PMDD (Premenstrual Dysphoric Disorder)

PMDD is a distinct, DSM-5-recognized mood disorder tied to the menstrual cycle, more severe than typical PMS, and it is diagnosed by tracking, not guessing. SSRIs and CBT targeted at premenstrual mood are the best-evidenced treatments.

Every claim below carries an evidence grade. What do these grades mean?

Liisa Hantsoo, PhDAssociate Professor of Psychiatry &…Johns Hopkins University School of Medicine Liisa Hantsoo, PhD

PMDD

PMDD: Track, Time, Treat

1Use a daily symptom-rating diary (a DRSP-style tracker) covering mood, physical and functional symptoms every day for at least 2 menstrual cycles (Daily entries, 2 cycles minimum)
2Take the completed 2-cycle chart to a psychiatrist, OB-GYN, or PMDD-literate therapist for a DSM-5-based diagnosis (n/a, physician visit)
3Ask your prescriber about an SSRI, dosed either continuously or luteal-phase-only depending on your case (Prescriber-directed only; never self-start or self-adjust)

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MENOPAUSE

Hormone Balance Protocol

1Get the right bloodwork (Cortisol (and its daily rhythm), a full thyroid panel (TSH, free T3, free T4, antibodies), sex hormones (estradiol, progesterone, testosterone), and consider a stool/microbiome test and a CGM)
2Eat for your hormones (Protein at each meal, plenty of cruciferous vegetables (broccoli, cauliflower, Brussels sprouts) for estrogen metabolism, fiber for the gut, and less sugar, alcohol and processed dairy)
3Dial down the stress load (Paced breathing: 5 second inhale, 10 second hold, 5 second exhale, 20 min twice daily; protect sleep; limit caffeine and alcohol)

What to buy

Chasteberry ~$12

Nutricost KSM-66 Ashwagandha ~$17

DIM ~$18

NOW Foods Phosphatidyl Serine ~$20

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Stacy Sims

MENOPAUSE

Female-Specific Training & Fueling

1Eat 1 to 1.1g protein per pound of body weight (About 1.8 to 2.2 g/kg per day (toward 2.0 to 2.3 g/kg in peri/post-menopause); 30 to 40g per meal hitting roughly 3g leucine)
2Fuel before training (About 15g protein pre-strength (a coffee plus protein shake works); add ~30g carbs if doing cardio up to an hour)
3Eat within 30 to 45 minutes after training (Reproductive years about 35g quality protein; perimenopausal and beyond 40 to 60g)

What to buy

LMNT Electrolytes ~$25

Thorne Creatine ~$40

Weighted vest ~$45

Protein powder ~$60

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Mary Claire Haver

MENOPAUSE

Menopause Strength & Metabolic Reset

1Strength train to protect muscle and bone (2 to 4 sessions a week, progressive resistance)
2Hit a real protein target (1.3 to 1.6g per kg of ideal body weight per day)
3Get enough fiber (25 to 35g per day, soluble and insoluble)

What to buy

NOW Foods Psyllium Husk ~$13

Nordic Naturals Ultimate Omega ~$32

Thorne Creatine ~$40

Vital Proteins Collagen Peptides ~$45

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TESTOSTERONE

Natural Testosterone Optimization

1Sleep 7 to 9 hours, consistently (Protect deep sleep; treat snoring/apnea)
2Lift heavy, don't over-do endurance (Resistance training most days; compound lifts)
3Get body fat into a healthy range (Avoid both excess fat and very low fat)

What to buy

Boron ~$9

Zinc lozenges ~$12

Tongkat ali ~$25

Thorne Creatine ~$40

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TESTOSTERONE

Testosterone, the Foundations-First Way

1Sleep, strength training, and muscle mass (7 to 9h sleep; regular resistance training)
2Reduce visceral fat and limit alcohol (Improve body composition; minimize alcohol)
3Correct vitamin D, zinc and magnesium (Dose to blood levels)

