At a glance
- Anhedonia is the loss of interest or pleasure in things that usually feel good, from hobbies to sex to time with people you love.
- It's one of the symptoms counted toward a PMDD diagnosis, alongside physical symptoms and at least one mood symptom (DSM-5-TR).
- In PMS, anhedonia can show up before your period and ease once bleeding starts, without needing a diagnosis.
- Doing something small anyway, even without expecting it to feel good, can help in the moment.
- If this pattern takes over most days for a week every month, bring two months of daily notes to a GP or gynecologist.
What is anhedonia?
Anhedonia means losing interest or pleasure in things that usually feel good. It's not the same as being tired or busy. The things themselves haven't changed, but your reaction to them has.
- A hobby that used to feel exciting now feels pointless
- Time with friends or your partner feels flat instead of warm
- Food, music or sex stop giving the lift they used to
It reflects a real shift in how your brain registers reward. That shift can show up on its own or alongside other mood changes during the luteal phase, the week or two before your period.
How does anhedonia show up in PMS and PMDD?
In PMS, a dip in interest or pleasure can turn up in the days before your period and ease once bleeding starts. It's common, and it doesn't need a diagnosis.
In PMDD, decreased interest in usual activities is one of the symptoms doctors look for, alongside physical symptoms and at least one mood symptom such as irritability, low mood or anxiety (DSM-5-TR).
| PMS | PMDD | |
|---|---|---|
| Timing | One to two weeks before your period | Mostly the last week before your period |
| Intensity | Noticeable but manageable | Marked, hard to push through |
| Confirmed by | A pattern you notice over a few cycles | Daily symptom ratings over at least two cycles |
A PMDD diagnosis needs at least five symptoms total, easing within a few days of your period starting. PMDD explained covers the full criteria, and what causes PMDD looks at why some brains react more strongly to normal hormone shifts.
What does the research say, and why does it matter for treatment?
Neuroimaging research on PMDD describes differences in how the brain responds to emotional situations, not just low mood in general. Studies found altered activity in the amygdala and reduced activity in the front of the brain that regulates emotion, a pattern tied to how emotional information gets processed, not to willpower (Frontiers in Neuroendocrinology, 2020).
Guidelines for premenstrual disorders, agreed by international consensus, recommend a few main options, and a doctor decides what fits your situation (ISPMD consensus, 2016):
- SSRIs, which can work even when taken only in the luteal phase
- Some hormonal contraceptives, which a 2021 meta-analysis found may ease premenstrual depressive symptoms, though the evidence is still limited (American Journal of Obstetrics and Gynecology, 2021)
- CBT
Coping ideas aren't treatment. Doing something small anyway, a short walk, a call with a friend, even without expecting it to feel good yet, can help in the moment. If you want somewhere to notice the pattern and calm down in the days before your period, Niyora is a PMS and PMDD support app. Its Moon feature lets you write down what's going on and see it from another angle before you decide what to do next.
What related terms should you know?
A few terms show up alongside anhedonia in PMS and PMDD research and explain what's changing in your body.
- Luteal phase: the second half of your cycle, when estrogen and progesterone fall and anhedonia tends to appear. See the luteal phase.
- Allopregnanolone: a hormone byproduct linked to mood changes before your period. See Allopregnanolone.
- Corpus luteum: the structure in your ovary that makes progesterone after ovulation, then breaks down and triggers the hormone drop. See Corpus Luteum.
For the research behind these terms, Niyora's research page summarizes PMS and PMDD studies in plain English.
From the research library
Research on low mood
1,946 studies in the library look at low mood in PMS and PMDD. They were published from 1964 to 2026, and each one has a short summary of what was tested and found.
1,946
studies, 1964 to 2026
How strong the studies are
- Strong study design
- 161
- Moderate study design
- 660
- Early or limited evidence
- 1,125
Cohort study, 2026
What genetic factors are linked to premenstrual symptoms?
One genetic location on chromosome 12 was clearly associated with PMS. The genetic factors linked to PMS are also linked to depression.
Strong study design
Systematic review, 2026
How often do mood disorders and PMS or PMDD occur together?
Very often. Between 42% and 49% of women have both PMS or PMDD and a mood disorder at the same time, depending on which condition was diagnosed first.
Strong study design
Systematic review, 2026
Does continuous paroxetine or birth control work better for PMDD?
Both antidepressants and birth control pills are effective for PMDD. Continuous paroxetine (an antidepressant) and DROS/EE 24/4 (a specific birth control) showed the strongest effects in studies reviewed, though the evidence comes from relatively few studies.
Strong study design
Randomised trial, 2026
Does Kundalini Reiki help reduce PMS symptoms and improve quality of life?
Yes, according to this rigorous double-blind study. Nursing students receiving Kundalini Reiki showed significantly greater improvements in PMS symptoms and quality of life compared to those who received placebo.
Strong study design
Cohort study, 2026
Does having PMS before pregnancy increase the risk of postpartum depression?
Yes. Women with a PMS history were 45 percent more likely to develop postpartum depression within one year after birth, with 5.4 percent of women with PMS developing it compared to 3.8 percent without PMS.
Strong study design
Systematic review, 2026
Does vitamin D supplementation help PMS symptoms?
Vitamin D reduced overall PMS severity and particularly helped with physical symptoms and depression, but the certainty of this evidence is very low. We cannot be confident in these findings yet and more high-quality research is needed.
Strong study design
Questions people ask
Is anhedonia the same as depression?+
No. Anhedonia is a symptom, loss of interest or pleasure, that can show up in depression, PMDD, PMS or on its own. In PMDD, anhedonia follows the cycle and eases within days of your period starting, while depression's anhedonia doesn't depend on timing.
Can PMS cause anhedonia?+
Yes. PMS can include anhedonia, a drop in interest or pleasure, in the week or two before your period, along with other mood or physical changes that come and go with your cycle. It usually eases once bleeding starts and doesn't need a diagnosis, unlike PMDD.
How is anhedonia diagnosed as part of PMDD?+
Anhedonia counts toward a PMDD diagnosis when it's one of at least five symptoms, tracked daily across two cycles, confined mostly to the week before your period, and easing within a few days of it starting, as set out in DSM-5-TR criteria.
What helps with anhedonia before your period?+
For anhedonia before your period, doing something small anyway, even without expecting it to feel good, like a walk or a short call with a friend, can help in the moment. SSRIs, some hormonal contraceptives and CBT are guideline-recommended options a doctor can discuss with you.
Does anhedonia mean something is wrong with me?+
No. Anhedonia linked to your cycle reflects how your brain responds to normal hormone shifts, not a flaw in you. Tracking it for a cycle or two can show whether it follows a pattern tied to your period, rather than something separate going on.
Sources
- 1.Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder, Archives of women's mental health, 2016
- 2.Neuroimaging premenstrual dysphoric disorder: A systematic and critical review, Frontiers in neuroendocrinology, 2020
- 3.Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials, American journal of obstetrics and gynecology, 2021