Premenstrual dysphoric disorder (PMDD)

A woman with red hair applies mascara to her eyelashes.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a mood disorder that is estimated to affect around 5.5% of women and people who experience periods. That’s around 80,000 people in the UK.

During the week before the onset of bleeding (known as the luteal phase of the menstrual cycle), these individuals experience severe mood and emotional changes including anxiety and low mood, a decreased interest in usual activities, difficulties concentrating and more. 

These symptoms start to improve within a few days after the onset of menstrual bleeding (the period).  

PMDD is directly linked to the menstrual cycle – however, it is not a result of a hormone imbalance but is believed to be a severe negative reaction to the natural fluctuations of oestrogen and progesterone that occur in the cycle.  

People with PMDD don’t experience any symptoms between their periods and ovulation.

Symptoms of PMDD

During the week before menstrual bleeding known as the luteal phase, people with PMDD experience symptoms such as:

  • depression or severe low mood
  • anxiety
  • decreased interest in usual activities (such as work, school, interacting with friends, and hobbies)
  • rapid and exaggerated changes in mood
  • irritability or anger
  • lethargy, becoming easily fatigued, or a lack of energy
  • hypersomnia or insomnia
  • feelings of being overwhelmed or out of control

These symptoms can be present for more than two consecutive cycles and start to subside within a few days after the onset of bleeding.

Individuals who have been diagnosed with another mood disorder, such as major depressive disorder, panic disorder or persistent depressive disorder (dysthymia) – may find the symptoms associated with this disorder worsen during the week before menstrual bleeding. 

This is called Premenstrual Exacerbation (PME) which is distinguished from PMDD due to symptoms continuing throughout the full month.

Although PME is not currently recognised as an official diagnosis, it is still important to acknowledge and discuss in order to be direct to the right treatment and support. 

Treatments

More research is needed to improve the treatments currently available for those living with PMDD.

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.

Whilst there are no physical tests to diagnose PMDD, the diagnosis is made by examining records of your mood kept daily for at least two menstrual cycles.

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.

If you think you are experiencing PMDD symptoms then speak to a GP or other health professional.

Last line treatments for PMDD

Chemical (temporary) menopause with Gonadotropin releasing hormone (GnRH) analogue injections can be helpful in reducing symptoms of PMDD in 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.
  • Try tracking your cycle and mood symptoms through apps like Me v PMDD.
  • Try peer support through IAPMD forums and video groups.
  • Have a look at some of the IAPMD guidance on how to 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 support group through IAPMD.

Resources

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.

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