What to buy

Thorne Vitamin D-5,000 ~$18

Comprehensive hormone panel

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TESTOSTERONE

Hormone Optimization, the Clinical Way

1Build the six foundations (Diet, exercise, sleep, stress, sunlight, purpose)
2Get a comprehensive hormone panel (Total & free T, LH, FSH, sensitive estradiol, SHBG, prolactin, thyroid, metabolic)
3Treat the underlying driver first (Address sleep apnea, obesity, metabolic and medication causes)

What to buy

Nutricost KSM-66 Ashwagandha ~$17

Thorne Vitamin D-5,000 ~$18

Comprehensive hormone & metabolic panel

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Gabrielle Lyon

MENOPAUSE

Muscle for Women & Menopause

1Treat muscle as the priority, not the scale (Build and keep muscle through midlife)
2Eat enough protein, finally (~1g per pound ideal body weight; 100g+ if over 50; 30 to 50g per meal)
3Resistance train, and don't fear it (3 to 4x a week; progress stimulus, not necessarily heavy)

What to buy

Sports Research Vitamin D3 + K2 ~$20

Thorne Creatine ~$40

Momentous Vegan Protein ~$55

Adjustable dumbbells ~$365

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Stacy Sims

ENDURANCE

Train & Fuel With Your Cycle

1Log your cycle and training for 2 to 3 months (Note cycle day, session quality, perceived effort, sleep and mood; a wearable or a simple journal both work)
2Schedule your hardest work day 1 through ovulation (Heavy lifting, sprints and high-intensity sessions in the follicular phase when you tend to tolerate stress and access carbs well)
3Keep training, but fuel and recover more (Slightly more protein and carbohydrate around sessions; allow more recovery; dial back only if you feel you need to)

What to buy

Iron supplement ~$13

Protein powder ~$60

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Sara Gottfried

MENOPAUSE

Cortisol, Stress & Perimenopause

1Morning light and a consistent wake time (Daylight soon after waking and a regular schedule, so cortisol peaks in the morning as it should)
2Understand the curve before testing anything (Cortisol rises sharply in the first 30 to 45 minutes after waking (the cortisol awakening response), then falls through the day and bottoms out at night. A single random reading has no context without knowing the time it was taken)
3Understand the limits of consumer cortisol tests (Salivary cortisol testing is validated for specific clinical questions, most notably a late-night sample to help screen for Cushing's syndrome, but a single consumer strip or at-home panel cannot diagnose "burnout" or a "wrecked" cortisol system)

What to buy

Thorne Magnesium Bisglycinate ~$32

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Stacy Sims

MENOPAUSE

Training Through Menopause

1Prioritise heavy resistance training (2 to 3 sessions/week, lower reps with real load and good form (think hard by the last few reps); movement quality first if new)
2Add sprint interval training (Short, all-out efforts of ~30 seconds or less with full recovery; a handful of rounds)
3Include plyometrics (Small doses of jump training (e.g. squat jumps, 8 to 10 reps, build to 2 sets))

What to buy

Thorne Creatine ~$40

Protein powder ~$60

Adjustable dumbbells / barbell set ~$315

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Mary Claire Haver

MENOPAUSE

The Galveston Diet

1Use a 16:8 eating window (Eat within an 8-hour window, fast the other 16 (mostly overnight); adjust if it does not suit you)
2Build meals from anti-inflammatory whole foods (Leafy greens, olive oil, berries, nuts, tomatoes, fatty fish; minimise added sugar, refined carbs and ultra-processed food)
3Shift your fat-to-carb ratio (Start higher in healthy fat with lower refined carbs; Haver's plan eases toward a more balanced ratio over the following weeks)

What to buy

Kasandrinos Extra Virgin Olive Oil ~$28

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Kyle Gillett

LONGEVITY

The Six Pillars of Health

1Eat a whole-food diet that fits you (Individualised whole-food eating; for many, managing total intake and metabolic health matters most (not everyone needs to restrict))
2Train, with resistance work as a priority (Regular exercise including resistance training; build strength and muscle as the foundation)
3Protect consistent, quality sleep (Regular schedule and good sleep habits; see the dedicated sleep protocols)

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Vonda Wright

MENOPAUSE

The Musculoskeletal Syndrome of Menopause

1Recognize the pattern (If you are in your 40s or 50s and dealing with new body-wide aches, stiff or painful joints, tendon problems or a frozen shoulder, know these can be driven by the hormone changes of menopause, not a personal failing or your imagination.)
2Get a DEXA scan for your bones (Ask your doctor for a DEXA scan to check your bone density, since bone loss during this time is silent until something breaks.)
3Strength train to protect bone and muscle (Do progressive resistance training and weight-bearing exercise most weeks. This is the single most powerful thing you can do to defend your bones and muscle.)

