PMDD (Premenstrual Dysphoric Disorder)
Understanding PMDD
Premenstrual Dysphoric Disorder (PMDD) is a hormone-related mood condition that affects around 3–8% of women of reproductive age. Unlike typical PMS, PMDD causes severe emotional and physical symptoms in the two weeks before menstruation, significantly disrupting daily life. It is recognised as a mental health condition and is linked to heightened sensitivity to normal hormonal changes in the menstrual cycle.
Symptoms and Diagnosis
PMDD symptoms include mood swings, depression, anxiety, irritability, fatigue, and physical issues like bloating, headaches, or joint pain. These symptoms follow a monthly pattern, appearing after ovulation and easing shortly after menstruation begins. Diagnosis can be difficult – on average, women wait over 10 years for a formal diagnosis in the UK. Tracking symptoms across at least two cycles is essential to confirm the pattern.
Treatment Options
First-line treatment in the UK often involves SSRIs (antidepressants), which can be taken daily or only during the luteal phase. Hormonal contraceptives (like Yaz or Yasmin) are also used to stabilise hormone levels, and in severe cases, doctors may recommend hormone-blocking medication or surgery. Cognitive Behavioural Therapy (CBT), lifestyle changes, and supplements like calcium or vitamin B6 may also help manage symptoms.
Living with PMDD
PMDD can affect relationships, work, and self-esteem – but with the right diagnosis and support, effective treatment is available. Women experiencing extreme cyclical symptoms are encouraged to track their patterns and speak with a GP. PMDD is real, treatable, and deserving of serious attention.
Quick Facts, Big Impact
Prevalence in the UK
Premenstrual Dysphoric Disorder (PMDD) affects around 3–8% of women of reproductive age in the UK – that’s potentially up to 1 million women. It typically emerges in the twenties or thirties and ceases after menopause. Despite being a recognised depressive disorder, PMDD is underdiagnosed and often misunderstood as severe PMS. The cyclical nature of symptoms means it’s commonly missed in clinical settings.
Diagnosis Delays
PMDD can take over a decade to be correctly diagnosed. Many women are misdiagnosed with depression, anxiety or even bipolar disorder before the cyclical pattern is recognised. On average, women see around six different doctors before receiving a diagnosis. Tracking symptoms across multiple menstrual cycles is essential for confirming PMDD, yet awareness among both patients and healthcare professionals remains low.
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Common Causes
PMDD is not caused by abnormal hormone levels, but rather by heightened sensitivity to natural hormonal fluctuations. After ovulation, the drop in oestrogen and progesterone is believed to disrupt mood-regulating chemicals like serotonin in women with PMDD. Stress, trauma, and a history of mood disorders may increase susceptibility, but the root cause is hormonal sensitivity.
Treatment Options
Treatment is highly individualised and depends on symptom severity. First-line approaches include SSRIs (antidepressants), which can be taken daily or during the luteal phase only. Hormonal contraceptives – especially those containing drospirenone – can help stabilise hormones. For severe or treatment-resistant cases, hormone suppression with GnRH analogues or surgical removal of the ovaries may be considered. CBT and lifestyle changes (e.g. diet, exercise, stress management) can also support symptom management.
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