Premenstrual Dysphoric Disorder (PMDD)

PMDD is a severe premenstrual condition.  Symptoms of PMDD vary, but
typically affect your emotional wellbeing.

Premenstrual Dysphoric Disorder (PMDD)

A severe premenstrual condition. Symptoms of PMDD vary, but
typically affect your emotional wellbeing.

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Premenstrual Dysphoric Disorder (PMDD)

PMDD is a severe premenstrual condition. Similar to premenstrual syndrome (PMS), PMDD symptoms are triggered by changing hormone levels in the luteal phase of your cycle (the two weeks before your period). Symptoms of PMDD vary, but typically affect your emotional wellbeing.

PMDD is more than feeling a bit emotional though. For lots of women, PMDD causes them severe mental distress and it impacts their daily lives. PMDD is becoming more widely recognized as a serious mental health issue and The American Journal of Psychiatry thinks that about 5% of women between the ages of 16 and 50 may have PMDD.
The negative feelings that come with PMDD are very real, and sadly many women don’t realize it’s their changing hormone levels that are making them feel the way they do. Women with PMDD can feel hopeless and experience thoughts of harming themselves when symptoms are at their worst.

If you think you may have PMDD it’s important to seek support and help as there is much that can be done to help you feel better. There’s no single test to diagnose PMDD, but a careful look at your medical history by an experienced healthcare provider will help you gain insight into the condition and answer the question, do I have PMDD? There are effective treatments for PMDD that can change your hormonal triggers and help to reduce your symptoms.

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Further reading

Your Cycle Explained

Mental Health & Hormones

Mental Health Life Hacks

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Symptoms of Dysphoric Disorder (PMDD)

Symptoms of PMDD are similar to those of PMS, but the effects are usually more severe for women with PMDD, especially when it comes to psychological symptoms.

Here are a few of the psychological and behavioral symptoms that might indicate you have PMDD:

Symptoms of PMDD

  • Changes to your mood, particularly feeling sad or more depressed than usual.
  • Tiredness or lethargy (that feeling of not wanting to do anything).
  • Feeling extremely anxious, stressed, or worried.
  • Feeling tearful or more emotional than usual.
  • Feeling irritable or annoyed by the people close to you.
  • Difficulty controlling your emotions. You may find yourself raising your voice or snapping at those around you more often.
  • Feeling angry or emotionally out of control.
  • Feeling bad about yourself including having negative thoughts about the way you look.
  • Feeling more forgetful.
  • Not sleeping well and waking more often than usual during the night.

Physical Symptoms of PMDD

  • Sore, ‘full’ or painful breasts.
  • Bloating in your stomach.
  • Constipation.
  • Cramps in your lower abdomen. These can cause pain that interfere with your daily activities.
  • Headaches or migraine episodes
  • Worsening acne or pimple breakouts. You may find you struggle with cystic acne around your jaw. This is where there is no visible ‘head’ to your pimple. These lumps can be sore and painful to touch.
  • Allergy flare ups.
  • Feeling clumsier and struggling with spatial awareness.

Diagnosing PMDD

There are guidelines that doctors will use to help diagnose PMDD.  In order to make a diagnosis, your healthcare provider will need to be able to identify 5 or more symptoms from a set list. These symptoms will need to have occurred each month over a 12-month period.

Your symptoms must include some of the following:

  • marked depression,
  • anxiety, tearfulness, irritability and anger,
  • increased appetite,
  • insomnia,
  • feeling overwhelmed or out of control.

The symptoms of PMDD are usually severe enough that they will interfere with your ability to function normally (such as at school or work). Your doctor will ask you about this and how you feel the symptoms you are experiencing are impacting you. They will also want to ensure your symptoms are not related to, or made worse by existing medical conditions or treatments, so be aware as your healthcare provider may ask you about your medical history including any relevant details about existing mental health conditions.

It is essential you have information about your periods that you can show your doctor, along with records of the symptoms you are experiencing when you seek support. There are plenty of apps to help with recording symptoms each month. Try to keep track of your symptoms for at least 3 months so you have a good idea of what your cycles look like, and the patterns that take place.

The timing of your symptoms and how much they may have an effect on your life are the main things your healthcare professional will want to understand. It may be useful to talk to those closest to you in order to gain other perspectives on your mood and your behavior throughout the month. Sometimes when the symptoms pass, we can forget how bad things were, whereas others will remember how our moods were more clearly.

If you’re worried about remembering all of the information, bring your symptom diary/app data to your doctor’s appointment to jog your memory.

Help with PMDD

There are lifestyle changes and talking therapies that can be beneficial when it comes to treating PMDD. Your doctor may also prescribe you the contraceptive pill. The pill helps to manage your symptoms by keeping your hormones levels stable throughout the month. Your doctor may also advise you to start using antidepressants. Whilst these will not address the impact your changing hormone levels have on your mood, they will help you to manage your symptoms.

Take a look at our information on treating PMS as the same advice will apply to PMDD.

Specialist treatment

Some specialist PMS/PMDD physicians may recommend estrogen therapy to help address the progesterone effects that causes mood changes in the luteal phase of your cycle (the two weeks before your period).

GnRH analogues are medications that ‘shut off’ the ovaries and are very good at helping with severe PMS and PMDD. The medication stops your normal cycle and the hormone changes that usually happen each month. This medication is only prescribed in specialist clinics.

If you take GnRH analogue medication, you need to ‘add-back’ hormones again. You essentially need to mimic a normal cycle by using hormone therapies each month. These are prescribed so that your hormones stay nice and level. You will need to have annual bone scans if you’re using GnRH analogues for more than 6 months. This is to ensure your bone health is well managed as a lack of hormones can impact your bone density.

Surgery to remove your ovaries (with or without removing your uterus too) is a last resort a clinician may suggest if nothing else has worked for your PMDD symptoms. Removing the ovaries means you will no longer have periods and therefore no monthly hormonal fluctuations will occur.

If you’ve had your ovaries removed, you will need to take estrogen and progestin replacement therapy. If you’ve had your ovaries and uterus removed (this is called a total hysterectomy) you will only need to take estrogen therapy after surgery.

Premenstrual exacerbation or PME – a different, but related condition.

Sometimes, existing medical conditions can worsen during the premenstrual period, and this is called Premenstrual Exacerbation (PME).

PME means an existing mental health condition (like a major depressive disorder or generalized anxiety disorder) will become more severe during the luteal phase of the cycle (the two weeks leading up to your period). Physical symptoms (such as muscular or joint pain) that are there most of the time may also worsen during the luteal phase.

For lots of people, it can be difficult to tell if it’s PMDD, or simply an existing condition getting worse. If you’re struggling to figure this out, you might want to think about doing a self screen to help understand your premenstrual experiences.

PME is not yet classified as a separate condition according to the latest medical classification system DSM-5-TR, as more research still needs to be carried out.

Seeking support

If you’re struggling with very low and negative thoughts including thoughts of harming yourself, reach out for support from any of the following organizations.

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