
Hey there! If you’re reading this, you’re probably all too familiar with the challenging mix of PMDD (Premenstrual Dysphoric Disorder) and EDS/HSD (Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder). But did you know that people with EDS/HSD are often dealing with a whole constellation of related conditions? Along with PMDD, it’s common to find autism, ADHD, and MCAS (Mast Cell Activation Syndrome) in this community. Each of these adds a unique layer of complexity.
One particularly intriguing—and sometimes infuriating—link between these conditions is histamine sensitivity. For some, this sensitivity leads to an MCAS diagnosis, while others experience symptoms triggered by histamine fluctuations even without MCAS. This histamine factor can worsen inflammation, pain, and even emotional symptoms. When PMDD joins the party, it can feel like an overwhelming cycle, but understanding how histamine may play a role can be a key to managing symptoms more effectively.
PMDD vs. PMS: Recognizing the Difference
Many people have heard of PMS, but PMDD is a more intense and less common condition, affecting an estimated 3–9% of people who menstruate, compared to the 48% who experience PMS. PMDD isn’t just “PMS times two”; it’s a much more severe disorder that can disrupt daily functioning and often requires medical intervention.
PMDD Symptoms: The Mental & Physical Toll
With PMDD, mental health symptoms like severe depression, irritability, and even suicidal thoughts are common, alongside intense physical symptoms like joint pain, bloating, migraines, and insomnia. Recognizing and diagnosing PMDD is essential because the symptoms can become debilitating without targeted treatment. Here’s what PMDD might look like:
The Mental & Emotional Rollercoaster
Severe depression that can appear suddenly
Anxiety ranging from unease to panic attacks
Mood swings and irritability, with an intense reaction to stress
Paranoia, intrusive thoughts, or feeling overwhelmed by everyday tasks
Social withdrawal, brain fog, and a general feeling of hopelessness
Suicidal thoughts (PMDD’s severity should never be minimized)
The Physical Fun (Spoiler: Not Actually Fun)
Extreme fatigue, often combined with insomnia
Severe cramps, breast tenderness, and joint pain (especially tough for those with EDS)
Headaches or migraines, changes in appetite, dizziness, and hot flashes
GI issues and heavy bleeding that add to physical discomfort
Autism, ADHD, and PMDD in the EDS/HSD Community
Research indicates that PMDD is more common in neurodivergent populations. For example, PMDD has been reported in up to 92% of autistic individuals and 46% of those with ADHD. Similarly, autism and ADHD are more prevalent in people with EDS/HSD, where sensory sensitivities, neurotransmitter differences, and genetic overlap might all play a role in amplifying hormonal impacts.
The reasons aren’t fully understood, but theories include:
Genetics: PMDD is highly heritable, and similar genetic patterns are found in ADHD and EDS/HSD.
Hormone Sensitivity: Many with ADHD experience chronically low dopamine levels, which may be especially affected by hormonal fluctuations. This can lead to heightened mood and energy swings, especially during PMDD phases.
Sensory Sensitivity: Autistic individuals often experience greater sensory sensitivity, which can make PMDD symptoms even more disruptive.
The Histamine Connection: PMDD, MCAS, and Beyond
A fascinating connection exists between PMDD, EDS/HSD, and histamine regulation. Histamine—a compound released by mast cells that regulates immune responses and plays a role in gut function—can also impact mood, inflammation, and pain. Many people with MCAS take H1 and H2 antihistamines (like Zyrtec and Pepcid) to manage symptoms, but they may notice flares of histamine-related symptoms around their menstrual cycle even while on medication.
The hormone fluctuations during the menstrual cycle influence mast cell behavior, leading to surges in histamine release at certain points. Here’s a breakdown of what this cycle can look like (we focus mainly on estrogen and progestrone for this post):
Days 1–5 (Menstrual Phase): Estrogen and progesterone are low, but inflammation can be high. This can lead to increased sensitivity and a feeling that regular antihistamine meds are less effective.
Days 6–14 (Follicular Phase): Estrogen levels start rising, and for those with histamine sensitivity, mast cells may start to activate. Symptoms like fatigue, joint pain, or mood swings may increase here.
Around Day 14 (Ovulation): Estrogen peaks, triggering a significant mast cell response and a surge in histamine. Even with regular MCAS meds, some people experience increased symptoms at this point.
Days 15–28 (Luteal Phase): Progesterone rises, which ideally stabilizes histamine release. However, in people with PMDD, progesterone may have a reduced effect, leaving estrogen and histamine interactions unchecked.

Why H1 and H2 Antihistamines work? H1 Antihistamines block the histamine receptors responsible for allergy-like symptoms and inflammation. For those with PMDD, they can help reduce symptoms like joint pain, inflammation, mood swings, and cramps, which often flare up during the menstrual cycle.
