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An introduction to PMDD: symptoms, diagnosis and management techniques

Laura Harcourt

Written byLaura Harcourt

Ms Roopa Navani

Reviewed byMs Roopa Navani

Portrait of a smiling mature woman standing in her apartment
PMDD can cause symptoms severe enough to disrupt your daily activities. Here, we’ll discuss these symptoms and how you can manage them effectively.
If you experience severe symptoms in the lead-up to your period that interfere with your daily functioning, you may have premenstrual dysphoric disorder (PMDD).

PMDD isn’t just your average bout of premenstrual syndrome (PMS). It’s a disorder that can cause a whole range of debilitating physical and emotional symptoms.1

Research into PMDD is ongoing, but millions of women experience its impact right now. We may not have all the answers yet, but you’re not alone. We do know that PMDD affects 5–8% of women and causes significant distress and disruption to day-to-day activities.1 The good news is, there are several ways to help reduce your symptoms and improve your quality of life.

In this article, we discuss all you need to know about PMDD and its symptoms – from how doctors diagnose and treat it, to some of the best management strategies you can try.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). Around 40–90% of people with periods experience at least one symptom of PMS each month like bloating or mood swings, but PMDD can significantly disrupt daily life.2,3

While PMS and PMDD share similar symptoms, PMDD symptoms are more intense, resulting in extreme shifts in mood, including depression, irritability, and anxiety.1,4 PMDD also typically causes significant distress and interferes with work, school, social activities, and relationships with others.1,5,6

Some researchers believe that PMDD may occur between ovulation and the start of your period, known as the menstrual cycle’s luteal phase.1,6

Causes of PMDD

While experts don’t currently know the exact reason for PMDD, they suggest that genetic, hormonal, biological, and environmental factors can all play a role.1,5,7

Due to the timing of symptoms, researchers suspect that hormone fluctuations after ovulation and before menstruation could trigger PMDD symptoms.6,7,8

Serotonin levels are also thought to contribute to PMDD. This chemical messenger in the brain helps to regulate mood and behaviour and, like hormone levels, can fluctuate throughout your menstrual cycle.1,7

PMDD symptoms

If you have PMDD, you may experience some of the symptoms listed below.

While these can differ in their occurrence, duration and severity from person to person, they tend to occur during most menstrual cycles, are present in the week before your period starts, and will typically improve after you start your period.4

Emotional symptoms

PMDD can cause a range of feelings and emotions that can become overwhelming. Some of the most common emotional symptoms of PMDD include:1,9
  • suddenly feeling sad or tearful
  • mood swings
  • increased sensitivity to rejection
  • irritability anger being argumentative or confrontational
  • low mood
  • anxiety
  • feelings of hopelessness
  • low self-esteem or poor self-image
  • anxiety
  • tension
  • feeling on edge, overwhelmed, or out of control 
When you’re going through emotional symptoms of PMDD, it can be helpful to seek support from your friends and family.

Although it can sometimes be challenging to describe what you’re going through to others, it’s important to know that your symptoms are real and that your feelings are valid. The simple act of having someone listen and show you that they care can help in itself.

Physical symptoms

Many of the physical symptoms of PMDD are similar to those of PMS but more severe. These may include:1,9
  • fatigue
  • depression
  • a lack of energy
  • appetite changes, such as overeating or craving specific foods
  • abdominal pain
  • headache
  • difficulty sleeping insomnia
  • breast tenderness or pain
  • bloating joint or muscle pain
  • restlessness 
  • nausea
  • constipation

Cognitive symptoms

PMDD is also associated with a range of cognitive symptoms. These can include:1,10,11
  • poor concentration
  • inattention memory problems
  • a lack of mental motivation
  • impaired work productivity

Diagnosing PMDD

If you suspect you might have PMDD, the first step is to consult your GP.5,12

During your appointment, your GP may ask you to track your symptoms over a couple of months to see whether they align with your menstrual cycle. They may also ask about your lifestyle, examine you, and request a blood test to rule out any other medical problems.12,13

There are specific criteria that doctors use to diagnose PMDD. For example, emotional, physical or cognitive symptoms all have to start several days before the start of a period, improve a few days after, and become minimal within a week.1,13
Symptoms of PMDD have to include at least one emotional symptom, such as mood swings, depression, or anxiety, and any number of physical or cognitive symptoms. They also need to be severe enough to result in significant distress and impairment across multiple areas of your life.1,8

Treatment options for PMDD

Several treatments can be effective at treating PMDD. Once diagnosed, your doctor will recommend the most suitable treatment for you depending on the symptoms you’re experiencing, their severity, and several other factors.14

Treatment for PMDD typically involves a combination of interventions, including lifestyle changes, talking therapy, nutritional supplements, and certain medications.1,14

Lifestyle changes

Your doctor will likely recommend certain lifestyle changes to help reduce the severity of your symptoms. This can include:1,14
  • exercising regularly
  • prioritising your sleep
  • managing your stress levels through relaxation, meditation, yoga, and breathing techniques
  • eating small, balanced meals containing complex carbohydrates every two to three hours
  • cutting down or stop smoking
  • reducing your alcohol consumption
Implementing these changes may reduce your symptoms of PMDD to a manageable level without any need for medication. However, your GP may also suggest you modify your lifestyle alongside another type of treatment.14

