What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a hormone-related disorder that affects not only your body but also how you feel.

As a more severe form of PMS (premenstrual syndrome), PMDD can particularly impact day-to-day life. Symptoms are thought to be triggered during the luteal phase of a woman’s menstrual cycle, when progesterone and oestrogen levels drop around days 22-24.¹ This phase starts around day 15 of a 28-day cycle and ends when your period arrives. Although symptoms can occur throughout this phase, it’s believed they are strongest during the second half.¹

It’s estimated that as many as 30% of women and people with periods experience moderate to severe PMS, while 5-8% in the UK have PMDD.²

PMDD was listed in the International Classification of Diseases (ICD-11) in 2019, validating the medical diagnosis of this serious women’s health condition. However, PMDD symptoms are similar to other health issues, which means it’s still going underdiagnosed.

Misunderstood symptoms of PMDD

Around 1.6% of women and girls experience symptoms of PMDD worldwide.³ There are a range of typical emotional and physical symptoms to be aware of, such as anxiety, headaches, breast tenderness/swelling and appetite changes.

However, there are also five symptoms of PMDD to look out for that can help with distinguishing the condition from other health problems and getting a more accurate diagnosis.

1) Feeling overwhelmed

While it’s normal to feel overwhelmed occasionally as a result of life stressors, it can negatively impact your health and is a sign of PMDD that shouldn’t be ignored. This may include having irrational thoughts about a situation, experiencing a freeze response where you avoid or postpone tasks, withdrawing from a situation and friends/family, or overreacting to situations that wouldn’t usually affect you.

2) Increased irritability

Being irritable around your time of the month is due to fluctuations in serotonin levels and can be a symptom of PMS. However, irritability on a more severe scale can be a sign of PMDD. Increased irritability may cause conflict in relationships and negatively impact everyday life, so it’s important to recognise this symptom, especially as this may be more noticeable around your period.

3) Muscle aches

This is a harder symptom to recognise if you regularly exercise and experience achy muscles from workouts. However, pay close attention to when the muscle aches happen, as if it aligns with your luteal phase and affects areas of the body you haven’t worked out as much, this could be a sign of PMDD that would instead go under the radar.

4) Bloating

A symptom many females will experience around their period is bloating, due to hormonal changes and water and salt retention. Yet, this is also a key sign of PMDD, especially if the bloating is severe, so it’s important to pay attention to this symptom.

5) Changes in sleep patterns

Struggling to sleep, sleeping more than usual or insomnia are also signs of PMDD. If you’re stressed and busy, you may put it down to these factors, however it could be PMDD symptoms such as anxiety that’s impacting your sleep. Hormonal shifts can also impact sleep patterns, which could be due to PMDD.

How to be effectively diagnosed

Some people find getting a diagnosis of PMDD really difficult. Mental health charity, Mind, highlights this could be due to it taking time to realise your symptoms follow a cycle and that they are linked to your period. It can also be because PMDD is not very well known, even amongst health professionals.⁴

Many symptoms of PMDD overlap with health issues including depression, anxiety and thyroid conditions. It’s vital to ensure you can provide as much detail as possible about your symptoms when visiting a medical professional, so the diagnosis can be as accurate as possible.

Noting down any correlations to your period will also help to distinguish if it is PMDD, too. A symptom diary can be invaluable.

Top tips for supporting your PMDD diagnosis

• Ask questions: Prepare for your appointment by writing down any questions you have or anything you’re unsure about, so you don’t leave the appointment with unanswered queries.
• Speak up: If you think you meet the criteria for most of the PMDD symptoms, voice this in your appointment by saying ‘I think I have PMDD’ during the conversation.
• Monitor symptoms: Keep a diary of your symptoms to find if they worsen during your luteal phase, which will help a doctor understand if it’s linked to PMDD or not.
• Be open and honest: Being honest with your doctor and yourself about your lifestyle is important, as small changes could impact your symptoms.
• Provide feedback: If a specific treatment is recommended that you’re hesitant about or have already tried, make sure to let your medical professional know.
• Seek further support: Ask to speak to a GP with a special interest in women’s health or for a referral to a gynaecologist if you aren’t responding to initial treatment and you feel you need more support or in-depth advice.

How to relieve PMDD symptoms

PMDD is a severe long-term women’s health condition, which affects each person differently. Getting a diagnosis as soon as possible is essential for easing symptoms, getting the right support and making life more manageable.

1) Lifestyle changes

Start with lifestyle changes to see if it eases symptoms and can complement any over-the-counter pain relief medications, or those prescribed by your doctor. Changes to help reduce the severity of symptoms include:

• opting for alcohol-free and decaffeinated drinks,
• eating more protein and carbohydrates,
• consuming less sugar and salt,
• and incorporating regular light exercise and meditation to help with relaxation and better-quality sleep.

2) SSRIs (selective serotonin reuptake inhibitors)

SSRIs are antidepressants that have been found to help PMDD and can either be taken daily or during your luteal phase, which your doctor will advise on. The dosage can be adjusted to suit you individually and reviewing after two months is important to make sure this treatment is suitable.

3) Oral contraceptives

The pill can help with reducing symptoms, especially oral contraceptive types that stop ovulation, however, there are side effects to take into account and different contraceptives will work for some and not others.

Trialling a specific contraceptive pill for three months, after discussing it with your doctor, will help to see if the treatment is right for you, and can be a test and trial option until you find the pill that works for you.

Build a strong support system

If you have PMDD, it’s important to build a support system around you. This can include partners, family, friends, and health professionals who understand the condition. Counselling can also play a role in helping you to develop coping strategies.

There are also specific PMDD support groups and online communities, which can provide both emotional support and valuable resources. For example:

• The International Association for Premenstrual Disorders (IAPMD)
• National Association for Premenstrual Syndromes (NAPS)
• Mind: Premenstrual dysphoric disorder

Supporting someone with PMDD?

It can be hard to know how to help, but there are a number of ways you can show support. From taking it seriously and understanding how difficult it can be to cope with symptoms, to knowing how to reassure them that symptoms will soon pass, and they they’re not alone. Mind provides a helpful list of ways you can support a loved one through their PMDD journey.

>More information on period health and the 4 menstrual phases can be found here.

References

1. What Happens to Hormone Levels During the Menstrual Cycle? – Flo
2. Raising awareness of PMDD – Royal College of Obstetricians & Gynaecologists
3. The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis – Science Direct
4. What if I'm struggling to get a diagnosis? – Mind