Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS). It can have a big impact on mental and physical health. If PMDD is affecting your life, we’re here for you.
It causes a range of emotional and physical symptoms every month during the week or two before your period. It’s sometimes referred to as ‘severe PMS’.
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PMDD happens during the time between when you ovulate and when your period starts. This is known as the luteal phase of your menstrual cycle. For most people, the luteal phase lasts around 2 weeks. But it can be longer or shorter.
During this time, you may experience PMDD symptoms every day. Or for a few days within the phase. Find out more from the NHS’s information on the stages of the menstrual cycle.
Many of us may experience symptoms of PMS. But if you have PMDD, these symptoms are much worse. They can have a serious impact on your life. It can make it hard to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal feelings.
See our page on symptoms of PMDD to learn more, including where to get support.
The exact causes of PMDD are not fully understood. Research suggests that you may be more sensitive to hormonal changes that happen during your monthly menstrual cycle.
The International Association for Premenstrual Disorders (IAPMD) website has more information on hormones and PMDD.
Research also suggests other factors that might cause PMDD, or make PMDD worse. They include:
Medical professionals may refer to PMDD as an endocrine disorder. This means it relates to your hormones.
But PMDD can cause mental health symptoms as well as physical ones. These include depression, suicidal feelings and anxiety.
For these reasons, PMDD is listed as a mental health problem in the DSM-5. This is one of the main manuals that doctors use to diagnose mental health problems.
How you understand your symptoms and experiences is up to you. This includes whether you see them as a mental health problem or not. The most important thing is getting treatment and support to help manage the effects of PMDD on your life.
PMDD can affect your mental and physical health in lots of ways. And these symptoms can have a significant impact on your life.
If you’re struggling with PMDD symptoms, we’re here for you.
The symptoms of PMDD are similar to the symptoms of premenstrual syndrome (PMS). But if you have PMDD, these symptoms can be much worse.
PMDD is also different for different people. You might also experience things which aren’t listed here.
If you have suicidal feelings as part of PMDD, this can feel very distressing. Visit our pages on suicidal feelings to learn more, including where to get help.
If you feel unable to keep yourself safe, it’s a mental health emergency. Get emergency advice.
As PMDD is linked to your menstrual cycle, it’s unlikely you’ll experience symptoms if you’re pregnant. But the symptoms may return once you begin ovulating again.
It can feel hard to get a diagnosis of PMDD. But there are things you can do if you’re struggling to get your doctor to understand your symptoms.
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To get a diagnosis of PMDD, the best place to start is to talk to your GP.
To help them understand your symptoms, your GP may:
They might ask you to record your symptoms over several months. This could make getting diagnosed feel like a very slow process. It can be frustrating if you have to wait a long time to get treatment.
Our page on self-care for PMDD has some ideas you can try in the meantime.
Some people find getting a diagnosis of PMDD can be really difficult. This might be because it can take a long time to realise that your symptoms follow a cycle. And that they’re linked to your period.
It can also be because PMDD is not very well known, even by health professionals.
It can be upsetting and frustrating if you feel like your GP is overlooking something, or not taking you seriously. There are things you could try:
If you’re trans or non-binary, you can still get PMDD. PMDD may increase feelings of discomfort with the gender you were assigned at birth.
You may find it difficult to talk to a GP, particularly if you’ve had a bad experience in the past. But you have a right to be listened to, respected and given the right support for you.
For information on how doctors should address your health needs, see the General Medical Council (GMC)’s guidelines on trans healthcare.
If you feel you’ve been treated unfairly by a healthcare professional, you can complain.
See Mind’s page on LGBTQIA+ mental health support to find services that help trans and non-binary people. This includes if you may have PMDD, and need some support getting diagnosed.
Your doctor might consider whether you have premenstrual exacerbation (PME) rather than PMDD.
PME is when existing mental health problems are made worse during the luteal phase of your menstrual cycle. The luteal phase is the time between when you ovulate and when your period starts.
If you have PME, your symptoms will continue after your period. But they will be less intense. This is why tracking your symptoms throughout your cycle is important, to help you get the right diagnosis.
