Low Cortisol

Horrible PMS? Could it be PMDD? with Rebecca Sairs

In this interview, Laurie and Rebecca Sairs discuss Horrible PMS? Could it be PMDD? as well as what PMDD can look like and what you can start doing now to help with your smyptoms.

Rebecca is a national board certified health and wellness coach and yoga instructor who helps women eliminate, reduce, and soften their PMDD symptoms naturally.

This is a transcription of an Instagram live conversation. You can find the full video on Laurie’s IGTV tab on Instagram and on soon on Youtube.


I’m coming live today with Rebecca, health and wellness coach and PMDD specialist. We’re gonna be talking about PMDD and PMS. 

What’s the difference? How do you get diagnosed with PMDD? What is PMDD? What does it look like?

I’m ready to dig into it, but first I’d just like you to introduce yourself to the audience and tell us how you got into this work.


I’m Rebecca Sairs. I am a national board certified health and wellness coach. I primarily work with women with PMDD, which we’re going to dive into in a minute all about that. 

For anyone unaware of a health and wellness coach, their main skill set is helping you take action and implement things, like your own personal goals around the treatment plan, your doctor’s giving you. So it’s really about action taking, which can be really hard for people with PMDD. 

I got into this work, because when I was in my late twenties, I was diagnosed with PMDD, after about a decade of honestly, just feeling like, “What in the world is going on with me?” in the sense of a lot of anxiety, a lot of depression, a lot of fatigue. 

Going to the doctor and being like, “You’re normal. Here’s the anti-depressant. Here’s birth control.”

I did a lot of that.

Another part of my story, I was on antibiotics a lot as a child teen and then in my twenties for a variety of reasons. So my gut health was totally shot, which also can contribute to my mood. 

Anyway, I was diagnosed with PMDD in my late twenties at 28. 

And then I did the antidepressant route. I just found that for me, the side effects of both antidepressants and birth control were really, really hard and really, really tough and made symptoms almost worse than PMDD itself. I ended up eventually working with a functional medicine doctor and made tremendous changes in my life. That helped me so much. 

So now I feel like I can get PMDD at times. It’s can still be there, but as far as the really debilitating symptoms of anxiety, depression and fatigue, those are so much better. 

That’s why I decided to work with women with PMDD and got my health and wellness certification. 


You’ve been through it. So the women that come to you, you know what they’re going through, you’ve been here. 

Let’s dig into the differences, because PMDD is different from PMS, but some people can see them as similar. 

Let’s start with talking about how they are alike. And then how do you get away from PMS to look at it more like PMDD?


I think that’s a good place to start. How are they similar? 

They’re similar in that they are both related to your menstrual cycle. So you’re going to experience it sometimes in your luteal phase of your cycle. That’s a time after ovulation and before your period, and then the symptoms can also be really similar. 

Mood symptoms are common. Sadness, anxiety, anger. Anger is really bad with PMDD. Depression can happen for both PMS and PMDD. Those more cognitive, behavioral or physical symptoms can occur with both as well. That might be things like breast pain, bloating, migraines, or fatigue. Hypersomnia, insomnia and cravings are big ones. 

I think we’re familiar with binge eating. Feeling a decreased interest in usual activities, lack of focus, those kinds of things.

So all of those can happen with either. Then again, they’re related to the menstrual cycle. So that’s the biggest similarities for the two. 

When we get into the differences, I compare PMS to being like a thunderstorm and PMDD being like a hurricane, maybe this is a very American-centric analogy. 

So with this thunderstorm, it’s going to cancel a soccer game. It’s going to disrupt a little bit, but within that, you have like different degrees. 

So you might have one which cancels your soccer game, but within half an hour, you’re out playing again. 

You could have a really severe thunderstorm which knocks out your power, knocks over a tree. It is very disruptive. 

PMS is sort of like this cultural narrative. Again, I can only speak for the U.S., but this cultural narrative, “Oh, she’s angry. It’s that time of the month. Oh, she has cravings. Hahaha.”

PMS kind of joked about and dismissed a little bit. 

It’s statistically very common, in the sense of upwards to around 80% of women who menstruate experience some sort of PMS symptom before their period.

