for others it can, and does, begin at a different stage in their reproductive lifetime*.

Symptoms can also worsen and change over time and/or around reproductive events such as pregnancy, birth, miscarriage, and perimenopause. Again, the reason for this is not fully understood yet. We hear from patients with a myriad of experiences.

It is thought that stress may contribute. Women/AFAB individuals with PMDD often report higher levels of stress, including:

  • Perceived stress - This is the feelings or thoughts that someone has about how much stress they are under at a given point in time or over a given time period. It is a measure of not how stressful someone’s life actually is but rather how they feel about it and also that person's ability to handle such stress.
  • Work stress - the amount of stress someone is under in employment.

These stressors, in combination with potential alterations in the body’s stress response system, may contribute to PMDD beginning.

Of note, many (but not all) of those with PMDD also have a history of trauma exposure, which may contribute to the development of PMDD (Eisenlohr-Moul et al. 2016; Perkonigg et al. 2004).

We hope that future research provides more answers to help understand the full etiology of PMDD and PME so that accurate support and treatment can be given.


*The end of the reproductive life cycle is marked by being postmenopausal. When you have natural menopause, this is marked on the day you have not had a period for 12 months due to menopause.

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