The International Association for Premenstrual Disorders (IAPMD) has more information about PME on its website.
Sometimes people with PMDD can be wrongly diagnosed with other mental health problems, such as depression or bipolar disorder. This is because they share some of the same symptoms.
If you have other physical or mental health problems, experiencing PMDD at the same time can make the symptoms worse.
For these reasons, it’s important to keep a detailed record of how you’re feeling over time. This is because PMDD symptoms will follow a regular monthly pattern.
If you’ve been given a diagnosis that doesn’t feel right for your experiences, you can discuss it with your doctor. This helps make sure you’re getting the right treatment.
See these pages on seeking help for a mental health problem for more information on getting the most from your doctor and making your voice heard.
There are some things you can try to reduce the impact of PMDD on your life.
Don’t put too much pressure on yourself. If something doesn’t feel possible for now, try something else or come back to it another time.
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Talking about your experiences might feel hard at first. But it can help to just have someone listen to you, and show you they care.
You might feel uncomfortable discussing anything to do with reproductive health. It might feel private or taboo, even though it’s part of many people’s everyday lives.
This could make it even harder to open up about health problems related to your periods. But telling others what’s going on can be the first step towards getting help and feeling better.
If you don’t feel like talking to someone you know, you could call a mental health helpline. Or if you don’t feel like talking at all, you could send a text or email.
You may find that talking to someone about periods can bring up difficult feelings about the gender you were assigned at birth. Or you may worry that it will lead people to misgender you (call you by a term that doesn’t match your gender identity). You may find it difficult to talk about it, even with close friends.
How you feel about your periods and how you cope with these feelings will be unique to you.
Mind has a list of LGBTQIA+ organisations you can contact to speak to someone who understands your experience.
There isn’t a specific organisation for PMDD information and support in the UK. But you could visit the International Association for Premenstrual Disorders (IAPMD) website. This is an American organisation.
UK-based organisation The National Association for Premenstrual Syndromes (NAPS) may also have information and support that helps.
Peer support brings together people who have had similar experiences. You might find it helpful to speak to others who have experienced PMDD.
If you feel unsure about talking to people online, this information on looking after your mental health online may help.
If your symptoms follow a pattern, you may be able to work out when you’re most likely to start having symptoms in the future.
For example, if you notice that over the past 3 months your symptoms have started 7 days before your period. You could try to work out when this would be for the upcoming months.
Being able to predict when your symptoms may start could help you put things in place for that time. For example, you could:
If you have a smartphone, you could try using a period tracking app. This can be very helpful if you have an unpredictable cycle. There are lots of apps available with different functions. You can research which one works best for you.
See Mind’s page on finding reliable mental health information online for tips on finding apps that are safe and reliable.
It can be hard to know what will help you feel better when you’re feeling low. It might help to create a self-care kit in advance. You can then use it whenever you need to.
A self-care kit is filled with things that normally cheer you up or help you relax. For example, you could include your favourite book, pictures or photos, hand or body creams, a stress ball or fidget toy, blankets or comfy clothes.
Or you could make a digital self-care kit. You could save photos, music, videos, messages or sayings that you find helpful. Or notes to remind yourself how to manage difficult situations.
Ask for reasonable adjustments
One of the criteria for a PMDD diagnosis is that it has a significant impact on your work, social, education or family life.
If PMDD is affecting your ability to work, take part in education, or get services when you need them, you may be able to ask for reasonable adjustments.
Mind’s pages on the Equality Act 2010 and reasonable adjustments have more information on what you may be able to ask for.
There are different treatments available for PMDD. You and your doctor should decide your treatment together. The decision should be based on how bad your PMDD symptoms are, your personal preferences, and whether you plan to get pregnant.
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When you first talk to your doctor, they may suggest lifestyle changes to improve your physical and mental health. These may reduce your PMDD symptoms to a manageable level, without other treatments. Or it may be something you try alongside another treatment.
They might suggest that you:
This will be different for everyone. The changes you feel able to make will depend on your personal circumstances and experiences.
