Premenstrual Dysphoric Disorder (PMDD) is a severe and often debilitating condition that affects many women, but it remains underdiagnosed and frequently misunderstood.
While most women experience mild mood changes or discomfort in the lead-up to their period, PMDD is much more than typical premenstrual symptoms. It involves extreme physical and mental health issues that can significantly impair a woman’s daily life.
Here, we explore what PMDD is, how common it is, why it is often misdiagnosed, and what you can do if you suspect you have it.
What is PMDD?
PMDD is a condition that affects the emotional and physical wellbeing of women, typically in the two weeks leading up to their period. PMDD is more than standard PMS; it’s a severe form of PMS that can cause extreme mood swings, irritability, depression, and anxiety, along with debilitating physical symptoms such as fatigue, joint or muscle pain, and headaches.
Unlike PMS, PMDD has a significant impact on a woman’s quality of life. It can affect relationships, work, and day-to-day functioning. For many, these symptoms can feel like a rollercoaster of emotions and physical discomfort, leaving them struggling to cope during their luteal phase (the second half of the menstrual cycle, after ovulation and before menstruation).
The symptoms of PMDD include:
- Severe mood swings, including deep sadness, irritability, and anger
- Intense feelings of hopelessness or worthlessness
- Anxiety and panic attacks
- Difficulty concentrating
- Fatigue and sleep disturbances
- Joint or muscle pain, headaches, and gastrointestinal issues
- Changes in appetite (e.g., cravings or overeating)
While PMDD occurs in the second half of the menstrual cycle, its severity and the level of impairment it causes are much higher than those typically associated with PMS.
How common is PMDD?
PMDD is relatively common, affecting approximately 5-8% of women of reproductive age. This means that in the UK alone, an estimated 1 in 12 to 1 in 20 women are living with this condition. However, despite its prevalence, many women go undiagnosed because the symptoms can easily be dismissed as “normal” premenstrual discomfort, or misattributed to other mental health conditions, such as depression or anxiety.
A report by Mind highlights that many women with PMDD are frequently misdiagnosed with other mental health disorders. This is often because the symptoms of PMDD – particularly the severe mood swings and depression – can mirror conditions like bipolar disorder or generalised anxiety disorder. However, unlike those conditions, PMDD is directly linked to the menstrual cycle and tends to resolve after menstruation begins.
Why am I struggling to be diagnosed?
Despite the high prevalence of PMDD, many women with the condition are left undiagnosed or misdiagnosed for years. One reason is the stigma and the normalisation of menstrual discomfort. Societal expectations often downplay the impact of menstrual health on women, which means that women might not feel comfortable seeking medical help or may not realise that their symptoms are not “normal.”
Misdiagnosis is another issue. For example, some women may be told they are simply experiencing depression or anxiety, when in fact their mental health symptoms are directly related to hormonal fluctuations. This delay in diagnosis can lead to years of unnecessary suffering and ineffective treatments.
The NHS stresses the importance of recognising the cyclical nature of PMDD, which helps distinguish it from other conditions. If a woman experiences significant mood and physical changes that correlate with the menstrual cycle, she may have PMDD and should speak to a GP.
The impact of hormones on women’s health
PMDD highlights the profound link between hormones and mental health. In women, hormones such as estrogen and progesterone fluctuate significantly throughout the menstrual cycle, and these fluctuations can directly affect brain chemistry, impacting mood, energy levels, and even pain perception. Research suggests that women with PMDD may have an abnormal response to these hormonal changes, making them more susceptible to the extreme symptoms that characterise the condition.
The hormonal shifts in the luteal phase (the two weeks leading up to menstruation) are thought to trigger changes in neurotransmitters, particularly serotonin, which is often referred to as the “feel-good” chemical in the brain. A drop in serotonin levels can lead to feelings of irritability, sadness, and anxiety – hallmarks of PMDD. Additionally, hormonal fluctuations can cause physical symptoms like bloating, muscle aches, and fatigue, which further exacerbate the emotional symptoms.
What should you do if you suspect you have PMDD?
If you suspect that you have PMDD, the first step is to track your symptoms. Keeping a diary of your symptoms over several menstrual cycles can help you and your GP identify patterns that align with the menstrual cycle. This can be especially helpful when seeking a diagnosis, as it will show that your symptoms are cyclical and linked to your period.
The NHS recommends the following steps if you think you might have PMDD:
- Track your symptoms: Use a calendar or an app to log when your symptoms start, peak, and subside in relation to your menstrual cycle.
- Seek medical advice: Speak to your GP if you notice significant mood swings or physical symptoms during the luteal phase of your cycle. They may refer you to a specialist, such as a gynaecologist, or suggest you keep a symptom diary to help diagnose PMDD.
- Rule out other conditions: It’s important to rule out alternative issues that might be causing your symptoms.
- Consider treatment options: There are a variety of treatments that may help manage PMDD, including lifestyle changes (diet, exercise, stress management), antidepressants (SSRIs), hormonal treatments (birth control or hormone therapy), and cognitive behavioural therapy (CBT).
Mind suggests that women who are dealing with severe mental health symptoms related to their menstrual cycle should consider seeking both medical treatment and emotional support. Finding a therapist who understands PMDD can be helpful, as well as joining support groups where women share their experiences.
Conclusion
PMDD is a severe and often misdiagnosed condition that can cause significant emotional and physical distress in women. While it is relatively common, many women go undiagnosed, and those who are diagnosed often face delays in receiving effective treatment. By understanding the connection between hormones and mental health, women can advocate for themselves, track their symptoms, and seek appropriate help.
If you suspect you have PMDD, it’s important to speak with your GP and get a proper diagnosis.
