Premenstrual dysphoric disorder (PMDD) explained

Suppose the days leading up to your period leave you feeling emotionally down, anxious, or withdrawn, and this happens regularly. In that case, it’s possible that you’re dealing with more than just typical premenstrual symptoms. 

Premenstrual Dysphoric Disorder, or PMDD, is a recognised medical condition that causes intense emotional and physical changes in the second half of the menstrual cycle. These symptoms can be distressing and difficult to live with, and it doesn’t help that they recur every month. 

How is PMDD different from PMS?

Most women experience symptoms of premenstrual syndrome (PMS) like irritability, bloating, or mood changes, which are generally mild and manageable. But PMDD is more intense. It includes severe emotional symptoms such as depression, anxiety, and anger that usually start one to two weeks before your period and ease once menstruation begins.

Women with PMDD often say they feel like a completely different version of themselves each cycle, with symptoms that interfere with their work, relationships, and daily functioning.

What causes PMDD?

PMDD is thought to result from how your body responds to normal hormonal changes in the menstrual cycle. While hormone levels may not be unusual, women with PMDD may be more sensitive to the shifts in oestrogen and progesterone that occur after ovulation.

These hormonal changes affect neurotransmitters like serotonin, which influences your mood and emotions.

There may also be links between PMDD and a history of trauma, mental health conditions, or a family history of similar symptoms. However, more studies are needed to really pinpoint the root causes of PMDD. 

Risk factors

Several factors may increase the likelihood of developing PMDD, including:

• A personal or family history of depression, anxiety, or trauma

• Sensitivity to hormonal changes

• High stress levels

• Smoking or substance use

• Other hormonal or reproductive health conditions

Common signs of PMDD

Symptoms of PMDD usually begin after ovulation and resolve shortly after your period starts. The most noticeable signs are emotional or behavioural, though physical and cognitive symptoms often appear too.

Emotional and behavioural symptoms

• Feeling unusually sad, hopeless, or tearful

• Intense irritability or anger, often affecting relationships

• Anxiety or feeling overwhelmed

• Mood swings or emotional sensitivity

• Losing interest in things you normally enjoy

• Difficulty concentrating or thinking clearly

• Withdrawal from others

• Suicidal thoughts, in severe cases

Physical and cognitive symptoms

• Fatigue or low energy

• Trouble sleeping or sleeping too much

• Food cravings or appetite changes

• Bloating, breast tenderness, or headaches

• Joint or muscle pain

• Brain fog or difficulty remembering things

• Changes in libido

How does PMDD affect everyday life?

PMDD symptoms tend to repeat each cycle and can seriously influence or even limit how you function. You may find it hard to keep up at work, connect with your loved ones, or stay consistent with your usual routines.

Many women describe a feeling of dread knowing this part of their cycle is approaching, and some feel isolated or misunderstood because others don’t see how difficult it is.

How do you get diagnosed with PMDD?

If you think PMDD might be affecting you, the first step is to start tracking your symptoms. Use a diary, app, or calendar to note how you’re feeling emotionally and physically each day, as well as when your period starts and ends.

Do this for at least two cycles. This record will help identify patterns and provide valuable information for your doctor.

When you're ready to speak with someone, your GP (general practitioner) is a good starting point. They can review your symptom history, rule out other conditions, and refer you to a specialist if needed.

Depending on your symptoms and medical history, you may be referred to a gynaecologist, endocrinologist, or mental health professional, such as a psychologist or psychiatrist with experience in hormone-related mood disorders.

What your healthcare provider will consider

To make a diagnosis, a doctor will usually:

• Look for a clear pattern where symptoms appear after ovulation and improve soon after your period starts

• Confirm that symptoms are present in most cycles and are not ongoing throughout the entire month

• Assess whether symptoms interfere with your work, relationships, or daily life

• Rule out other physical or mental health conditions, such as depression, anxiety, thyroid disorders, or chronic fatigue

Diagnosis is based on guidelines from the DSM-5, which require at least five symptoms, including one related to mood, to be present during the luteal phase and to improve shortly after menstruation begins.

A supportive GP can guide you through this process, help interpret your symptom tracking, and connect you with the right team to move forward.

Why a diagnosis might get delayed

PMDD is sometimes mistaken for other conditions, particularly when mood symptoms are the most visible. Some women are told they have depression or anxiety without any link made to their cycle.

In other cases, their symptoms are dismissed as ordinary PMS. Clear, consistent tracking can help your doctor make a more accurate diagnosis and recommend the right support.

What are the treatment options?

Treatment depends on your symptoms, health history, and personal goals, including whether you want to have children in the future. Many women find that combining self-care and medical support brings the best results.

Self-care and lifestyle support

• Exercise can help lift your mood and ease tension

• Balanced nutrition can support hormone and energy levels

• Mindfulness or relaxation techniques may reduce anxiety

• Good sleep habits improve emotional and physical resilience

• Tracking your symptoms will give insights into your cycle and help with planning

These strategies can make daily life feel more manageable, especially when paired with clinical treatment.

Medical support

• Antidepressants (SSRIs): These may be prescribed either daily or only during the luteal phase and are often effective in easing emotional symptoms

• Hormonal contraception: Some birth control pills, particularly those with drospirenone, help regulate hormonal fluctuations that can trigger symptoms

• Cognitive Behavioural Therapy (CBT): Therapy can be useful for managing thoughts, building coping skills, and improving emotional resilience

• GnRH agonists or surgery: These are used in rare, severe cases and work by stopping ovulation entirely. These options affect fertility and come with side effects, so they are usually considered only when other treatments haven’t worked

It's important to speak with a qualified medical professional before starting or changing any treatment. PMDD affects each person differently, and what works for one woman may not be right for another.

Avoid self-medicating, as some treatments can interact with or affect other health conditions. A doctor can guide you safely through your options and help you find a treatment plan that fits your needs.

Final thoughts

Living with PMDD can feel unpredictable and exhausting, especially if others don’t fully understand what you’re going through. But this condition is recognised and treatable.

If you're noticing a pattern of mood and physical symptoms that disrupts your life every month, consider speaking to your GP or a mental health professional as soon as possible.