Talking therapy may help you manage the mental health symptoms of PMDD. For example, cognitive behavioural therapy (CBT) is effective for some people with PMDD.
Your doctor may refer you to an NHS talking therapies service. These services treat mental health problems such as anxiety and depression.
But what services are available depends on where you live. The waiting lists can be long. You can find out whether services are available near you through the NHS talking therapies webpage. In England, you can self-refer to see a therapist.
SSRIs (selective serotonin reuptake inhibitors) are a type of antidepressant. They’re often the first recommended treatment for PMDD.
Your doctor may recommend you take SSRIs daily throughout the whole month or just during your luteal phase. The luteal phase is the time between when you ovulate and when your period starts.
It’s normally recommended that you don’t start and stop taking SSRIs suddenly. But studies have shown that taking SSRIs only during the luteal phase can help with PMDD. And withdrawal symptoms are not as intense.
If your doctor prescribes you SSRIs, they should review them with you after 2 months. This is to make sure they’re working for you. You can also contact your doctor, if you have any concerns about the SSRIs you’re taking.
If they aren’t working, your doctor may suggest a different treatment. Or an adjustment to the antidepressants.
There’s also some evidence that SNRIs (serotonin and norepinephrine reuptake inhibitors) can help with PMDD. But your doctor is most likely to offer you an SSRI. See Mind’s pages on antidepressants for more information on SSRIs and SNRIs.
Before deciding to take any drug, it’s important to make sure you have all the facts you need to make an informed choice.
See Mind’s pages on things to consider before taking medication and your right to refuse medication for more information.
If you’re trans or non-binary, your treatment options may differ if you’re taking or considering taking hormone treatments. You can speak to your GP or specialist to explore what treatment would work best for you.
This useful contacts for LGBTQIA+ mental health lists organisations that can offer you support.
Oral contraceptives (often just called ‘the pill’) may reduce the symptoms of PMDD by controlling or stopping your periods. But the evidence for the pill as a treatment for PMDD is mixed. Some people find it helps to reduce their symptoms, but others find it makes their symptoms worse.
The pill can also cause side effects. And you shouldn’t take it if you’re trying to get pregnant.
Oral contraceptives come in different types with different mixes of hormones. Some hormone combinations may not work well for you. As PMDD happens during your ovulation, pills that stop ovulation may be better for managing your PMDD symptoms.
If you and your doctor think this medication might help, it’s likely your doctor will give you a 3 month trial. This is to see if the treatment is right for you. Visit the NHS information about combined oral contraceptives to learn more.
Your doctor may suggest you take painkillers or anti-inflammatory drugs, such as ibuprofen. These may help you manage the physical symptoms of PMDD, like headaches, joint and muscle pains.
You may be able to get these without a prescription from your doctor. But it’s a good idea to discuss it with your doctor or pharmacist first to make sure that they’re suitable for you.
Gonadotropin releasing hormone (GnRH) analogues are medications. They typically come as injections. They reduce the symptoms of PMDD by bringing on a temporary menopause.
This treatment should only be considered if no other treatments have worked. They can help some people, but can cause side effects like loss of bone density. This increases your risk of developing osteoporosis (a condition in which your bones become weak and break more easily).
Because of this, treatment is often limited to 6 months. And it’s usually combined with hormone replacement therapy (HRT). HRT relieves symptoms of menopause and reduces bone density loss. Visit the NHS page about HRT to learn more about this treatment.
If you use GnRH analogues for more than 2 years your doctor should organise regular bone density scans to check for osteoporosis.
In very severe cases, your doctor may talk to you about removing your womb (uterus), ovaries and fallopian tubes. The aim of this surgery is to stop your PMDD symptoms by stopping your monthly cycle. It should only be considered if other treatments haven’t helped.
If you’re considering surgery, your healthcare professional should first advise you to use GnRH analogues and hormone replacement therapy (HRT) for 3 to 6 months. GnRH analogues have a similar effect on your hormones as having your ovaries removed. So they will give you an idea of how you may feel after the operation.