Usually it’s mild, maybe a little moderate. They’re probably not going to go to their doctor about it. It’s not that big a deal. 

I would consider that your thunderstorm that rolls through in a few minutes and then you move on with your life, not a big deal.

But there’s other people with PMS where it would be considered clinically significant. They’re probably going to go to their doctor. It’s going to be pretty disruptive. That would be more like the thunderstorm that rules in takes out your power. It takes out the tree, that kind of thing. 

And then we have PMDD, which is more like a hurricane. So it comes in, it totally destroys the neighborhood. Maybe there’s flooding after it’s over. You’re rebuilding. It’s just that severe with your symptoms, totally disrupting your life.

Some people find it hard to keep a job or go to school. It can ruin relationships. So I mean, it’s really devastating. 

That’s one way that they’re a little bit different. Another is the commonality of it. A thunderstorm is super common, hurricanes aren’t as common. Same with PMS, maybe up to 80% of women have experienced it. The more clinically significant PMS is a lot lower. I’ve seen rates between 3% to 8% or up to 20%. With PMDD, it’s also 3% to 8% that experience it. 

It’s usually the one in 20 statistical issues and then how frequent it is, PMS generally speaking. I would say definitely track and see what’s true for you. PMS is that five to seven days before your period. 

Whereas with PMDD some people can start right after ovulation and lead up till their period or a day or two when their period starts. So it can last a lot longer too. They might notice that it starts right after ovulation and then gets worse and worse and worse before their periods. 

Those are some of the differences, how common it is, how severe it is, how frequently it occurs and then thinking about diagnosis. I don’t know if we want to jump into that.


Sure. My next thought was, how many women are out there being dismissed as having PMS.

Is blood sugar instability at the root of your hormone woes?               

Find out if blood sugar imbalance could be at the root of your fatigue, brain fog, cravings, moodiness, increasing stress, hair loss, period or skin problems, expanding waistline — & more!


Probably a lot. I don’t think I have a number for that, but probably a fair amount. 

I mean a big struggle with PMDD is that it’s a relatively newly recognized diagnosis. I wouldn’t say it’s a new thing, but it’s newly recognized. 

So a lot of people do go to their doctor and sometimes doctors don’t even know about it. So the patient has to do a lot of educating their doctor and really advocate for themselves. 

I feel like if you have PMDD, you really have to advocate for yourself. I would say, if you have a friend or partner that can go with you to your doctor’s appointments and be that supportive person, I would say do that. 

But looking at diagnosis, for both PMs and PMDD, your doctor is going to want to rule out other conditions.

So things like thyroid, which can have that mood component as well, can often be a misdiagnosis. 

Perimenopause, especially for women in their late thirties and forties to fifties are potentially going through perimenopause. So you want to rule that out.

Bipolar is another common misdiagnosis just because with PMDD, you have like a couple of weeks where you feel really good. And then you have a couple of weeks where you feel maybe more depressed or anxious. I think I forgot to mention, but even like suicide ideation, suicidal thoughts can come along with PMDD. So it’s very serious. It’s something that should be taken very seriously. 

There’s no tests really to figure out PMDD. So you have to rule out all these other things, migraines, IBS, chronic fatigue or other common things. You want to rule those out. 

For you, as the patient, a really good thing to do is to track your symptoms for a couple of cycles. So you can go online, do a Google search, and find a PMDD tracker. Me v PMDD has a good app, if you want to go digital and track your symptoms for a couple of cycles and then bring that information with you to your doctor, because that will be really helpful for him or her to look at. 

What they’re going to look for for a PMDD diagnosis is do you have at least one mood symptom, such as anxiety, depression or anger. Do you have at least one from the other categories? So the fatigue, insomnia or cravings. And then do you have five or more total between the two categories? Do they disrupt your life? So do they interfere with work or school relationships?

Is there a clear pattern of the symptoms? Do they start after you ovulate and do they finish by the time your period arrives or within a few days of your period starting? So you should definitely have days where you don’t have symptoms. 

If you have symptoms all month long, but they get worse before your period, sometimes that’s referred to as premenstrual exacerbation or PME. I don’t know if your doctor would know that phrase necessarily, they might, but it’s not really a diagnosis. It’s more just identifying that maybe you have this underlying condition, like anxiety or depression and you have it all month long, but it gets a lot worse before your period. 

