Period pains are one of the common symptoms that affect an estimated 90% of women. While PMS can leave us feeling awful physically, many haven’t heard of PMDD - a severe form of PMS that can lead to anxiety, clinical depression and a higher risk of suicidal ideation

Most of us have heard of PMS (premenstrual syndrome), the name given to the signs and symptoms people that ovulate experience in the days or even weeks leading up to their period. It’s estimated that anywhere from three in four menstruating people to 90% of women experience some form of PMS.

Mood swings, food cravings, tender breasts, painful cramps, fatigue, irritability and depression can all be typical symptoms of PMS. But have you heard of PMDD? And could you be experiencing it without even realising it?

We answer your biggest PMDD questions, and share everything you need to know about premenstrual dysphoric disorder, signs to look out for, and how you can find help.

What is PMDD?

PMDD (premenstrual dysphoric disorder) is a very severe form of PMS, thought to affect around one in 20 women. Sometimes referred to as ‘severe PMS’, PMDD causes a number of different emotional and physical symptoms monthly in the weeks running up to your period. Occurring during the luteal phase (between when you ovulate and your period stats), some people have symptoms for a few days, while others will have them every day during the run-up to their period.

While most people who ovulate will experience some form of PMS during their lifetime, those with PMDD experience symptoms that have a much greater impact. PMDD can make it harder to work, socialise, and even maintain healthy relationships. For some, PMDD can lead to suicidal thoughts. One global study released in 2022 revealed that as many as 34% of those with PMDD have attempted suicide.

On average, it takes 12 years and seeking support from more than six healthcare professionals before most patients are able to gain a diagnosis of PMDD. An overwhelming 98% feel that symptoms of PMDD put a significant strain on their romantic relationships, 97% say they affect their family relationships, and over half (56.7%) have lost a partner due to PMDD.

Premenstrual dysphoric disorder can develop at any time during your reproductive years, though on average, symptoms begin around age 26. Symptoms often interfere with your ability to do day-to-day things and can occur during some or most of your cycles (though some months may be worse than others).

How do I know if I’ve got PMDD? Signs and symptoms

People with PMDD can experience different symptoms. These can include emotional and physical symptoms:

Emotional symptoms

  • mood swings
  • feeling upset, tearful, tense, angry, irritable or on-edge
  • lack of energy
  • decreased interest in activities you normally enjoy doing
  • increased feelings of anxiety, overwhelm, hopelessness, or being out of control
  • trouble concentrating
  • suicidal thoughts or feelings

Physical symptoms

  • breast tenderness or swelling
  • muscle or joint pain
  • changes in appetite (food cravings, overeating)
  • trouble sleeping
  • feeling bloated
  • headaches

Does PMDD make you feel suicidal?

Some people with premenstrual dysphoric disorder experience suicidal thoughts. Current research indicates that those with PMDD are at an increased risk of suicidal ideation than those without PMDD. Whether you are experiencing passive suicidal ideation or are worried about suicidal thoughts, it is important to reach out for help and support. If you are worried about your immediate safety, go to your nearest A&E department or call 999. Or if you want to talk with someone, Samaritans are available 24 hours a day, 365 days a year on 116 123.

Is PMDD a physical or mental health problem?

PMDD is most commonly defined as an endocrine disorder (meaning your hormone levels are too high or too low). However, it is also included within the DSM-5 (the diagnostic and statistical manual of mental disorders, most commonly used by mental health professionals in the US) as a type of depressive disorder.

While many people experience physical symptoms, it is also common for them to experience a variety of different mental health symptoms too. These can include anxiety, depression, and suicidal thoughts. Getting the right help and support is important in ensuring you can feel in control of your symptoms and lessen the impact of PMDD on your life.

Are PMS and PMDD the same thing?

PMDD is a more severe type of PMS. While both can have physical and emotional symptoms, PMDD can have more severe symptoms that may be more likely to cause disruption in your day-to-day life, as well as to affect your relationships.

What causes PMDD?

Researchers still don’t fully understand the causes of PMDD, but they do believe that being very sensitive to changes in hormone levels could be one of the reasons. Factors that could cause or worsen symptoms are also thought to include genetics, smoking, trauma (such as physical or emotional abuse), and stress.

How do you find out if you have PMDD? Getting a PMDD diagnosis

Speaking with your GP is the first step towards getting a diagnosis. In order to help them better understand the symptoms you are experiencing, you may be asked to:

  • Share a detailed record of your symptoms. Your doctor may ask for two months (or longer) or symptoms to be recorded, as this can help them to see if there are any patterns emerging. They may ask you to keep a diary or give you specific questions to answer regularly.
  • Talk about your medical history - particularly mental health problems or diagnosis.
  • Give details about your lifestyle (if you smoke, drink, how often you exercise or how well you sleep).
  • Go for a physical examination or blood tests. This is so they can rule out other potential issues.