H2 Antihistamines primarily target the stomach but also help reduce overall inflammation. They can ease digestive issues like bloating and discomfort, and for people with PMDD, they may also help manage heavy menstrual bleeding, which is often tied to increased inflammation during the luteal phase of the cycle.
If you’re taking antihistamines for MCAS or histamine-related symptoms, consider discussing with your doctor whether adjusting doses around the menstrual cycle could help balance symptoms.
Managing the PMDD + EDS/HSD + MCAS Combo
Living with a combination of PMDD, EDS/HSD, and MCAS requires a careful, individualized approach to symptom management. Here are some tips to help keep things manageable:
Talk to Your Doctor About H1 and H2 Blockers
If you’re not already taking H1 and H2 antihistamines (like Zyrtec or Pepcid) for MCAS, it’s worth discussing with your doctor to see if they could help manage your symptoms. If you are already using them, ask your doctor about adjusting the dosage around your cycle, especially during ovulation and the luteal phase, when histamine levels can spike and symptoms tend to intensify.
The Ibuprofen Strategy
Instead of waiting for severe pain, consider taking ibuprofen as soon as you feel the first signs of your period approaching. This approach can:
Help keep pain under control
Reduce heavy bleeding
Tame inflammation before it becomes unmanageable
Supplements that Support Stability
Some supplements, when used strategically, may help take the edge off your symptoms. Remember to check with your doctor before starting any new supplements, as it’s especially important to avoid unwanted interactions:
Vitamin C: Stabilizes mast cells to reduce histamine release
Quercetin: A natural antihistamine that’s gentle on the body
Vitamin B6: Mood support during PMDD
Magnesium: Eases cramps and promotes restful sleep
Omega-3s: Reduces inflammation
Iron: Helps manage fatigue if you experience heavy periods
Gentle Movement and Stress Management
Physical activity and stress relief are both crucial to symptom management, but with EDS/HSD, it’s essential to avoid overexertion. At ParaMotion, we believe that gentle movement can help ease pain, improve mental clarity, and relieve stress which can help keep symptoms in check. Some ideas:
EDS-friendly dynamic stretching: Helps relieve muscle tension without straining your joints
Deep breathing: A simple, quick way to reduce stress and calm your nervous system, and also your mast cells.
Slow yoga: this gentle practice can be very effective
On particularly tough days, even a few deep breaths or some light stretching can make a difference. Listen to your body, and don’t push yourself beyond what feels manageable.
Track Everything
Keeping a symptom diary can reveal patterns that help you anticipate flare-ups and identify which interventions work best. Be sure to log:
MCAS and PMDD symptom patterns
Foods, supplements, and medications that help (or don’t help)
Which days of the cycle feel hardest on your symptoms
Cycle-Aware Planning
When possible, use your cycle as a guide to manage energy and plan activities. For instance:
Stock up on safe foods before PMDD week
Schedule major tasks during your better weeks
Create a “PMDD emergency kit” with heating pads, comfortable clothes, safe snacks, and go-to supplements
Why Recognition and Treatment Matter
When dealing with multiple conditions, it’s common for symptoms to be misattributed or overlooked. For example, people with EDS/HSD often experience increased pain and fatigue with PMDD, which can be dismissed as “just hormones” or “just hypermobility.” However, understanding that PMDD, MCAS, and neurodivergent traits can interact provides a more accurate picture of your health. Awareness, diagnosis, and individualized treatment are essential to manage these overlapping challenges effectively.
You’re Not Alone
If this sounds like your experience, you’re not alone! Many people with EDS/HSD also live with PMDD, MCAS, ADHD, or autism. Learning to navigate these interconnected conditions can be tough, but there’s a whole community out there that understands. You don’t have to do this alone, and there are resources and support groups to connect you with others who get it.
Want to share your own experience or tips? Drop them in the comments below—your insights might just be the thing that helps someone else feel a little less alone.
At ParaMotion, we know that no matter what exercise program you follow, some movement might not be optimal for the EDS body and can still lead to injury and flares. That's why, we are handpicking everything from Pilates, Yoga, Functional Strength and Mobility training in our program so that it's safe and causes no pain.
EDS patients need different style of cueing than others so it's not only the exercises but also the ability to understand how the EDS body reacts to certain movements and cue it into the right alignment.
ParaMotion reflects our philosophy: "Para" stands for the parasympathetic nervous system which is turned off for most of us as we are stuck in a fight-or-flight sympathetic state. "Motion" represents movement by which we can learn to turn on our parasympathetic system to promote tissue connection, ease pain, and prevent injury.
Whether you’re dealing with chronic pain, fatigue, or the unique challenges of neurodivergence, we’re here to empower you with science-based therapies tailored to your body’s needs. Imagine waking up with less pain, feeling stronger, and more connected to your body—our goal is to make that vision your reality.
Join our waitlist or book a 1-1 consultation today so we can help you become pain free.
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