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Mental Health Awareness and PMS/ PMDD

Are you aware of an important health issue called Premenstrual Dysphoric Disorder (PMDD) that affects 1/10 women? Discover all you need to know here.

What is PMDD?

Most of us have heard of Pre-menstrual Syndrome, or PMS, but not many have heard of PMDD-Premenstrual Dysphoric Disorder. The two are often linked, or thought of as similar, but there are actually some pretty serious differences between them.

Dr Ayanthi Gunasekera, Specialist Registrar in gynaecology at London Gynaecology explains more:

“PMDD can be described as very severe form of premenstrual syndrome (PMS). It can cause a range of emotional and physical symptoms every month during the week or two before the start of your period.

“Around 20-30% of women will get significant PMS symptoms and the prevalence of PMDD is estimated to be 5-8% in menstruating women."

What are PMDD symptoms?

Again, the symptoms of PMDD are quite similar to PMS, but suffers tend to experience them a lot more intensely. Dr. Gunasekera went on to tell us though that diagnosis is not always easy for many women:

“It (PMDD) encompasses a spectrum of symptoms, which can make diagnosis and the connection with periods difficult. It was included in the DSM (The Diagnostic and statistical Manual of Mental Disorders) in 2013, and research published in 2017 found a genetic basis for the unusual sensitivity of people suffering from PMDD to oestrogen and progesterone. As you can see this is all quite recent and the lack of consensus and knowledge leads to problems with misdiagnosis.“

It’s thought that the seemingly similar symptoms to PMS may be the reason why doctors aren’t always able to correctly diagnose PMDD straight away.

PMDD symptoms often seriously affect a woman’s ability to carry out everyday activities and in some cases can be debilitating.

Emotional symptoms of PMDD

Many of us suffer from fatigue, bloating (due to fluid retention), temporary weight gain, sleep disturbances and changes in appetite- and there are a few ways to deal with these common PMS symptoms.

For example, making changes to improve your sleep, your diet and exercise can all help massively.

But if you’re experiencing these symptoms on a much more severe scale, you might actually be suffering from PMDD.

Dr Gunasekera told us:

“Some of the common symptoms of PMDD include:
·       Mood swings with feelings of extreme anxiety, sadness and increased irritability
·       Depression with feeling of hopelessness
·       Aggressive angry feelings
·       Decreased performance in work and sports
·       Lack of concentration and inability to perform to usual standards
·       Poor quality of sleep”

Some women may also experience suicidal thoughts. If you are experiencing this, please do seek help straight away. Mind has some great advice on how to cope and keep yourself safe.

Physical and behavioural symptoms of PMDD

There are also some pretty miserable physical and behavioural symptoms to deal with when it comes to PMDD too.

Dr. Gunasekera explained:

“Physical symptoms include abdominal cramps, headaches, breast tenderness and hot flushes,” while the Mind website also notes that some women may experience pain in muscles and joints, feeling bloated and changes in appetite too.


Now, do you have these signs of PMS, but in a severe form? One way to find out is to ask the question: “Do these changes get in the way of my regular life? Do they cause trouble at work or with family and friends?” If you answer yes, then you could have PMDD. 

What causes PMDD?

So far, studies have found two main causes for PMDD, but research has concluded that there may be certain risk factors that could also be to blame.

Hormone sensitivity

Research shows that a sensitivity to the fluctuating levels of hormones that takes place during the menstrual cycle is one main cause of PMDD.

Dr. Gunasekera says that the drop in oestrogen and progesterone have some pretty marked effects in the brain:

“PMDD is thought to be caused by hormonal changes caused by ovarian function, affecting the neuroregulators (particularly serotonin) in the brain. This is thought to affect the serotonergic pathway in the brain leading to mood related symptoms.”

Dr. Gunasekera also advises that “using medication to switch off the ovarian function can be diagnostic if it leads to complete resolution of symptoms.”

Studies do show that cutting off oestrogen and progesterone stops symptoms of PMDD in women with the condition- and these symptoms then re-emerged when the hormones were re-introduced. 


Researchers at the National Institute of Health (NIH) found that women with PMDD are more sensitive to the effects of the sex hormones oestrogen and progesterone, due to a molecular mechanism in their genes.

"For the first time, we now have cellular evidence of abnormal signalling in cells derived from women with PMDD, and a plausible biological cause for their abnormal behavioural sensitivity to estrogen and progesterone” commented Dr Peter Schmidt, of the NIH's National Institute of Mental Health, Behavioural Endocrinology Branch.


Some studies have found a potential link between women who smoke and PMDD. If you’re concerned about smoking or you need help giving up, the NHS Stop Smoking service has some great resources to help you.


Doctors believe that stress and past traumas can also have an affect on PMDD symptoms, and in some cases can make them worse. More research is needed, but current studies have found that there are links, so it’s worth taking steps to reduce stress if you can. It’s also a good idea to seek help in dealing with past traumas that could be affecting your symptoms too.

History of depression or anxiety

Some women with a family history of depression, mood disorders, PMS or PMDD may also be more at risk of developing the condition.

One report states that 30-70% of women with PMDD have a history of mood disorders, and these women are also more likely to develop further mental health issues than women who do not suffer with PMDD.

If you need to talk to someone about your emotional wellbeing, Mind has lots of advice and links to services that can help.

PMDD treatment

The good news is that there are treatments for PMDD that can ease symptoms and help you to live a normal life during your period. Dr. Gunasekera’s advice is to keep a track of your symptoms and to speak up if you need help.

“If the symptoms are affecting your well-being, quality of life, work or relationship, it is important to see your GP or a gynaecologist. It is helpful to keep a diary of symptoms which will help the doctor assess the severity and cyclical nature of your symptoms and is an important part of the diagnosis."

Your doctor might recommend the following treatments:


Selective Serotonin Reuptake Inhibitors (SSRIs) are a type of anti-depressant that could be helpful if you have PMDD. Your doctor might recommend you take them every day, or just during your luteal phase when symptoms occur.

Contraceptive pill

Some women are prescribed the contraceptive pill to manage symptoms. These work by controlling or stopping your period, and therefore limiting hormone activity in the body. Your doctor can advice whether or not this method of treatment is suitable for you.

Pain killers and anti-inflammatory tablets

Some women find that keeping their physical symptoms under control helps massively when PMDD symptoms are bad. Your doctor might advisee you to take these as and when needed.

Talking therapy

Some women will benefit massively from Cognitive Behavioural Therapy (CBT) counselling- speak to your doctor about this option. Sometimes talking to another person about your feelings and finding different coping mechanisms can be life changing.

Lifestyle changes

Self care is not just a buzz word. There are lots of things you can do to help ease your symptoms and changes you can make in your lifestyle. Some women even find that just these simple changes are enough to manage their symptoms month by month.

If you can, try to make changes in your diet, improve your sleep and take regular exercise. Reducing your stress levels and keeping en eye on how much alcohol and caffeine you drink can also help.

Herbal Remedies

If you’re considering taking a supplement to treat PMDD, please speak to your doctor first. Some women have anecdotally reported an improvement by taking calcium carbonate for physical symptoms, while others have reported that vitamin B6 can be helpful. It’s also thought that Agnus cactus may be able to relive feelings of irritability but there are no studies to back this up.