Premenstrual Dysphoric Disorder (PMDD) is a severe, clinically diagnosable form of premenstrual syndrome (PMS). It is a hormone-based mood disorder where you experience intense emotional and physical symptoms in the week or two before your period (the luteal phase) that significantly interfere with your daily life, work, and relationships.
PMDDis a recognized medical condition, not a personal weakness or “just bad PMS.”
The symptoms are cyclical, appearing after ovulation and resolving within a few days of your period starting. It affects an estimated 3-8% of women and people who menstruate.
Common Symptoms
PMDD symptoms are severe and primarily affect mood and behaviour, though physical symptoms are also present. You must have at least 5 symptoms, with at least 1 being a core mood symptom.
Core Mood & Behavioural Symptoms (At least one of these)
- Severe mood swings, sudden sadness, or increased sensitivity to rejection.
- Marked irritability, anger, or increased interpersonal conflicts.
- Significantly depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, or feeling “on edge.”
Other Common Symptoms
- Decreased interest in usual activities.
- Difficulty concentrating, feeling “foggy.”
- Profound lack of energy, fatigue.
- Changes in appetite (overeating or specific food cravings).
- Sleep problems (too much or too little).
- Feeling overwhelmed or out of control.
- Physical symptoms: Breast tenderness, bloating, headaches, joint/muscle pain.
Crucial Pattern: Symptoms must be absent in the week after your period.
Causes & Risk Factors
The exact cause is not fully understood, but it is believed to be linked to an abnormal brain response to normal hormonal changes during the menstrual cycle.
- Hormonal Sensitivity: People with PMDD are thought to be exceptionally sensitive to the normal rise and fall of oestrogen and progesterone after ovulation. This sensitivity affects serotonin, a key brain chemical that regulates mood.
- Genetic Link: It often runs in families.
- Risk Factors: Personal or family history of depression, anxiety, postpartum depression, or other mood disorders. History of trauma or stress can also be a factor.
Diagnosis
There is no blood test or scan for PMDD. Diagnosis is clinical and based on a strict pattern.
- Symptom Tracking: Your gynaecologist will ask you to keep a daily symptom diary (e.g., using a scale from 1-10) for at least two menstrual cycles. Apps or paper charts can be used. This is the most important diagnostic tool.
- Diagnostic Criteria: Your symptoms must meet specific criteria (like the ones listed above) and show a clear, repetitive pattern linked to your cycle.
- Rule Out Other Conditions: Your gynaecologist will ensure symptoms are not due to another underlying condition like depression, anxiety disorder, thyroid disease, or perimenopause, which can be continuous or erratic.
Management & Treatment Options
Treatment is highly effective and aims to stabilise mood by targeting hormonal fluctuations or brain chemistry.
Lifestyle & Complementary Therapies (Foundation for Management)
- Regular Exercise: Can boost serotonin and reduce stress.
- Balanced Diet: Small, frequent meals rich in complex carbs; reducing salt, caffeine, alcohol, and sugar, especially in the luteal phase.
- Stress Reduction: Mindfulness, yoga, cognitive behavioural therapy (CBT) specifically for PMDD.
- Sleep Hygiene: Prioritising regular, quality sleep.
Medications (First-Line)
- SSRI Antidepressants: These are often the first-choice medication. They work rapidly on serotonin and can be taken either continuously every day or intermittently (just in the 14-day luteal phase). Examples: Sertraline, Fluoxetine, Citalopram.
- Hormonal Treatments: To stop ovulation and stabilise hormones.
- Combined Oral Contraceptive Pill: Certain pills (like those containing drospirenone, e.g., Yaz/Yasmin) taken continuously (skipping the placebo week) are FDA-approved for PMDD.
- GnRH Agonists: Induce a temporary, reversible medical menopause. Used for severe, treatment-resistant PMDD, often with “add-back” hormone therapy to protect bones.
Specialist Support:
- Cognitive Behavioural Therapy (CBT): Highly effective in developing coping strategies.
- Surgical Option: In the most extreme, unremitting cases where family is complete, oophorectomy (removal of ovaries) followed by HRT may be considered as last resort.
Possible Complications & Long-Term Outlook
- Impaired Functioning: Can severely impact work performance, academic achievement, and social life.
- Strained Relationships: Extreme irritability and mood swings can damage relationships with partners, family, and friends.
- Co-existing Mental Health Issues: High risk of major depressive episodes, anxiety disorders, and suicidal thoughts.
- Positive Outlook: With the correct diagnosis and a tailored treatment plan, most people experience significant improvement and regain control of their lives.
Frequently Asked Questions (FAQs)
Q: Is PMDD just a bad case of PMS?
A: No. While they share symptoms, PMDD is distinguished by the severity of emotional symptoms (like anger, despair, suicidal thoughts) and the degree of functional impairment. It is a distinct psychiatric diagnosis.
Q: Are the mood symptoms “all in my head”?
A: No. The symptoms are very real and have a clear neurobiological basis secondary to your brain’s sensitivity to hormonal shifts. It is a physical disorder with psychiatric manifestations.
Q: Will I have this forever?
A: Symptoms typically continue until menopause. However, with effective management, they can be well-controlled month-to-month. Symptoms naturally cease after menopause.
Q: Can I take an SSRI only when I feel bad?
A: The unique feature of PMDD is that intermittent luteal-phase dosing of SSRIs (taking them only in the 14 days before your period) is a proven and effective strategy, unlike for major depression.
Q: If I have PMDD, will I be a bad parent or have postpartum depression?
A: Having PMDD does not predict your ability to parent. However, you are at a higher risk for postpartum depression or anxiety. Informing your obstetrician allows for a proactive support plan during and after pregnancy.
eGynaecologist Advice
- You must track your symptoms daily for at least two full cycles before your consultation. This record is the single most important tool for an accurate diagnosis and effective treatment plan.
- You should seek a consultation with a gynaecologist or psychiatrist experienced in PMDD if your premenstrual symptoms are severe enough to disrupt your work, education, or relationships. You do not need to suffer in silence.
- You must be open to trying medication, particularly SSRIs, which are considered first-line treatment. They work differently for PMDD than for chronic depression and can bring rapid relief.
- You should build a personalised wellness toolkit that includes lifestyle strategies (diet, exercise, sleep) and psychological support (CBT) alongside any medical treatment for the most comprehensive management.