What to buy

Protein powder ~$60

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Vonda Wright

MENOPAUSE

Strong Over 40: Keep Your Muscle

1Do progressive strength training (Lift weights 2 to 4 times a week and gradually make it harder over time, whether that is more weight, more reps or better control. Getting stronger is the goal.)
2Build around big compound movements (Center your training on squats, hinges (like deadlifts), pushes, pulls and carries, which train the most muscle and translate directly to real life.)
3Eat enough protein (Spread protein across your meals to give your muscles what they need to repair and grow after training.)

What to buy

Protein powder ~$60

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Louisa Nicola

MENOPAUSE

Women's Brain Health & Perimenopause Protocol

1Combine aerobic, resistance, and high-intensity training (Aerobic sessions for BDNF/hippocampal support, 2-3x/week resistance training, occasional higher-intensity intervals)
2Track and protect sleep through hormone shifts (Aim for consistent sleep timing; treat early waking (e.g. ~2am) as a hormone-related pattern worth discussing with a clinician; keep the room cool)
3Omega-3 and creatine (as in the general brain protocol) (Omega-3 to an 8%+ index; creatine dosed as in the general brain-health protocol)

What to buy

Nordic Naturals Ultimate Omega ~$32

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IMMUNITY

Vitamin D: Test, Don't Guess

1Get a 25(OH)D blood test (A standard 25-hydroxyvitamin D blood draw, ask for it at your next physical or order one directly if it is not routine at your clinic)
2Compare your result to both reference standards (Under 12 ng/mL: deficient. 12 to under 20: inadequate for bone health (NIH). The Endocrine Society's clinical guideline sets a higher bar for at-risk patients: under 20 ng/mL deficient, 30 ng/mL minimum for sufficiency, 40 to 60 ng/mL to comfortably clear that bar. Above 50 ng/mL, watch for potential adverse effects.)
3Get 10 to 30 minutes of midday sun on bare skin, several times a week (Shorter for lighter skin, longer for darker skin or higher latitudes; skip this or use sun protection instead if you burn easily or have a personal or family history of skin cancer)

What to buy

Vitamin D3 supplement ~$26

25(OH)D blood test

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Lara BridenNaturopathic DoctorAuthor, Period Repair Manual Lara Briden

PCOS

PCOS by Type: Treat the Root Cause

1Rule out other causes of androgen excess before accepting a PCOS diagnosis (n/a)
2Test triglycerides, ALT or fasting insulin, not just blood glucose or HbA1c (If insulin is high, this is likely driving the androgen excess; roughly 70% of PCOS diagnoses fit this type)
3Note whether symptoms started 3 to 6 months after stopping a drospirenone or cyproterone birth control pill (If your LH is elevated, Briden's herbal choice is peony and licorice; if prolactin is high-normal instead, she uses vitex (chasteberry), never both, and never vitex if LH is elevated)

What to buy

Myo-Inositol Powder ~$16

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Simon Hill

HORMONES

Male Fertility: The 90-Day Reset

1Know when to stop self-managing and get tested (A semen analysis after 12 months of trying, or after 6 months if your partner is 35 or older)
2Stop any testosterone or anabolic steroid use, and tell your doctor (Full stop, under medical supervision, not a taper you design yourself)
3Quit smoking, and cut alcohol back (No smoking. Keep alcohol occasional rather than daily)

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Lara BridenNaturopathic DoctorAuthor, Period Repair Manual Lara Briden