Talking therapy

If you have moderate to severe PMDD symptoms, your GP may refer you for counselling or talking therapies, such as cognitive behavioural therapy (CBT). Some research indicates that CBT that takes place either in-person or online can be beneficial for people with PMDD.14-18

Medications

Alongside talking therapy and various lifestyle recommendations, your GP may also recommend taking certain over-the-counter or prescription medications for PMDD. This may include:1,7,14,19,20,
  • paracetamol or anti-inflammatories like ibuprofen or aspirin for pain
  • combined oral contraceptives for managing or stopping periods
  • antidepressants known as selective serotonin reuptake inhibitors (SSRIs) to reduce emotional PMDD symptoms
Please speak to your GP when it comes to the use of over-the-counter or prescription medications for the treatment of PMDD, and they will help you find the right solution.

The final say

PMDD is a complex and challenging disorder that can have a significant impact on your daily activities. But this doesn’t mean this has to take over your life, there’s many options to look into as we’ve discussed above.

Usually starting just before a period and subsiding in the days afterwards, the condition can cause a diverse array of emotional, physical and cognitive symptoms.

While some of these symptoms are similar to PMS, PMDD symptoms are typically much more severe and can include various mental health-related difficulties, such as anxiety and depression. That’s why it’s so important to consult your GP for their advice.

By assessing your symptoms, your GP can not only diagnose PMDD but also provide appropriate management strategies to improve your quality of life.

Remember, you’re more than your PMDD.

Sources

  1. Mishra, S., et al. Premenstrual dysphoric disorder. National Library of Medicine. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532307.
  2. Green, L., et al. Management of premenstrual syndrome. BJOG: An International Journal of Obstetrics & Gynaecology. 2016;124(3):e73–105. https://doi.org/10.1111/1471-0528.14260.
  3. Sammon, CJ., et al. Recording and treatment of premenstrual syndrome in UK general practice: A retrospective cohort study. BMJ Open. 2016;6(3):e010244. https://doi.org/10.1136/bmjopen-2015-010244.
  4. Tiranini, L., et al. Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Faculty Reviews. 2022;11. https://doi.org/10.12703/r/11-11.
  5. NHS. PMS (premenstrual syndrome) [Internet]. [cited 2024 April 18] Available from: https://www.nhs.uk/conditions/pre-menstrual-syndrome/
  6. Mind. Premenstrual dysphoric disorder (PMDD): What is PMDD? [Internet]. [cited 2024 April 18] Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
  7. Hantsoo, L., et al. Premenstrual dysphoric disorder: Epidemiology and treatment. Current Psychiatry Reports. 2015;17(11). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890701
  8. IAPMD. Hormones and PMDD [Internet]. [cited 2024 April 18] Available from: https://iapmd.org/hormones-and-pmdd
  9. Gudipally, PR., et al. Premenstrual syndrome. National Library of Medicine. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560698.
  10. Le, J., et al. Cognition, the menstrual cycle, and premenstrual disorders: A review. Brain Sciences. 2020;10(4):198. https://doi.org/10.3390/brainsci10040198.
  11. Lin, PC., et al. Early and late luteal executive function, cognitive and somatic symptoms, and emotional regulation of women with premenstrual dysphoric disorder. Journal of Personalized Medicine. 2022;12(5):819. https://doi.org/10.3390/jpm12050819.
  12. Mind. Premenstrual dysphoric disorder (PMDD): How is PMDD diagnosed? [Internet]. [cited 2024 April 18] Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
  13. ICD-11 for Mortality and Morbidity Statistics [Internet]. icd.who.int. [cited 2024 Feb 23]. Available from: https://icd.who.int/browse/2024-01/mms/en#1526774088.
  14. Mind. Premenstrual dysphoric disorder (PMDD): What are the treatments? [Internet]. [cited 2024 April 18] Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/treatment/ .
  15. Weise, C., et al. Internet-based cognitive-behavioural intervention for women with premenstrual dysphoric disorder: A randomized controlled trial. Psychotherapy and Psychosomatics. 2019;88(1):16–29. https://doi.org/10.1159/000496237.
  16. Haffmans, J., et al. The Effects of Light Therapy and Cognitive Behavioral Therapy in Premenstrual Dysphoric Disorder (PMDD). Journal of Affective Disorders. 2008; vol. 107, p. S86. https://doi.org/10.1016/j.jad.2007.12.072.
  17. Hantsoo, L., et al. Treatment of Premenstrual Dysphoric Disorder (PMDD): Advances and Challenges. Advances in Psychiatry and Behavioral Health. 2021; vol. 1, no. 1, pp. 91-106. https://doi.org/10.1016/j.ypsc.2021.05.009
  18. Cary, E., et al. Premenstrual Disorders and PMDD - a Review. Best Practice & Research Clinical Endocrinology & Metabolism. 2024; vol. 38, no. 1, p. 101858. https://doi.org/10.1016/j.beem.2023.101858 .
  19. Carlini, SV., et al. Evidence-based treatment of premenstrual dysphoric disorder. The Journal of Clinical Psychiatry. 2020;81(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716347.
  20. Lete, I., et al. Contraceptive options for women with premenstrual dysphoric disorder: Current insights and a narrative review. Open Access Journal of Contraception. 2016;7:117–25. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683150.
 
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