Many people are familiar with PMS, but what is PMDS or PMDD? Cycle Power with Franzi Ruhnau

Franzi from Zyklus Power clarifies: Many menstruating individuals are familiar with PMS (premenstrual syndrome). But what is PMDD (premenstrual dysphoric disorder)? Franzi shares her personal story, which has turned into a mission to educate more people about cycle knowledge. She founded the platform ZYKLUS POWER and coaches employees in companies, menstruating individuals, and their loved ones on how to treat themselves more mindfully.

While both conditions are characterized by cyclical symptoms, they differ significantly in their severity and the impact on daily life.

Franzi, how nice that you have time for an interview. Please tell us your personal story!

Thank you, I'm thrilled to be here! My story with PMDD began before I even knew this disorder existed.² For years, I felt like I had to cram my life into 10-14 'good days' a month. The rest of the time was marked by dark thoughts, severe mood swings, suicidal thoughts, and complete exhaustion. I thought I simply wasn't resilient enough to lead a normal life. No doctor could help me, and I was at my wit's end. The turning point came when I discovered PMDD and started tracking my cycle. My symptoms finally had a name—and there were ways to manage them. This realization not only changed my personal life but also revolutionized my view of work, resilience, and success.

How did you then find help, and what did you change in your life?

The game changer was tracking my cycle. Only then could I recognize the patterns and understand that my 'doomsdays' were related to the second half of my cycle. When I learned about PMDD, everything fell into place like a puzzle. I began to intensively study the connections between the cycle and the psyche, to change my diet, to set boundaries and above all: to finally take my mental and physical health seriously. Today, I know that there are ways to deal with PMDD - and this realization has not only saved my life, but also my marriage.

What is PMS (Premenstrual Syndrome)?

PMS encompasses physical and emotional discomfort that typically occurs one to two weeks before menstruation and improves after bleeding begins. Approximately 25% of all menstruating people experience PMS with varying degrees of intensity. The exact mechanisms are not fully understood, but hormone fluctuations - especially in estrogen and progesterone - play a central role. Factors such as stress, diet, and lifestyle can also influence symptoms.

Typical symptoms of PMS:

• Physical: Bloating, breast tenderness, headaches, water retention, nausea
• Emotional/psychological: Irritability, mood swings, sleep problems, lack of energy
• Behavioral: Food cravings, increased susceptibility to stress, limited social interactions.

It's really important to me to make it clear: PMS is not a mental disorder and can often be alleviated with small adjustments in diet, exercise, and self-care. And: The premenstrual phase is not only negative, it is also full of superpowers³ that help you to see more clearly what is really important to you.

What is PMDD (Premenstrual Dysphoric Disorder)?

PMDD (Premenstrual dysphoric disorder (PMDD)) is a more severe form of PMS and affects between 3% and 8% of all menstruating people, which is up to 2.6 million people in German-speaking countries. Comparable to the prevalence of diabetes, but with the difference that everyone has heard of it.

Unlike PMS, PMDD focuses on the psyche: Symptoms such as depression, anxiety, irritability, or feeling overwhelmed are typical. These symptoms occur in the luteal phase (second half of the cycle) and disappear with the onset of menstruation. Particularly important: PMDD is not a weakness of character, but a strong reaction of the brain to natural hormonal changes.

At least five symptoms must be present, including one from the emotional area:

• Emotional symptoms: Mood swings, depressive mood, anxiety, increased willingness to engage in conflict
• Physical symptoms: Breast tenderness, bloating, joint pain
• Behavioral symptoms: Difficulty concentrating, sleep disturbances, appetite changes

What exactly can you do if you observe the symptoms in yourself?

PMS and PMDS are widespread but different challenges that can affect menstruating people. For both, the following applies: Track yourself before you wrack yourself. Track your cycle and get to know your own individual patterns! This not only provides you with 'aha' moments, but also gives your doctors a sound basis for diagnosis and treatment.

Record for at least two to three cycles when your symptoms occur, how severe they are, and when they subside. Apps, notes on your mobile phone, a small diary or my tracking sheet can help you with this.

You can treat PMS well with these adjusting screws:

• Nutrition: Sufficient vitamins and minerals such as magnesium or vitamin B6 can positively influence hormone balance.
• Exercise: Regular physical activity promotes blood circulation and helps reduce stress.
• Stress management: Relaxation techniques such as yoga or meditation have a balancing effect.
• Individual strategies: It is important to test different approaches and listen to your body's signals.

PMDD often requires targeted medical treatment. Anyone suffering from symptoms should not hesitate to seek medical advice – both conditions are treatable and do not have to be simply accepted.

