Premenstrual dysphoric disorder (PMDD)

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What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS). It causes a range of emotional and physical symptoms every month during the week or two before your period. It is sometimes referred to as 'severe PMS'.

PMDD occurs during the luteal phase of your menstrual cycle. This is the time between when you ovulate and when your period starts. The luteal phase lasts approximately two weeks for most people but can be longer or shorter.

During this time you may experience PMDD symptoms every day, or for a few days within the phase. The NHS website has more information on the stages of the menstrual cycle and when they occur.

Many of us may experience symptoms of PMS. But if you have PMDD, these symptoms are much worse and can have a serious impact on your life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal thoughts.

The best way to describe it is that, once a month, I pressed my own self-destruct button and literally let my (normally very happy and satisfying) life implode around me. Then when the dark thoughts lifted and cleared, I spent the next 2 weeks trying to pick up the pieces.

What are the symptoms of PMDD?

If you have PMDD, you might find that you experience some of symptoms listed below. But it's different for different people, so you might also experience other kinds of feelings which aren't listed here.

Emotional experiences

• mood swings
• feeling upset or tearful
• lack of energy
• less interest in activities you normally enjoy
• feeling hopeless
• suicidal feelings
• feeling angry or irritable
• feeling anxious
• feeling tense or on edge
• feeling overwhelmed or out of control
• difficulty concentrating.

Physical and behavioural experiences

• breast tenderness or swelling
• pain in your muscles and joints
• headaches
• feeling bloated
• changes in your appetite, such as overeating or having specific food cravings
• sleep problems
• increased anger or conflict with people around you
• becoming very upset if you feel that others are rejecting you.

As PMDD is linked to your menstrual cycle, you will likely not experience symptoms if you are pregnant. You may find that the symptoms return once you begin ovulating again though.

In the depths of PMDD I tend to just retreat to my bed. I get very depressed and my anxiety goes sky high. I get hugely fatigued and can't keep my eyes open. I sleep for about 18 hours a day.

What are the causes of PMDD?

The exact causes are still not fully understood but researchers believe that PMDD is caused by being very sensitive to changes in hormone levels. Recent research suggests that PMDD is associated with increased sensitivity to the normal hormonal changes that occur during your monthly menstrual cycle.

See the International Association for Premenstrual Disorders (IAPMD) website for further information on hormones and PMDD.

There is research to suggest other possible causes for PMDD, as well as things that may make your PMDD worse. Some of these possible factors are:

• Genetics. Some research suggests that increased sensitivity to changes in hormone levels may be caused by genetic variations.
• Smoking. Some research suggests that smoking can have an impact on your hormone sensitivity.
• Trauma and stress. Other research has shown that in some cases PMDD may be linked to stressful and traumatic past events, such as emotional or physical abuse. Stress may also make your PMDD symptoms worse.

Is PMDD a mental health problem?

PMDD is commonly defined as an endocrine disorder, meaning that it is a hormone-related disorder. But as well as physical symptoms, people with PMDD also experience a range of different mental health symptoms such as depression, suicidal feelings and anxiety.

For these reasons, it is listed as a mental health problem in the DSM-5, one of the main manuals that doctors use to categorise and diagnose mental health problems.

Ultimately, it's important to remember that how you understand your symptoms and experiences is up to you. The most important thing is that you get the support you need and deserve to help you manage the effects of PMDD on your life.

Every month for 30 years I barely managed to come through each month intact. PMDD is not merely bad PMS. It is so much more serious than that, and is absolutely life changing.

Living with PMDD

Watch Laura talk about her experiences of PMDD, and what she's found helpful:

This information was published in August 2021. We will revise it in 2024.

References and bibliography available on request.

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