What is PMDD?

Reviewed by our clinical team

Lots of women experience PMS (premenstrual syndrome, also known as PMT or premenstrual tension) before their period, but for some the symptoms are really serious and hard to cope with.

If you find that coping with everyday life is very difficult in the two weeks before your period, and that your work and relationships are affected by your mood or behaviour in a major way, you might be experiencing PMDD, or premenstrual dysphoric disorder.

PMDD causes

PMDD occurs during the luteal phase of your menstrual cycle i.e. the time between ovulation and when you start bleeding. For most women this is a period of roughly two weeks – during this time, PMDD symptoms may be felt every day or may come and go.

It’s not clear why some women experience premenstrual dysphoric disorder (PMDD). However, it’s thought to be caused by heightened sensitivity to changing hormone levels, particularly progesterone.

There’s some evidence to suggest that certain factors increase your risk of PMDD, including genetics, smoking and past experiences of trauma.

PMDD symptoms

The symptoms of PMDD are similar to the symptoms of PMS, but more severe. PMDD is sometimes called "severe PMS".

The most notable aspect of PMDD is how it affects mood and behaviour. You might have PMDD if you experience the following in the days before you period:

• Mood swings 
• Feeling very upset or tearful 
• Feeling anxious 
• Feeling angry or easily irritated 
• Clashing with people around you 
• Struggling to sleep 
• Lacking energy 
• Losing interest in your normal hobbies 
• Feeling overwhelmed 
• Having trouble concentrating  
• Changes to appetite and eating habits e.g. binge eating 

If you feel like this all of the time rather than just before your periods, this is not PMDD and you should speak to your GP about this. People who have PMDD typically start to feel "normal" within one or two days of their period starting. 

In the most extreme cases, PMDD can cause suicidal feelings. If you start thinking about harming yourself, you should get emergency help by: 

• Calling 999 
• Going to A&E 

You can also get help and advice by calling 111 or the Samaritans on 116 123. 

Physical symptoms of PMDD 

In addition to the mental and behavioural symptoms described above, you might also have physical symptoms, such as: 

• Breast tenderness 
• Bloating 
• Cramps 
• Pain in the muscles and joints 
• Headaches 

PMDD treatment 

It’s a good idea to see your GP if you find that your premenstrual symptoms are having a big impact on your daily life. There are a few different treatment options you can try, starting with changes to your lifestyle.

Lifestyle changes

Normally, the first tactic for managing PMDD is to try the following:

• Exercising more regularly 
• Eating a healthier diet 
• Getting better, more regular sleep 
• Reducing stress 
• Cutting back on alcohol and caffeine 
• Quitting smoking, - smoking can make you more sensitive to hormonal changes 

For some women, these changes alone might be enough to reduce symptoms. 

Medication 

If lifestyle changes don’t make enough of a difference, your GP might prescribe some medication.

Antidepressants, and particularly SSRIs, have been found to reduce PMDD symptoms, whether or not you are depressed. You might be advised to take them on a daily basis, or just during the luteal phase of your cycle.

Another option is to try the combined contraceptive pill. This stops ovulation and that's why it can help with PMDD symptoms, particularly if you don't have the usual seven-day break every month. It is thought that a pill containing Drospirenone (such as Yasmin, Lucette or Eloine) works best. However, some women find that the combined pill doesn’t help with PMDD at all, and even makes symptoms worse.

In more severe cases where other treatments haven’t worked, your GP may prescribe gonadotropin releasing hormone (GnRH) analogues. This medication is usually combined with hormone replacement therapy to combat its side effects, which include loss of bone density.

Supplements

Some dietary supplements, including calcium and vitamin B6, vitamin D, magnesium, agnus castus (chaste berry) or evening primrose oil are found to be helpful by some. Unfortunately, though, we currently don't have enough scientific evidence to be able to actually recommend any of them. There’s usually no harm in trying these kinds of supplements, but it’s best to check with your GP before you start taking them. 

Therapy 

Talking therapy like cognitive behavioural therapy (CBT) can be really helpful for coping with the psychological symptoms of PMDD. If you’re interested, contact your GP about getting a referral – you can learn more about the process at this page on the Mind website. 

Surgery

If your PMDD is very severe and causing debilitating symptoms that don’t respond to other medications, there is the option of surgery. 

You could have a total hysterectomy to remove your uterus, as well as an operation to remove your ovaries and fallopian tubes. This will stop your periods altogether and therefore bring an end to your PMDD symptoms.

This is an extreme option that carries a risk of complications, as with all surgery, and it’s not appropriate for women who want to get pregnant in the future.

References

https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
https://www.nhs.uk/conditions/pre-menstrual-syndrome/
https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/treatment/
https://www.webmd.com/women/pms/supplements-help-with-pms