So again, you want to figure out what’s causing these symptoms, it might be an underlying condition or it might be PMS or PMDD. So that’s how you get the PMDD diagnosis.

For PMS it would be more, do you have one to four symptoms? So it’s less symptoms. And again, if it’s clinically significant PMS, it could still be disrupting your life to some degree. So that’s a little bit of the difference between the diagnosis.


That’s so helpful. So like you said, a lot of doctors might not be able to recognize it. If you’re the patient and you think this is what it could be, keep track of your symptoms and bring something to your appointment that can help kind of advocate for yourself.


Even if you track and you’re realizing, maybe it’s not as clear on the symptoms, that still gives you great information. I would say if you have any thoughts at all that you might have PMDD start tracking.


Just in general tracking is good for a lot of reasons. 

So if it is PMDD, what are the options? What can we do about it?


So when you go to like your GP or your OB GYN, they most likely are going to prescribe SSRI antidepressants or birth control. 

So the interesting thing about SSRIs with PMDD is sometimes you don’t have to take them continuously. They’re only prescribed for your luteal phase. So you only have to take them for a couple of weeks. I think the statistic with SSRIs is that around 60% to 75% of people with PMDD find it really, really helpful. 

Just because PMDD is so severe, I feel like if that helps you and that gets you to a place where you can advocate for yourself more and start doing other things, by all means look into it. 

But I always want to encourage you to do your research and know the pros and cons, the risks and the benefits of anything you’re doing.

They’ll also look at birth control and it’s commonly prescribed for PMDD. Anecdotally, I’ve heard really mixed things. Some people find it like they have symptoms all month long on the pill and they really hate it, other people find it helpful. 

Those are the first medication routes recommended. Some people get hormone replacement therapy or a hysterectomy. Those are more extreme and usually come later. The first-line is probably going to be SSRI and birth control. 

As far as therapy, usually cognitive behavioral therapy is recommended. Again anecdotally, I know a lot of people have found body-based therapies really helpful. So that could be like sensorimotor psychotherapy or somatic experiencing.

There’s some mixed research on if trauma plays a role in PMDD or not. That’s why a body-based therapy might be helpful. 

So I would say if you can afford therapy, if you’re interested in therapy, I would definitely recommend it. 

Just research your options and choose the one that might be a good fit for you.

I would start with lifestyle and nutrition. I feel like these recommendations are sort of not very sexy, but the first thing I would do, if you have PMDD, is really make sure that you have a solid support team. Meaning does your partner, do your friends, know about PMDD? Making sure that they’re educated about it as well, so that they know what’s going on and can support you. Friends, family, as wide a net as you can get, and then your healthcare team, again, depending on where you live might be really hard. You might have to advocate pretty strongly for yourself, but finding people who believe you, when you say you got these things, like you’re not just making it up, can be really helpful. So getting support I think is tremendous. 

After that, I would make a plan for your tough days. For example if you are someone who has suicide ideation, make sure you have a plan, phone numbers to call, people you can call when you’re feeling that way, as well as in the moment relief ideas for things like depression, anxiety or anger. Find things that work for you in the moment, maybe it won’t totally solve everything, but it can give you a sense of control and give you options. Because when you’re in those moments, a lot of times you can’t really think super clearly. So having that list, putting it on your fridge and getting ideas of what to do. 

Another huge thing is stress. So stress can make your symptoms worse, whether you have PMS or PMDD. So really paying attention to that. 

I know when you were on my podcast, we talked a lot about stress. So I would say, go listen to that episode. (Find the episode here) 

Laurie had tons of great stuff to share about that. Finding ways to reduce your stress as much as possible. Obviously we all come from different backgrounds and have varying degrees of how we’re able to deal with stress.

For the things that you maybe can’t control, how are you building your resilience towards that? Whether it’s yoga, getting outside, spending time with friends, a good book or whatever your thing is make sure that you prioritize that. This can have such a tremendous impact on premenstrual symptoms.

