Dear Two Moons Readers, I’m Justine Carino. In my group practice based in New York and Connecticut, my team and I help individuals, couples, and families reduce anxiety, improve relationships, and build lives that reflect their core values. I also support ambitious women navigating stress and perfectionism through coaching programs and I’ve seen firsthand how hormonal health plays a key role in emotional wellbeing. I’m grateful to share some of that insight with you here today.
As a psychotherapist treating the mental health of women and teenage girls for over 14 years, I have seen a variety of challenges that girls and women face when trying to manage symptoms of anxiety and depression related to their hormones. I have also experienced them myself.
When I was 16 years old I was diagnosed with Polycystic Ovarian Syndrome. The only information I was given at the time was that I would need to go on birth control in order to get my period, and I would have difficulty getting pregnant and may struggle with infertility.
When I was 30 years old, my husband and I decided we were ready to start a family and I came off birth control. This was the first time I ever experienced the hormonal changes women go through during their cycle and I was thrown for a loop. I found myself getting very sad, emotional and my mood was extremely labile, so I considered meeting with a psychiatrist. My mood quickly changed once my period ended and I felt like I was myself again.
It took a few months of these highs and lows to realize that my shift in mental health was due to changes in hormones from my menstrual cycle and I never followed through with the psychiatric consult. This was something many of my patients reported, but I got to experience it first hand and I am fortunate enough to say that my symptoms are only mild. Millions of women are experiencing severe mental health challenges related to their hormones.
Amongst one of the most stressful and overlooked conditions related to women’s health is Premenstrual Dysphoric Disorder (PMDD). PMDD is a debilitating mental health condition that affects about 31 million girls and women worldwide, and unfortunately it is often overlooked and misunderstood.
PMDD causes severe emotional and physical symptoms in the 1-2 weeks leading up to a woman’s period and some of my patients have even reported experiencing intrusive suicidal thoughts. While the traditional treatment approach for PMDD often involves medication, there are also holistic strategies that can offer significant relief.
In this blog, we'll explore how a combination of therapy, lifestyle changes, and seed cycling can help women manage their PMDD symptoms. By addressing both the mind and body, these approaches work in harmony to reduce anxiety and depression, balance hormones, and improve overall well-being.
Whether you're seeking to take control of your PMDD symptoms or simply curious about these methods, this blog will provide helpful insights to guide you toward a more balanced and peaceful cycle.
Could it Be PMDD? Here’s What to Watch For
First you need to know about the symptoms of Premenstrual Dysphoric Disorder. PMDD sometimes gets disguised as a mood or anxiety disorder, but here are some markers to pay attention to if you are curious if you fit the criteria.
For the majority of your menstrual cycles, in order to meet criteria for PMDD, at least 5 of the following symptoms must be present during the week before menstruation begins, start to improve within a few days after the onset of menstruation, and become minimal or absent in the weeks after:
- Mood swings that can include crying spells
- Irritability and interpersonal conflicts
- Depressed mood and hopelessness
- Anxiety or feeling on edge
- Decreased interest in your usual activities
- Difficulty concentrating
- Lethargy
- Changes in appetite
- Sleeping more or less than usual
- Feeling overwhelmed or out of control
- Physical symptoms such as breast swelling or bloating
You might wonder how these criteria differ from “typical” symptoms of a menstrual cycle. Some women may only experience 1-3 of these symptoms during their cycle, therefore not meeting criteria for PMDD.
Also, these symptoms are associated with significant distress and interfere with a woman’s overall functioning to the point that it may become debilitating. Other psychiatric disorders must also be ruled out as a cause of these symptoms. Sounds pretty awful, right?
Here is what you can do about it…
PMDD, Therapy and the Power of Knowing Your Triggers
Going to therapy and working with a therapist that you connect with and trust can teach you effective tools to help you manage your anxiety and depression during the weeks leading up to and during your period. One of my favorite therapeutic modalities for treating these symptoms is cognitive behavioral therapy (CBT).
CBT addresses the negative thought patterns and emotional responses that often intensify during the premenstrual phase. Through CBT, we can learn to first recognize and then challenge these negative thoughts, reducing overall emotional reactivity to them and replacing it with more helpful coping mechanisms to ease the distress. CBT equips women with coping strategies to manage mood swings, irritability, and anxiety that accompany PMDD.
By changing how one thinks and reacts to their symptoms, therapy can help reduce the overall emotional burden of PMDD and improve your quality of life.
Additionally, therapy offers a safe space to explore the underlying triggers of PMDD, fostering self-awareness and empowering women to navigate their experiences with greater resilience. Therapy also helps people identify their support system; the people that they can turn to and rely on when their symptoms hit. I’ve invited many family members and significant others into therapy sessions so they can learn more about the disorder and how they can be supportive to my patients.
In addition to engaging my patients in CBT, I talk to them about how lifestyle changes can be a nice complement to the work done in therapy to treat PMDD.
I believe everyone needs a mental health routine that they prioritize, which includes creating boundaries with their schedule to engage in their unique coping mechanisms that help them feel anchored and grounded.
These coping mechanisms are things that I want my patients to practice every day, week and month to help them keep their stress levels and emotional reactivity lower.
From Sleep to Seed Cycling: Holistic PMDD Support
The first recommendation I make for a mental health routine that can help a woman struggling with PMDD is getting consistent sleep around 8-9 hours that leaves them feeling rested. The limbic system, which is the area of the brain that controls emotion, needs sleep to reset every single day in order to manage emotions effectively.
Second, I encourage women to stick to a consistent exercise routine a few days per week to reduce tension and boost endorphins, which helps combat the irritability and fatigue that comes with PMDD. Exercise should be anything that gets you moving and you enjoy doing for at least 30-45 minutes. In addition, I teach clients a variety of mindfulness exercises to help them stay present when their symptoms hit throughout their cycle, so this may include adding daily or weekly mediation practices, journaling or gratitude lists into their mental health routines.
Lastly, I highly recommend women engage in seed cycling to help manage symptoms of PMDD. Seed cycling is a natural approach that can also be used alongside many prescription medications, involving rotating specific seeds - flax, pumpkin, sesame, and sunflower, throughout the menstrual cycle to support the body’s changing hormonal needs. In addition to raw seeds, vegan capsules containing the powdered seeds tailored to each half of the cycle are now available through Two Moons, to make the practice more convenient for modern lifestyles. Two Moons can also be used alongside many medications (except for dopamine-related ones); please consult your doctor and the Two Moons FAQ.
During the first phase of the cycle, which is the follicular phase, flax and pumpkin seeds are consumed to support estrogen production. In the second half, or luteal phase, sesame and sunflower seeds are used to promote progesterone levels.
By aligning seed consumption with the body's natural hormonal rhythm, seed cycling may help reduce symptoms of PMDD, such as mood swings, irritability, and fatigue. Many women report experiencing improvements in their symptoms, making seed cycling a promising complementary practice to therapy, lifestyle changes and medication.
🌱 To learn more about how to seed cycle, check out this how-to page, as well as some of the research studies indicating how seed cycling can improve cycle related mood symptoms.
While this blog discusses health topics, it is not a substitute for professional medical advice. Always consult your doctor or other qualified healthcare provider regarding any question you might have regarding your health.
About the Author
Justine Carino, LMHC, is a licensed psychotherapist and host of the Thoughts from the Couch podcast. She leads a group private practice in NY and CT and offers coaching to help women manage stress and perfectionism. Her advice has been featured in Cosmopolitan, Forbes, HuffPost, and Verywell Mind, and she’s spoken for top organizations like Eileen Fisher and Lockheed Martin. Learn more at www.carinocounseling.com.