With PMDD, it's particularly important to seek medical advice to rule out other causes (e.g., thyroid disorders or depression)

In addition to diagnosis, there are measures that can also help you with PMDD:

• Adjust diet: Less sugar, alcohol and processed foods, more fresh nutrients like magnesium and vitamin D.
• Exercise: Gentle exercise such as yoga or walks can reduce stress.
• Stress management: Relaxation techniques such as breathing exercises or meditation are particularly helpful.

And very important: Be patient with yourself – it takes time to find your way.

Warning signs where you should seek professional help immediately

If you notice that you are suffering from suicidal thoughts or feel like you see no way out, please seek help immediately. Talk to your doctor, call the suicide hotline (in Germany, for example, 0800 111 0 111), or contact a crisis service. You are not alone, and there are people who want to help you.

How does the diagnosis and treatment of PMDD work?

The diagnosis is based on clear criteria. Here is a checklist of symptoms, of which at least five must occur (one of them from the bold marked "core symptoms"):

• Depressed mood, hopelessness, feelings of guilt
• Anxiety, tension, or severe irritability
• Mood swings (e.g., crying, sudden sadness)
• Irritability or anger, often associated with conflicts
• Decreased interest in activities
• Difficulty concentrating ("brain fog")
• Lack of energy or severe fatigue
• Changes in appetite (cravings or loss of appetite)
• Sleep disturbances (e.g., insomnia or increased need for sleep)
• Feeling of loss of control or being overwhelmed
• Physical symptoms such as breast tenderness, joint or muscle pain

The symptoms must occur in the luteal phase of most cycles of a year and disappear with menstruation. Treatment includes lifestyle changes, therapies (e.g., cognitive behavioral therapy, cycle coaching), and in some cases medications such as SSRIs. Unfortunately, there is no quick fix, but with patience and the right support, you can find your way

I'm actually writing a book about this right now (here's the waiting list). In it, I'll show you how your cycle can be the key to your mental health. And how you can elegantly get through the bad PMS and PMDD days without questioning your life every time or causing an incredible amount of damage in your social environment.

What myth would you like to debunk?

That PMS and PMDD are the same thing – that's simply wrong, as you've just learned! PMS can be very stressful. However, PMDD is not a 'severe form of PMS', but a serious, cycle-related disorder that is triggered by natural hormonal changes in the second half of the cycle.

It even has its own independent diagnosis in the ICD-11⁵. PMDD is officially recognized there as a gynecological disease that affects both the body and the psyche. This shows how complex the connection between hormones and the brain is. And no, menstruating people don't just have to deal with it or 'endure'. PMDD is real, biologically explainable, and deserves serious attention – and above all the right support. Nobody should be left alone with these symptoms!

Please explain again what you do at ZYKLUS POWER and what your services look like!

At ZYKLUS POWER, I work on both an individual and a systemic level. For individuals, I offer 1:1 coaching to help them use their cycle as a resource, whether it's to manage PMDD or to generally improve their quality of life and resilience.

At the same time, I bring awareness of cyclical living and working into the workplace. I support teams and managers in creating cycle-friendly structures - for example, through regenerative leadership, more flexible time models, or a better understanding of mental and physical rhythms. My experience in NGOs, public administration, and large companies helps me to build bridges between personal health and sustainable work concepts.

What are your most important insights, what would you like to give women as they go on their way?

Life becomes so much better when you make peace with your body – and your cycle. Our society, which is linear, performance-oriented, and often merciless, has practically untaught us this natural rhythm. Resting without feeling guilty and following your own needs is a rebellious act. But here's the truth: breaks are not a luxury, they are a central component of true productivity. Anything else is a lie.

My most important message: You are not crazy. You are cyclical. But you live in a world that doesn't recognize that. And because so many of us have never learned to understand the processes in our bodies, a large part of our suffering arises. That doesn't have to be the case! There is also a solution for you and a path to a life that feels much better.

Your cycle is honest – it is like a mirror and a magnifying glass. It shows you how you live, love, and work. Instead of dismissing it as a weakness, we should use its power: for personal transformation and for a more humane working world. Our bodies hold the key to a regenerative, people-friendly future. Let's listen to them!

For you personally, this means: You are not weak or 'broken'. Your body is sending you signals – and they want to be heard. When you understand your cycle, you will find the key to a more fulfilling life.

For companies, this means: Cyclical work models don't mean less performance – they stand for sustainable efficiency. When people are allowed to work in their natural rhythm, not only they themselves benefit, but the whole team. Better climate, more creativity, sustainable success – these are the results when we bring cyclical thinking into the working world.

It's time to forge an alliance with your body and your cycle – for more quality of life, more resilience and real change.

Artikel by Susanne Feldt, reviewed by Franzi Ruhnau, Period Coach