Premenstrual dysphoric disorder (PMDD)

What is PMDD?

For women and people who have periods, the monthly menstrual cycle can bring a range of physical and emotional symptoms.

Although there is much more we need to find out about the causes, it’s likely the menstrual cycle causes changes in hormones leading up to and during a period.

The days between ovulation and the onset of menstrual bleeding (the period) are referred to as the luteal phase. The luteal phase is characterised by the rise and fall of the hormones oestrogen and progesterone.

Premenstrual dysphoric disorder (PMDD) is a mood disorder with symptoms starting during the luteal phase of the menstrual cycle and ending within a few days after the start of the period.

Every person’s premenstrual symptoms differ, and every experience is valid.

However, to be diagnosed with PMDD, these symptoms need to be associated with extreme distress and interfere with ‘everyday’ functioning.

These symptoms typically present the 7-10 days before menstruation, and improve or subside within a few days of the period starting.

Psychological symptoms can include:

feeling depressed or severe low mood
anxiety and/or feelings of being ‘keyed up’ or ‘on edge’
rapid and exaggerated changes in mood
irritability or anger
decreased interest in usual activities e.g. work, school, friends, hobbies
difficulty in concentration
becoming easily fatigued, or lacking in energy
change in appetite and sleep
feeling overwhelmed or out of control

Physical symptoms can include:
breast tenderness or swelling
joint or muscle pain
bloating
weight gain

If you’ve already been diagnosed with a condition like depression, panic disorder, or persistent depressive disorder (dysthymia) and your symptoms get worse during the luteal phase of your menstrual cycle, this is called premenstrual exacerbation (PME), not PMDD.

Whilst there are no physical tests to diagnose PMDD, the diagnosis is made by tracking symptom severity alongside your menstrual cycle for at least two months.

Recent research has shown that 80% of people who have periods report experiencing mild mood or physical changes during the luteal phase (i.e. premenstrual symptoms).

However, it is estimated that only 1% to 5% of women and people with periods experience PMDD. That is around 80,000 people in the UK.

Anyone who has periods can have PMDD. It is important that everyone can receive the support they need with their mental health.

the impact of hormone replacement therapy can have effects on symptoms. Charities such as The PMDD Project and the International Association of Premenstrual Disorders (IAMPD) can provide information and links to support groups.

Treatments

More research is needed to improve the treatments currently available for those living with PMDD. If you think you’re experiencing PMDD symptoms, speak to a GP or other health professional.

Lifestyle changes are usually the first step to try to help minimise the symptoms of PMDD.

Getting plenty of sleep and exercise whilst eating a healthy diet that is rich in protein, complex carbohydrates, fruits and vegetables.

This may be especially challenging while experiencing these symptoms but reducing stress and getting enough sleep can help improve your wellbeing in the long-term.

Selective serotonin reuptake inhibitors (or SSRIs) are a type of antidepressant that are typically the first treatments that doctors recommend.

They can sometimes be taken daily throughout the whole month or just during your luteal phase. They are used to help to reduce the mood symptoms associated with PMDD.

There are several different types of SSRIs so it’s important to work with your doctor to find the one best suited to you.

Combined oral contraceptives (often referred to as the pill) can sometimes be helpful with managing symptoms of PMDD by controlling or stopping ovulation. However, the evidence for this as a treatment is mixed.

Talking therapy and counselling can be useful in helping to manage the psychological symptoms of PMDD. Some research does support cognitive behavioural therapy (CBT) being effective for managing symptoms for some people with PMDD.

Chemical (temporary) menopause with Gonadotropin releasing hormone (GnRH) analogue injections can be helpful in reducing symptoms of PMDD forin some people.
The treatment is often limited to few months and should be combined with hormone replacement therapy (HRT) to relieve menopause symptoms and reduce bone density loss, which is some of the side effects associated with the treatment.

Surgical menopause is only recommended in very severe cases and carries a risk of complications and cannot be reversed.

It involves a bilateral oophorectomy (an operation to remove your ovaries and fallopian tubes), sometimes together with a total hysterectomy (an operation to remove your uterus), and requires follow-up treatment with HRT.

Tips for people with PMDD

If you are struggling to talk to your GP about PMDD, the International Association for Premenstrual Disorders (IAPMD) has some guidance on advocating for yourself.
Find peer support through forums and support groups like the PMDD Project where you can find a supportive community of people with PMDD.
Talk about PMDD with the people in your life.

Tips for partners, family and friends

Ask the person with PMDD what they find helpful.
Educate yourself by reading about PMDD.
Look after yourself while you support them.
Join a PMDD support group.

Take part in our PMDD research

Our PreDDICT study aims to understand PMDD and how individuals at risk of psychiatric disorders are impacted by reproductive events, such as the menstrual cycle.

Resources

NCMH leaflet: Premenstrual dysphoric disorder (PMDD)
NCMH mood diary: We have produced mood diaries to help you track your symptoms over two of your menstrual cycles. This can be used to take to your GP.

Piece of Mind podcast: PMDD – the hidden link between hormones and mental health

Becci Smart and Chloe Apsey to discuss the reality of living with Premenstrual dysphoric pisorder (PMDD) and the research currently taking place at the NCMH that’s looking to learn more about improving diagnosis and treatment.

Animation: What is PMDD?

Webinar: Myths and Misconceptions of PMDD

Professor Arianna Di Florio who is leading research into PMDD at the NCMH was joined by Laura Murphy from the International Association for Premenstrual Disorders (IAPMD) to discuss the common myths and misconceptions of PMDD from a clinical and personal perspective.