Premenstrual dysphoric disorder (PMDD)

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a hormone-based mood disorder. It causes both physical and emotional symptoms during the luteal phase of the menstrual cycle (from around seven to 10 days before your period). If you have PMDD, you may feel extreme mood shifts that can be debilitating, impacting your day-to-day life and relationships.

Research from the Journal of Affective Disorders shows that around 1.6% of people with periods have PMDD (this equates to around 31 million people across the globe). As this is a largely under-diagnosed condition, however, those in the field suggest a more reasonable estimate is that 5% of people who have periods have PMDD.

It is thought that those with PMDD have an increased sensitivity to certain hormones which leads to the symptoms. Other factors such as genetics, a history of smoking and experience of trauma are also thought to have a role to play. 

In this video, psychotherapist Lauren Connors (MBACP) breaks down what PMDD is, how it affects mental health, and how therapy can help you regain balance.

What is the difference between PMS and PMDD?

Premenstrual syndrome (PMS) is the term used for how you can feel in the lead up to a period. It includes mood swings, increased irritability and tiredness. Physically you may experience bloating, breast or chest tenderness and a change in appetite. This all happens as a result of hormone changes in the body.

PMDD has similar symptoms to PMS but is much more severe and can be life-altering for those living with it. 

PMDD symptoms

If you have PMDD, there are a range of symptoms you may experience, including the following:

• intense mood swings
• feeling low and hopeless, potentially even having suicidal thoughts
• feeling anxious and struggling to focus on tasks
• low energy and difficulty sleeping
• feelings of anger or rejection, possibly leading to conflicts with those around you
• experiencing overwhelm and feeling out of control
• headaches and other muscle/joint pain
• feeling bloated
• change in appetite
• chest or breast tenderness

Because this condition is linked to your menstrual cycle, you will experience these symptoms in the time between ovulating and having your period. This happens every month and can make everyday activities feel difficult. 

Remember, everyone is different and therefore you may experience symptoms unique to you. The important thing to know is that you’re not alone in what you’re going through and that support is available. Getting a diagnosis is a helpful first step to finding the right help.

Getting a PMDD diagnosis

Speaking to your GP can help you get a diagnosis. It can be helpful to track your symptoms for a couple of months before your appointment (or your doctor may ask you to do this after the appointment). Tracking your symptoms alongside your monthly cycle can help you spot patterns that line up with a PMDD diagnosis.

Your doctor should ask some questions to learn more about your experience, including your medical history and your lifestyle. They may ask for physical tests (like blood tests) to see if anything else is contributing to the symptoms. 

Some people do find it difficult to get an accurate diagnosis and data indicates that people wait an average of 12 years to get it. This is because, unfortunately, PMDD is not widely known. Having a record of your symptoms can help, as well as taking the NICE guidelines for PMDD (National Institute for Health and Care Excellence) and someone who can advocate for you to appointments.  

If you feel your doctor is overlooking your symptoms, you can ask to speak to a specialist (someone who works with mental health, gynaecology or endocrinology). You may not always be able to, depending on your GP surgery, but it is a good idea to ask. 

Why are conditions like PMDD overlooked?

Some conditions in the medical field, often those affecting women and those assigned female at birth, have historically been misunderstood. For example, the term ‘hysteria’ was commonly used to describe symptoms experienced by women in the past. 

Times have changed and we have a greater understanding of these kinds of problems today, but there is still a way to go. More research and training are needed to raise awareness in the medical industry and eliminate stigma.

While waiting for support, you may find it helpful to use self-help measures and support groups to help you cope - scroll down to our self-care section for more.

PMDD treatment options: What can help?

If you are diagnosed with PMDD, your doctor will work with you to decide which treatment option is best for you. Several approaches can help including the following:

Lifestyle changes

Making changes to your lifestyle can improve general well-being as well as physical and mental health. These may be recommended before trying other treatments, or alongside them. 