Some people may be offered an operation to remove the ovaries and fallopian tubes, but not the womb. This is called a bilateral oophorectomy.
This may mean having to take progesterone (a hormone produced during the second half of the menstrual cycle) afterwards, as part of your HRT. It may mean you continue to experience symptoms similar to PMS.
All surgery has a risk of complications. And these operations can’t be reversed. You and your doctor should only consider them if you’ve already tried every other treatment, and nothing has worked.
The surgery would not be appropriate if you want to get pregnant or think you would want to get pregnant in the future.
Living with PMDD
Our thanks to Mind for allowing us to share this film.
There is some limited evidence that certain supplements may reduce premenstrual symptoms. For example:
But these are not officially recommended as treatments. This is because there’s not enough strong evidence that they can treat PMDD.
If you’re thinking about taking a supplement, speak to your doctor or pharmacist first. Taking them alongside other medications or in the wrong dose could be dangerous.
If you’re supporting a partner, friend or family member who is experiencing PMDD, it can be hard to know how to help. But there are lots of ideas you can try.
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Some people with PMDD find it hard to explain what they’re going through. It’s particularly difficult when others dismiss their experiences as “just that time of the month” or “just something all women experience”.
These misconceptions are not true. And they can make it hard for anyone who experiences PMDD to open up about how they feel.
It’s important to understand that PMDD can have a large effect on someone’s life. The symptoms are real, and can be very difficult to cope with.
Find out as much as you can about PMDD. This will help you understand what they’re going through. Reading about people’s personal experiences in blogs can help too.
You can also ask them about their own experience of living with PMDD, and how it affects their daily life.
PMDD can affect people in different ways, so it’s important to ask what things they’d find most helpful.
They may just want emotional support. Or there may be practical things you could do. For example, helping with tasks such as household chores or food shopping could take some of the pressure off them.
Even with support, someone with PMDD may have times when they’re irritable. They may act differently to how they usually do. It can be hard to support someone if they don’t seem to appreciate help.
It’s not easy, but you may need to be more patient than usual. Remember that this won’t last forever and their symptoms should get better within a few days.
When they experience their symptoms, they might say or do things that upset you. If this happens, it can help to wait until after the symptoms have passed before bringing it up. That way they may feel more able to talk about it.
When they experience symptoms, you can try to reassure them that the symptoms will soon pass. Let them know that you’re there to support them and that they’re not alone. It often helps to just know that there’s someone around who understands.
Some people with PMDD experience suicidal feelings. This can be difficult to cope with, for both of you. See our pages on supporting someone who feels suicidal for information about how you can help.
PMDD symptoms happen at specific times in the menstrual cycle.
If you can predict when the symptoms are likely to start, you can plan things in advance that might help. For example, you could schedule time to help out with daily chores. Or you could plan activities to help them to relax. You could make sure you’re around to offer your support.
It might also help to avoid planning any activities during times that they might find difficult.
Our information on treatments for PMDD and self-care have information on getting support for PMDD. You could also encourage them to seek help from their GP.
But not all healthcare professionals are aware of PMDD or fully understand it. Some people can face barriers to getting the treatment and support they deserve.
It can help to remind them that PMDD is a recognised condition like many others. And that they deserve treatment and support.
Knowing that you’re there to support them could help them to keep trying, if they do face barriers. You could even consider becoming their advocate.
Supporting someone can be really hard. It’s common to feel overwhelmed at times.
Try to look after your own mental health too. This will help you to have the energy, time and distance you need to be able to offer support. You could:
See these pages on coping while caring for someone else for more suggestions on what you can do, and where you can go for support.
Our friendly team at the Portsmouth Mental Health Hub are here to help.
Enter your details and someone will call you back between 8am and 6pm, Monday to Friday.
If you or someone you know needs urgent mental health help, please call 111 – the NHS non-emergency number. It’s available 24 hours a day, 7 days a week and is free from any phone. They have specialist mental health nurses who can support adults and young people.
In a life-threatening emergency, always call 999.