Getting a diagnosis can be a lengthy process that some find particularly difficult, as PMDD is still not well known or understood (even amongst healthcare professionals). Some people find that recording their symptoms and cycle over a long period of time (while seeking help and beyond the period you may be asked to keep a diary) can help them to feel more prepared and confident in talking about and explaining their symptoms.

Downloading the National Institute for Health and Care Excellence (NICE) guidelines for PMDD treatment can also be helpful, as it gives step-by-step guidelines on the diagnosis and treatment of severe PMS (another term commonly used for PMDD). Becoming more familiar with this, and even sharing it with your GP can be helpful if they are unfamiliar with PMDD diagnosis or treatment.

While availability can vary between areas, asking your GP to speak with a doctor specialising in mental health, gynaecology or endocrinology is another option.

How to treat PMDD

Without help and support, PMDD will not go away on its own. Monthly symptoms usually go away within a few days of your period starting, but PMDD as a whole will keep returning until you are pregnant or enter menopause. The good news is, a mixture of medication, lifestyle changes, and psychotherapy can help reduce or stop symptoms.

These include:

  • Lifestyle changes. The NHS recommends a number of different lifestyle changes to help with PMS. This could mean ensuring you exercise regularly; eating a healthy, balanced diet or try eating smaller, more frequent meals; sleeping for the recommended seven to eight hours a day, and reducing stress through self-care activities such as yoga and meditation.
  • Dietary supplements. Another recommendation from the NHS can be using dietary supplements. Some studies have shown vitamin B6, calcium, vitamin D, and magnesium can be effective ways to relieve PMD symptoms, and may also help with PMDD. However, it’s worth speaking with your GP first to ensure this is the right option for you, and what dose you should consider.
  • Medication. Your GP may be able to prescribe antidepressants to help alleviate symptoms related to your mental health. If you experience physical pain (headaches, cramps, breast tenderness, muscle aches) your GP may recommend over-the-counter painkillers. Some GPs may also recommend birth control pills such as the combined contraceptive pill to reduce symptoms of PMS and PMDD.
  • Talk therapy. If anxiety or depression are symptoms you are experiencing, psychotherapy may be recommended. Specific types of therapy such as CBT (cognitive behavioural therapy) can offer an effective way of treating mood and anxiety disorders, as well as help you to cope better with physical symptoms such as pain.
Counsellor Marian Hanson explains more about CBT

For severe cases, your doctor may be able to talk to you about surgical options. MIND explains more about how surgery for PMDD can work, the potential side effects and complications.

Some people find that complementary therapies may help with symptoms. However, it is worth noting that there is currently limited evidence of how effective these methods are. These can include:

  • Acupuncture (using needles in various parts of your body to stimulate nerves and produce natural painkillers).
  • Reflexology (applying pressure to certain areas of your body to encourage healing, and relieve stress and tension).

Self-care for PMDD

If you are struggling to get an official diagnosis, or are just looking for small changes you can make to help lessen your symptoms, there are many different things you can try. Not all self-care options will help everyone, so it’s important to try different options and to keep exploring until you find what works best for you.

Speaking with someone you know and trust can be a big help. This can help to avoid feelings of isolation, as well as to help you to connect with others who may have similar experiences. Talking with someone you care about can also help you to feel more comfortable speaking out, and may help you to find the right words to express yourself and your experiences. Not everyone finds talking with loved ones about sensitive issues to be easy. For some, it may feel easier to speak with a counsellor or therapist, as they can offer an outside perspective, and they may feel less worried about being judged or asking loved ones for emotional support.

Creating a self-care box in advance can provide you with a helpful resource you can use whenever you need it the most. This doesn’t have to be anything complicated or expensive. Keep a few small things that make you happy, help you feel relaxed, or typically cheer you up in one place. This could mean keeping your favourite book, tea, or snacks in a small box ready for when you need them. Keeping a notebook to help you track your thoughts and feelings can also help, as can including printed-out affirmations or words of encouragement to help you through when you are feeling particularly rough.

Tracking your cycle to get a better idea of when symptoms are likely to occur can be helpful for others. This can give you more time to prepare and rearrange more stressful life events or tasks, as well as to plan activities that you enjoy and are more likely to give you a positive mood boost. Period tracking apps can be a good way of doing this. The Me V PMDD app is one such app, created specifically to help track your symptoms, treatment, access further resources, and even keep a self-love journal.

Reducing stress and promoting relaxation can also be helpful. Counselling Directory shares relaxation techniques and tips to help you manage your stress levels.

*Finding the right help and support isn’t always easy. Talking to someone can offer a positive first step to help you better understand how you are feeling while offering an outlet to express yourself – without worrying about how it may impact friends, family, or loved ones.

If you need to talk to someone right now about distressing thoughts or feelings, contact the Samaritans on 116 123. If you are worried about your immediate health or wellbeing, visit your nearest A&E department or call 999.

If you are looking to speak with a therapist, or feel like you are ready to try CBT to help alleviate symptoms of PMDD, visit Counselling Directory or enter your postcode in the search box below to find a qualified, experienced therapist near you.*