Some changes your doctor may suggest include:

• doing more physical activity
• improving sleep habits
• lowering stress levels
• eating a more varied diet

If you currently smoke or drink, it’s recommended that you quit smoking and reduce the amount of alcohol you have. 

Making small changes at first can help this feel more manageable, as well as having a strong support network around you.

Dietary changes

While more research is needed, certain nutrients are thought to help ease symptoms of PMS and PMDD, such as calcium, vitamin B-6 and magnesium. It’s important to speak to your doctor before making drastic changes to your diet or trying new supplements.

Medication

Certain medications may also be recommended to help you. These might include painkillers to help with physical symptoms or antidepressants to help ease emotional symptoms. You may be advised to take antidepressants throughout the month or just at the time your PMDD symptoms kick in. 

Contraceptives 

Birth control like the pill may be recommended to help regulate your cycles and hormones. Different approaches can be tried here, so work with your doctor to explore your options. You will likely be offered a trial to see how the contraceptive affects your symptoms. 

GnRH analogue injections

Gonadotropin-releasing hormone (GnRH) analogue injections can be used to bring on a temporary menopause. This is usually only offered if other approaches haven’t helped and it may be limited to six months. This is because it can have side effects, including a loss of bone density. It is often combined with hormone replacement therapy (HRT) to help with this and to ease any symptoms of menopause.

Surgery

In extreme cases, your doctor may suggest surgery as an option. This involves removing your uterus, ovaries and fallopian tubes to stop your monthly cycle. This can have a big impact both emotionally and physically, and will likely only be suggested if other treatments haven’t helped. 

Herbal remedies

Again, further research is needed in terms of herbal support for PMDD, but it’s thought that chasteberry could be helpful. Complementary approaches like herbalism aim to complement existing treatments, so be sure to check with your doctor that anything you try won’t conflict with their guidance. 

Be aware that if you are trans, non-binary or trying to get pregnant, your treatment options may differ. Your doctor can work with you to find the best approach for you.

Is PMDD a mental health condition?

PMDD is considered an endocrine disorder because it relates to hormones. It does cause mental health symptoms though, and so it is listed as a mental health problem in the DSM-5 (a manual used to diagnose mental health conditions).

Due to its mental health symptoms, PMDD can be incorrectly diagnosed as another mental health condition, like bipolar disorder. Some people may also have coexisting conditions that make PMDD harder to diagnose. Tracking your cycles and symptoms can help you and your doctors understand what you’re experiencing better. 

The connection between PMDD, mood disorders, and chronic conditions

It’s thought that up to 70% of people with PMDD also have another health condition. Some conditions that have been found to commonly occur alongside PMDD include:

• anxiety
• depression
• bipolar disorder
• ADHD and autism
• Trauma (including PTSD and C-TPSD)
• chronic conditions like chronic fatigue syndrome, IBS and migraines

These intersections can make diagnosis a longer process. This can feel tiring and frustrating, but you’re not alone. With time and the right support, you can find the help you need.

As PMDD impacts and intersects with mental health so much, you may be recommended to try psychotherapy.

Can a therapist help with PMDD?

Speaking to a therapist can help you manage the mental health-related symptoms of PMDD and its impact on your life. The type of therapy you’re offered will depend on your particular circumstances and integrative approaches are thought to be best suited to the complexities of PMDD. Dialectical behavioural therapy (DBT) may also be recommended or, if you’ve experienced trauma, trauma-centred CBT.

• Integrative counselling brings together different elements of specific therapies, depending on the individual’s circumstances.
• DBT helps us deal with difficult feelings and regulate our emotions.
• Trauma-centred CBT uses a trauma-aware approach to help develop coping skills.

The aim of talking therapy for PMDD is to help you understand what may trigger you when your emotions are heightened and what you can do to regulate your emotions. 

A therapist can also give you a safe space to talk to someone about your feelings, helping to limit any feelings of loneliness you may be having. It can also help you strengthen your relationships by improving your communication skills. 