Low Cortisol

Movement and exercise is good for any mental health. With PMDD specifically, you’re probably gonna find that at the beginning of your cycle, you’re going to feel more energetic and more energized and more able to do maybe a little bit more intense workouts. During your luteal phase you might need to shift to more gentle stuff and that’s okay. That kind of goes to the menstrual cycle awareness stuff. If nothing else, PMDD teaches you that pretty quickly. 

As far as food, you can go down the rabbit hole pretty fast. If you’re working with a nutritionist, you can get a very specific plan.

If we’re speaking more generally, make sure you’re adding in nutrient dense foods, eating lots of fiber and complex carbs through the form of lots of vegetables, get that protein and healthy fat at every meal and snack. That’s really important to help multiple things, such as regulating blood sugar, getting you lots of nutrients and helping with inflammation. 

I think anything you can do to decrease inflammation can be important for any type of chronic condition. So whether that’s food, sleep or positive relationships, there’s lots of ways to address that. 

Again I think gut health is important for any mood disorder, but definitely PMDD. The gut is your second brain, so to speak. So make sure that your gut is really working well and functioning well. 

We didn’t really talk about causes, but PMS is often thought to be an estrogen dominance thing. In comparison PMDD isn’t thought to be that. Your hormones are not out of balance,  but your body reacts to them differently.

That said, I think it would still be important to have your hormones working as optimally as they could be, but that’s generally not like the main focus for PMDD. 

Then last but not least, I would advocate for you again to keep track of your cycle. Even if you have a PMDD diagnosis, I would still continue to track symptoms and then track the things that you’re trying. If you do implement something like exercise or stress reduction just see how it impacts you, so that you have clear evidence of what is and what is not helpful for you. 

Those are some of the things I would look at first.


That’s helpful. All of the lifestyle things people can start doing right away. 

So if you’re reading this and thinking, “I think I have PMDD,” you can start doing some of these lifestyle pieces and tracking of course. 

Do the women that you work with tend to find that these sort of lifestyle shifts and all the tips that you mentioned, create a big enough shift to make a difference?


It depends on the person and how long they’ve been living with these lifestyle shifts. They’re not magic and you don’t always see the results right away, which can be discouraging. But yes, when they’re implementing these lifestyle shifts, they do see shifts in their PMDD. 

For some people it might not totally get rid of all their symptoms. And then I would say the next step is to keep digging. There’s lots of avenues you can take. Histamines can play a big role for some people. If you are someone who experiences symptoms around ovulation, if anxiety and migraines are your big symptoms, I would say, look into that. For other people it’s neurotransmitters that can play a role. 

I would say working with a functional practitioner to figure those things out are some of the next layers. I would say that functional practitioners do build resilience to some extent, but some people might not find full relief with them. I still feel like it’s a great place to start, especially if you don’t want to spend a lot of money on testing or supplements and all of it.


Right. Either way bringing in that lifestyle for your PMDD is going to be necessary anyway.


For sure. It’s basically that foundational piece. From there you may need to keep building on and keep exploring.


Thank you, you gave lots of great tips.

You can work with your doctor. You can advocate for yourself and what to do if you, if you do get diagnosed with PMDD or even if you just think you have it, what you can start doing right away. 

That’s been so helpful. I love that you came to join me today and just before you go, um, is there like how can people find you, um, how can they follow your work if you have any ways that we can just see a follow along, let us know.

Find out more:

Connect with Rebecca Sairs on Instagram @pmddhealthcoach or check out her website, where you can find her podcast as well. 

This information is for educational purposes only and is not intended to diagnose, manage, or treat disease or serious conditions. Always check with your doctor before making any changes. It’s important to consult a well-informed health practitioner for personal advice about your situation before relying on general information we’re all wonderfully unique.

Laurie Villarreal, FNLP, CHWC, FNS, LMC, CPT, RYT

Hi, I'm Laurie, a functional nutritionist and board certified health coach, athlete, dog-mom, and biohacking adventure-lover. After having struggled for years to find lasting solutions for my own debilitating hormone-related symptoms, I created my online practice to begin helping other active, driven women get the support they need. I now help  women around the world elevate their health, energy, business and life by optimizing their hormones with personalized nutrition and lifestyle tweaks. Together, we discover new tools and strategies that keep you showing up at your best so you can play even bigger in your life and work.

Let's Connect: