Premenstrual Dysphoric Disorder (PMDD) is often described as “PMS on steroids,” but that barely scratches the surface. Affecting an estimated 3–8% of people who menstruate, PMDD can turn half of every month into a battle with depression, anxiety, rage, or even suicidal thoughts. Despite the impact, it remains little known, frequently dismissed, and dangerously under-researched — especially when it comes to queer and gender diverse people.

For sexologist and clinical nurse consultant Kendall Buckley, the condition isn’t just professional — it’s personal. Discovering they had PMDD during their Master of Sexology led Kendall to dive into the research themselves, and today they specialise in working with LGBTQIA+ and FLINTA communities navigating sex, relationships, neurodiversity, and complex conditions like PMDD.

We spoke with Kendall about what PMDD really is, how it overlaps with gender dysphoria and queer health, and why tracking your cycle might be the most powerful tool of all.

Can you tell us a bit about your work and why you became interested in PMDD as a queer sexologist?

Absolutely! I first became interested in PMDD while doing my Master of Sexology because that’s when I discovered I actually had it. At the time, there was no Australian research on the condition, so I thought fine, I’ll do it myself, and made it my dissertation topic.

When I started my Masters, I had no plans to work one on one with clients. The dream was mass media sex ed. But it was talking with other people who had PMDD, sharing what I’d learned, hearing their stories, and helping them piece things together that lit me up. This condition is complex. It often takes someone walking alongside you to help you understand it and yourself. That is where I realised I could have the biggest impact.

Outside of PMDD, I provide sex and relationship therapy exclusively for the LGBTQIA+ and FLINTA community. Most of my work is with sapphics navigating sexuality, gender, relationships, or just life in general. A lot of people come to me simply because they want a queer therapist and that’s what they get!

What is PMDD, and what causes it?

PMDD is a psycho-neuro-endocrine disorder that affects around 3 to 8 percent of people who menstruate. What makes it unique is that symptoms only show up in the luteal phase, which is the time between ovulation and bleeding (days 14-28).

Symptoms include depression, anxiety, irritability, mood swings and, for some, suicidal thoughts. These are not just “bad moods.” They severely impair daily functioning, relationships, work, and study. PMDD is in the DSM 5 which means it is officially recognised as a psychiatric disorder, not just PMS with bad PR.

The exact cause is not yet known largely because research into PMDD only began in the last twelve years. Plus, we all know that research into conditions affecting people AFAB, especially ones concerning menstruation haven’t historical been popular – unless they can make money from it. Rant aside my own research (that I did for love not profit) points to chronic stress and trauma as key factors. People with PMDD essentially have an abnormal reaction to normal hormonal shifts. Years of stress overuse the body’s fight or flight system, which depletes neurotransmitters like GABA and serotonin. The result is a brain that can’t buffer hormonal ups and downs in the way it should.

What’s the difference between PMS and PMDD?

Most people, about 80 percent, will experience some PMS. In the two weeks before menstruation, progesterone rises and oestrogen dips. Progesterone decreases serotonin and dopamine but metabolises into allopregnanolone or “allo,” which opens up GABA-A receptors to let calming GABA flow through. Alcohol and benzos target the same receptor, so allo is like your body’s little chill pill.

The problem is that allo only works if you’ve got enough GABA in the tank. Chronic stress and trauma deplete GABA. In PMDD, instead of getting a bit flat or grumpy, you end up anxious, depressed, hypervigilant and sometimes suicidal.

In simple terms, PMS will not ruin your life. PMDD will (if you don’t do something about). It feels like a dark cloud that for two weeks of every month torches everything you love, burns your relationships to the ground and then as soon as you bleed, the sun comes out and rainbows appear. You feel light again and motivated because oestrogen and progesterone are back, but you are also left picking up the pieces. Then the next cycle begins.

What are the options for management and treatment?

The current gold standard treatments are:

• SSRIs such as sertraline or fluoxetine, taken either every day or just in the luteal phase
• Oestrogen dominant oral contraceptives such as Yaz or Yasmin, which suppress ovulation
• Cognitive Behavioural Therapy (CBT) to support coping

There is emerging evidence for other treatments that support neurotransmission, but the studies are not yet big enough to make them gold standard.

