What is Premenstrual Dysphoric Disorder (PMDD)?

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Premenstrual Dysphoric Disorder (PMDD) is a hormone-based mood disorder, affecting approximately 1 in 20 female and assigned female at birth individuals. This makes it about as common as Diabetes, yet awareness of the condition in both medical fields and the general population is lacking.

What is PMDD?

PMDD is a cyclical hormone-based mood disorder. It is not caused by a hormonal imbalance, but rather by the brain having a severe negative reaction to normal hormonal fluctuations across the menstrual cycle. PMDD symptoms arise during the Luteal Phase of the menstrual cycle (around 12-7 days before your period starts), and these symptoms resolve within a few days of menstruation.

What are the symptoms of PMDD?

Symptoms of PMDD can look like other mood disorders, which is why it is important to carefully track your cycle and your symptoms if you think you might have PMDD (more on this later). Symptoms of PMDD include:

• Mood swings, low mood, tearfulness, increased sensitivity to rejection

• High irritability and anger leading to conflict in relationships

• Depression, hopelessness, feelings of worthlessness, feelings of guilt

• Feeling tense, anxious, or on edge

• Feeling out of control

• Difficulty thinking or focusing (brain fog)

• Fatigue

• Lack of interest in daily activities (work, hobbies, relationships)

• Changes in appetite (such as binge eating)

• Changes in sleep (sleeping too much or too little)

• Bloating

• Weight gain

• Cramping and joint pain

• Breast tenderness

Diagnosis of PMDD

PMDD is recognised in the ICD-11 and the DSM-5 (diagnostic manuals in the UK and US). For a diagnosis of PMDD, you will need to demonstrate five of the above symptoms, with at least one of the symptoms in bold. Getting a diagnosis of PMDD can be a lengthy process, with some reports that it has taken people an average of twelve years, and consultations with 6 different professionals, to receive a diagnosis.

PMDD will not show up on any blood, saliva, urine, or hormone tests. The only way to receive a diagnosis is to demonstrate clear evidence that symptoms begin in the Luteal Phase, and resolve following menstruation. A minimum of two tracked cycles is required.

The Daily Record of Severity of Problems (DRSP) is the gold standard tracking chart, and can be found here. However, you can use any method of tracking, such as apps like Flo and Clue, so long as they can provide you with the information needed.

Treatments for PMDD

PMDD treatment will be different for everyone, and it is important to work with your healthcare provider for find what works best for you. Treatments include:

• Combined contraceptive pill

• Selective Serotonin Reuptake Inhibitors (SSRIs, like Sertraline)

• Talking therapies (such as CBT)

• Medical menopause (only considered if previous treatments have been ineffective)

• Surgical menopause (only considered if previous treatments have been ineffective)

Alongside these treatments, it is often helpful to have a number of self-help strategies you can call upon to help guide you through the Luteal Phase. I have created a pack of resources available as a PDF download, which can be found here.

For more information and advice on PMDD, please see the International Association for Premenstrual Disorders website.