Tracey Sullivan Pharmacy Features Writer

Pre-menstrual dysphoric disorder (PMDD) has been described as “PMS on steroids”. It is a hormone-based mood disorder characterised by severe psychological (and sometimes physical) symptoms. The symptoms are usually associated with clinically significant distress and interfere with work, school, social activities and relationships. While up to 80% of people who menstruate experience symptoms of pre-menstrual syndrome (PMS), only 5 to 10% of people get PMDD.


How is PMDD different to PMS?
With PMS, people experience mild emotional and physical symptoms in the week before their period. While these symptoms can be unpleasant, they don’t cause much in terms of life disruption.


With PMDD, sufferers experience severe, life-impairing emotional and sometimes physical symptoms that last anything from one to two weeks before their period. The symptoms usually go away two to three days after their period starts and the person goes back to normal…until the next month. The term “dysphoric” means “a consistent state of profound unhappiness and dissatisfaction”.


How is PMDD diagnosed?
A diagnosis requires at least five symptoms to be present. Using a diary to track the menstrual cycle is also very important to see what and when the symptoms occur, as the timing of symptoms is very telling. Up to 90% of people living with the disorder are undiagnosed. PMDD can be misdiagnosed as other mental health disorders such as bipolar disorder, generalized anxiety disorder, or depression. However, they key difference between these disorders and PMDD is that PMDD symptoms are cyclical rather than continuous.

Physical symptoms:

  • cramps
  • bloating
  • joint/muscle pain
  • headaches
  • breast tenderness.

Psychological symptoms:

  • depressed mood
  • anger, irritability
  • trouble concentrating
  • mood swings, frequent crying
  • insomnia or feeling very sleepy
  • feeling overwhelmed or out of control
  • appetite changes (food cravings or binge eating)
  • lack of interest in activities or relationships that are normally enjoyed
  • tiredness, low energy
  • sadness, despair
  • panic attacks
  • thoughts of suicide/self-harm.


What causes it?
Doctors and scientists are unsure why some people suffer from PMDD. It appears that the neurotransmitter serotonin may play a key role. Serotonin is our happy hormone and levels of this hormone fluctuate throughout the menstrual cycle depending on estrogen levels. It is thought that people with PMDD are extra sensitive to the fluctuating hormones of the menstrual cycle and react severely to these fluctuations. The reason that PMDD is worse in the days before a period (second half of the cycle, also called the “luteal phase”) is because estrogen levels (and other hormones) begin to fall after ovulation, and then start to rise again once menstruation starts.


How is PMDD treated?
Identification and treatment of PMDD can be life-changing for sufferers. Currently a combination of medicines can bring enormous relief.

  • Selective serotonin reuptake inhibitors (SSRI’s): The mainstay of treatment are the SSRI anti-depressants sertraline, fluoxetine and paroxetine. SSRIs help to balance serotonin levels in the brain to regulate mood, relieve anxiety and depression, and improve sleep. For some people, they don’t need to take their SSRI every day, just in the last two weeks of their cycle.
  • Oral contraceptives: used to suppress ovulation and help regulate the hormonal swings of the menstrual cycle
  • Menopausal hormonal therapy (MHT/HRT): for older women hormone replacement therapy can help even out hormonal fluctuations
  • Pain relievers: anti-inflammatories such as ibuprofen or naproxen can relieve cramps, headaches and joint pain
  • Surgery: as a last resort some women opt for a THBSO (Total Hysterectomy with Bilateral Salpingo Oophorectomy) which removes both ovaries and the uterus.


Do lifestyle changes help?
Lifestyle changes can decrease the severity of symptoms:

  • prioritise sleep
  • manage stress (mindfulness, relaxation techniques)
  • exercise regularly
  • take vitamins such as magnesium, calcium and vitamin B6
  • increase protein intake and stabilise blood sugar levels by eating whole foods
  • consider an anti-inflammatory diet
  • decrease sugar, salt, caffeine and alcohol intake
  • consider CBT (Cognitive Behavioural Therapy).


While there is still a lack of awareness of PMDD in the medical community, a growing number of women are being diagnosed with PMDD. Early diagnosis and treatment can have huge positive impacts on the daily lives of sufferers. Don’t suffer alone, and don’t go under-diagnosed. Talk to your health professional if you feel that your PMS symptoms are affecting your daily life.

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