“Counselling can help with PMDD, as it offers us an opportunity to explore and unravel these feelings. It can also give us the space to voice them out loud, without fear of judgement or embarrassment. As well as exploring what we feel, we can also reflect on how these feelings impact our everyday life. Our relationships with others, our work, our sense of identity.”

- Counsellor Georgina Sturmer (MBACP)

PMDD and relationships

If you have PMDD you’ll understand how much your mood and mental health is affected. This can lead to difficulties in your relationships. Loved ones may not know how to support you and you may feel like you become a different person before your period. 

Your mood changes may make it difficult to express what you need. You may feel like you need to push people away and end up isolating yourself at certain points in your cycle. 

Everyday stresses and arguments can also feel intensified because of PMDD, leading to conflict and miscommunication. All of this can make navigating relationships feel more difficult, but it can be done.

Understanding your condition and how the symptoms show up for you is a great place to start. This should help you communicate with loved ones, explaining how PMDD affects you and how it may impact them. 

Together, talk about what may be helpful (and unhelpful!) for you when symptoms hit. Consider what you need and where your loved ones can support you. You may have certain coping mechanisms that help, is there any way to bring in your loved ones? For example, if going for a run helps to reduce stress, could your partner, friend or family member join you?

How can I support a loved one with PMDD?

If someone you care about has PMDD, there are ways for you to support them. Some ideas include:

• Learning about PMDD and how it impacts people.
• Asking how PMDD affects your loved one specifically.
• Asking how you can be there for them when they’re struggling with symptoms.
• Offering to join in with their self-care activities.

If your relationships are being affected by your PMDD and you’re struggling to improve things yourself, it can be helpful to speak to a therapist who offers specialist couples therapy for PMDD. They can help you understand the impact of the condition on your relationship and what may help.

Self-care for PMDD

Taking care of ourselves is important for everyone, but when something is affecting our mental health it can be especially important. If you have PMDD there are some self-care measures you can put into place to help you cope better with the symptoms. Here are some ideas to get you started.

Work on your self-awareness

The more you know yourself and your specific set of symptoms, the better you’ll be able to recognise them. Research PMDD and make notes when you feel you are experiencing symptoms to spot potential triggers and patterns. 

Journaling about your feelings can also help to improve self-awareness in general as it offers space to reflect and investigate emotions. 

Track your cycle

Tracking your cycle and having an awareness of your symptoms can help you plan ahead. For example, you may be able to move certain events to a time when you’ll feel better. Of course, this isn’t always possible, but being aware of when your next cycle is due can help you not be caught off-guard and feel more prepared.

Find someone to talk to 

Talking to someone about how you’re feeling can help you feel less alone. This may be a friend, family member or partner. You may want to try peer support groups, spaces where you can talk to other people with PMDD, who understand what you’re going through.

Mental health charities often have support lines where you can speak to a listening volunteer. This can be a helpful option if you're feeling low - find a list on our helplines page. 

Find ways to reduce stress

Stress can feel even tougher to cope with when you have PMDD, so finding ways to reduce stressors can help. This may include relaxation techniques like:

• meditation
• breathing exercises
• getting more physical activity
• spending more time in nature

If there is an area in your life causing stress, consider reaching out to a professional for support. This may involve addressing work-related stress or easing family tensions. 

Some people find alternative and complementary therapies helpful in reducing stress, such as aromatherapy, reflexology and Reiki. We’re all different, so experiment and see what feels like a good fit for you.

Working with a doctor, a therapist and upping your self-care creates a well-rounded approach to managing PMDD. What you’re going through may feel incredibly difficult at times, but there are ways to ease symptoms and feel more like yourself, every day of your cycle.

If PMDD is affecting your life, speaking to a therapist can help. Use our site to find a qualified professional today.

Further resources

• The International Association for Premenstrual Disorders (IAPMD)
• The National Association for Premenstrual Syndromes (NAPS)
• PMDD self-care (Mind)