PCOS

Myo-Inositol for PCOS: The Dose, and the Honest Grade

1Get PCOS confirmed by a clinician before you treat it (PCOS is a diagnosis of exclusion. Thyroid disease, high prolactin, non-classic congenital adrenal hyperplasia and androgen-secreting tumours can all look like it, and the assessment involves cycle history, androgens, thyroid and prolactin. This page is not a diagnosis and cannot be used as one.)
2Take 2 g of myo-inositol twice a day, 4 g in total (4 g a day is the dose most myo-inositol PCOS trials used, taken as 2 g twice daily in water. Trials ran myo-inositol alone at 1 to 4 g a day, most at 4 g, and myo-inositol plus folic acid at 2 to 4 g with 200 to 400 mcg of folic acid. This is the dose Lara Briden gives in her own write-up as well.)
3Do not take D-chiro-inositol on its own (If you buy a blend, the ratio to look for is 40 parts myo-inositol to 1 part D-chiro-inositol. Understand that this specific ratio rests on very low certainty evidence: it comes from physiological reasoning and mouse models, plus two small human trials comparing ratios. Plain myo-inositol on its own is the better-supported choice.)

What to buy

Myo-Inositol Powder ~$16

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Kelly CaspersonUrologistFounder, The Casperson Clinic Kelly Casperson

MENOPAUSE

Local Vaginal Estrogen for Genitourinary Syndrome of Menopause

1Get GSM named by a clinician instead of self-diagnosing it (GSM is diagnosed on the symptom picture (dryness, burning, pain with sex, urinary urgency or frequency, recurrent urinary tract infections), with or without physical findings, once other causes are ruled out. Bring the urinary symptoms up explicitly, because they are the half most often left out of the conversation.)
2Clear the two hard stops with your clinician before anything is prescribed (Any undiagnosed vaginal bleeding, and any postmenopausal bleeding, has to be worked up first. A personal history of breast cancer or another hormone-sensitive cancer needs your oncologist's input, particularly if you are on an aromatase inhibitor. Casperson's own published position is that women with a breast cancer history may still be able to use it but should clear it with their oncologist, because each person is different.)
3Know what the starting phase normally looks like, so the prescription makes sense when you get it (The usual pattern is nightly for the first two weeks or so, then a drop to maintenance. Typical US product labeling regimens are a 10 mcg estradiol vaginal insert nightly for 14 nights, or roughly 0.5 to 1 g of estradiol vaginal cream nightly for about two weeks. These figures come from product labeling, not from a trial, and your own prescription is the one that counts.)

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Rena MalikBoard-Certified UrologistPrivate urology & sexual medicine practice Rena Malik

ERECTILE DYSFUNCTION

Erectile Dysfunction: The Lifestyle-First Approach

1Talk to a healthcare provider about new, sudden, or worsening ED, especially if you are younger or have risk factors like high blood pressure or diabetes (n/a, one conversation with a clinician)
2Aim for at least 45 minutes of vigorous cardio (brisk walking, jogging, swimming, cycling) three times a week (45+ minutes, 3x/week)
3If you smoke, quitting is one of the highest-leverage changes for mild ED (n/a)

What to buy

Citrulline ~$18

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Liisa Hantsoo, PhD

Associate Professor of Psychiatry & Behavioral Sciences · Johns Hopkins University School of Medicine; Director of Research, Johns Hopkins Reproductive Mental Health Center

How is PMDD different from regular PMS?▾

PMDD (premenstrual dysphoric disorder) is a DSM-5-recognized mood disorder, meaningfully more severe than typical PMS: symptoms cluster in the luteal phase (roughly the 1-2 weeks before a period) and resolve within a few days of bleeding starting, confirmed across at least two tracked cycles. Liisa Hantsoo, PhD, Director of Research at the Johns Hopkins Reproductive Mental Health Center, notes it is frequently missed or dismissed as 'just PMS.' This is informational only, not a diagnosis.

What actually helps PMDD?▾

SSRIs have the strongest evidence base of any medication class for PMDD and can be dosed continuously or luteal-phase-only depending on the prescriber's judgment; this is prescription-only and physician-directed, never self-started. Cognitive behavioral therapy targeted specifically at premenstrual mood, distinct from general anxiety therapy, is a non-drug option some clinicians provide.

Experts behind PMDD (Premenstrual Dysphoric Disorder) protocols

Follow to get their new protocols in My Protocols

Liisa Hantsoo, PhD

Associate Professor of Psychiatry & Behavioral Sciences

1 protocol