On the management side, the biggest game changers are:

• Reducing and limiting stress (remember stress decreases GABA)
• Strength training (this promotes BDNF to rewire your traumatized brain)
• Eating enough protein (tryptophan turns into serotonin that you need)
• Reducing caffeine and alcohol (both deplete GABA)
• Tracking your cycle like your life depends on it

Finding a therapist who actually understands PMDD is essential because treatment needs to be holistic. And yes, it is brutal, but things can get so much better. I am living proof of that.

For someone who experiences gender dysphoria related to their period, how might PMDD make things more difficult?

For those who experience dysphoria, the biggest triggers are usually the physical symptoms. Bloating, swelling in the chest or hips, and of course bleeding. PMDD symptoms often ease once bleeding begins, but if bleeding itself triggers dysphoria, then the “relief” never comes.

Even if physical symptoms are not the main issue, the luteal phase is already a sensitive, low capacity time. Dysphoria stacked on top of PMDD makes things even harder, which is why treatment and management are so important.

For queer and gender diverse folks, there is an extra layer here. You are already fighting to be taken seriously in healthcare. Add PMDD to the mix and you often face even more dismissal or confusion.

What are some common relationship difficulties, and how have you helped people overcome them?

PMDD hits hardest in close relationships. When you are hypervigilant and running on empty, even tiny things can set you off. Knowing yourself and what you need is vital. I can’t stress here enough the importance of tracking your cycle. Something that I identified in the context of a five-year relationship was that without fail on day 22 of my cycle we would fight. Through tracking you will identify patterns which you can then establish rules with your partner that factor in challenging those times e.g. “let’s agree not to have big chats on these days” and sticking to that. So is having a partner who can hold boundaries, is not co-dependent and knows when to step back is vital. PMDD is not your partner’s responsibility, but they do need to know how and when to support you – and that is your job to tell them how.

In my practice, I help people by focusing on holistic care. That includes cycle tracking so they can anticipate, regulate and communicate capacity and needs. Medication absolutely if required. Exercise. Adequate nutrition, especially protein. And setting boundaries and expectations with partners, friends, and workplaces.

What barriers to healthcare access do people with PMDD face?

Awareness has grown in the last ten years, but many people are still dismissed, minimised, or misdiagnosed. Early studies showed it took an average of 20 years to get a diagnosis. That number is lower now, but misdiagnosis is still common.

Even when a clinician has heard of PMDD, they do not always understand the physiology well enough to get it. That is why cycle tracking and bringing your own data to an appointment is so powerful. It helps ensure you are diagnosed and treated correctly.

What are some comorbidities associated with PMDD?

The most common are C-PTSD, ADHD and Autism. They show up again and again in the research and in my practice.

How does PMDD affect sexual health and wellbeing?

This really varies. Generally, if you are anxious, depressed or stressed, sex is not top of the list unless you use it to regulate yourself. With PMDD, you are often so dysregulated that even someone chewing too loudly can make you fantasise about smashing their head into a wall (a fantasy I often had). So, sex might not exactly be on people’s mind.
For people with ADHD, symptoms often worsen in the luteal phase because progesterone lowers dopamine. If sex is part of your dopamine seeking pattern, that is something to factor into your awareness of self.

Connection and intimacy are still essential for many people’s wellbeing and when you are out of the luteal phase, sex and intimacy can feel amazing, sometimes even heightened depending on what phase you’re in, which is true for all people who menstruate. Knowing your cycle helps you lean into those windows of pleasure and connection.

How can people with diagnosed or suspected PMDD advocate for themselves?

The most powerful thing you can do is track everything.

• Mood
• Thoughts
• Behaviours
• Conflicts
• Triggers

Keep it in a locked note on your phone so you do not censor yourself. Do it for at least six months. Patterns will leap out at you. You will see your good days, your worst days, what helps, and what makes things worse.

Bring that record to your GP. From a diagnostic perspective, they need evidence that you have been symptomatic for at least six months. The criteria are strict, and they should be, but your data makes their job easier.

It also helps distinguish PMDD from premenstrual exacerbation (PME), where an existing condition flares up in the luteal phase. Treatment differs, so knowing what you are dealing with matters.

The bottom line, control what you can. Collect that data. Knowledge of yourself is power.