Premenstrual dysphoric disorder (PMDD)

What's PMDD?

PMDD is a severe type of premenstrual syndrome (PMS). It affects 1 in 50 people who have periods.

PMDD symptoms start in the weeks before your period and can make it difficult to get on with life normally. They happen during the second half of your menstrual cycle — after you ovulate. Symptoms are more severe four days before your period up until the second or third day of your period. 

Symptoms usually go away in the week after your period.

What causes PMDD?

The exact causes of PMDD are unknown, but you might be very sensitive to the hormonal changes happening in your body. Genetic variations you inherit from your parents could be a reason for this.

Some evidence suggests you’re more likely to have PMDD symptoms if you’ve experienced past traumatic or stressful events. 

PMDD symptoms

PMDD symptoms are like PMS symptoms, but much worse. Both have physical and emotional symptoms, but when you have PMDD, the emotional symptoms are so severe that they cause significant disruption to your life.

Symptoms for both PMS and PMDD include:

• tummy pain
• bloating
• fatigue
• joint pain
• headache
• breast pain
• changes in your behaviour — like binge eating
• finding it hard to concentrate
• feeling overwhelmed and/or out of control

PMDD symptoms also include:

• feeling hopeless or depressed
• severe anxiety
• mood swings
• suicidal feelings
• feeling angry and irritable

These symptoms almost completely go away in the week after your period.

PMDD symptoms, unlike PMS symptoms, really interfere with your day-to-day life. They can be very distressing and might affect your ability to work, go to school, or do daily activities.

If you’re having suicidal thoughts, you can call the Samaritans for free on 116 123. 

Find out how hormones can affect your sleep.

How is PMDD diagnosed?

You should see a GP if PMDD is affecting your everyday life. 

They might ask you to track your symptoms every day for at least 2 months. This can help clarify if your symptoms follow a pattern during your menstrual cycle. If you have physical symptoms, they might also suggest you have a blood test to rule out other health problems like thyroid disorders.

If you experience at least a few of these symptoms and they’re having a big impact on your life, your doctor might diagnose you with PMDD.

Your GP can discuss a few management options with you, but if none of these work for you, you might find it helpful speaking to a specialist.

Is there treatment for PMDD?

There are things you can do to manage your PMDD symptoms at home, including:

• getting plenty of sleep — this can give you the energy to cope with difficult emotions
• regular exercise — this can reduce depression and help you relax
• meditation — this might help you relax
• maintain a healthy diet — this might help improve your mood and energy levels

If these don’t work and PMDD is still having a big impact on your life, your GP or specialist might recommend:

• hormonal medicine — like the combined pill
• antidepressants — citalopram is often used to alleviate anxiety and to keep your serotonin levels consistent throughout your menstrual cycle
• painkillers or anti-inflammatory drugs
• talking therapy — like cognitive behavioural therapy (CBT)

If your PMDD symptoms are very serious, your doctor might suggest treatments that lead to temporary menopause. These are called gonadotropin-releasing hormone (GnRH) analogues.

They might also talk to you about having an oophorectomy — an operation to remove your ovaries. This might or might not be combined with a total hysterectomy — an operation to remove your womb (uterus). You can’t get pregnant after these surgeries, so they’ll only consider this if your symptoms are very severe.