PMDD diagnosis

What is PMDD

Premenstrual dysmorphic disorder or PMDD is a condition that severely affects 5-8%¹ of a woman’s quality of life during the luteal phase (the 2 weeks before your period) of their cycle (what are phases of your menstrual cycle?). PMDD is an American diagnosis which may be referred to as severe PMS in the UK. However, PMDD is becoming a more commonly used term in the UK too. 

How to prepare for a PMDD doctor’s appointment

At a doctor’s appointment, they will ask you questions about yourself and how you feel at different points of your menstrual cycle. The only way you can answer these questions is by tracking your symptoms. 

How to track PMDD symptoms

Keeping a PMDD diary is a useful way to accurately express the severity and number of symptoms you experience. We recommend recording symptoms for at least 2 menstrual cycles, so there is enough data to establish a relationship between symptoms and timing of the cycle². However, if you can record it for longer, that is even better. 

This questionnaire “The Daily Record of Severity of Problems”, was designed to make your symptom-tracking simpler. Print it out and note down everything, the more information you can collect, the more your doctor can get an understanding of what you are going through. 

What will my doctor ask me at a PMDD appointment?

Doctors will ask about:

• Symptoms you are experiencing 
• The time in your menstrual cycle in which they occur
• If there could be any underlying physical or mental health conditions

Sadly, there is no PMDD blood test. Diagnosing PMDD is a diagnosis of exclusion, meaning  other conditions have to be ruled out, alongside showing you fit the criteria for PMDD. If you have noted down your symptoms and the extent to which they affect your day-to-day, this is a good time to show them your recordings. 

They will also go through your past medical history, family history and go through any medications you are currently taking. We have some research that has indicated PMDD is an inheritable or genetic condition³. So if your mother is a PMDD sufferer, your risk of having PMDD could be higher than the general population. 

Your doctor could ask for a blood test to rule out conditions that mimic PMDD such as low thyroid function (hypothyroidism), pregnancy, and perimenopause (only if you are under the age of 45, or do not have periods while using progestogen-only contraception)⁴. The symptoms of these conditions are present throughout the whole cycle, unlike PMDD where symptoms are just during the luteal phase. 

How to get a PMDD diagnosis

The criteria to be diagnosed with PMDD have been created by the American Psychiatric Association. They include⁵:

• At least 5 symptoms are present 7 days before the onset of your period
• Improvement in symptoms a few days after your period starts
• A week after your period stops, symptoms should be minimal or completely absent 
• Symptoms should severely interfere with normal day-to-day activities (work/school) or relationships with others

The 5 symptoms needed to be diagnosed with PMDD can be any of the following:

At least one of:

• Mood swings, feelings of rejection, becoming suddenly very sad or tearful
• Anger, irritability or arguing more
• Depressed mood, low self esteem or hopelessness
• Anxiety, tension or feeling on edge

Plus any of these symptoms:

• Not being interested in your usual hobbies
• Difficulty concentrating
• Tiredness or lack of energy
• Change in appetite, overeating or cravings
• Sleeping too much or not being able to sleep
• Feeling overwhelmed or out of control
• Breast tenderness
• Joint or muscle pain
• Bloating or weight gain

In the UK, you may be diagnosed with severe PMS, which doesn’t meet the strict criteria above for PMDD, but still have a similar effect on your quality of life. 

UK criteria⁶:

• Symptoms only present in the luteal phase (1 or 2 weeks before your period starts)
• The severe intensity of symptoms affects your ability to complete day-to-day activities (work/school) and keep your relationships with friends and family
• As your period arrives, the symptoms get better
• After a week of starting your period, symptoms completely disappear
• This occurs with each menstrual cycle

This is the general criteria in the UK. Based on the severity of the symptoms, the doctor can diagnose you with severe premenstrual syndrome (PMS). There is no set number of symptoms that need to be met. 

In both the UK and US classification systems, the symptoms cannot be caused by any other conditions (such as anxiety, depression, personality disorder) or caused by substances (like drug abuse or medication)⁶. 

Why PMDD can be misdiagnosed as other mental health problems

PMDD can be misdiagnosed as depression⁷ or bipolar disorder⁸ as they share some common psychological symptoms like low mood, unstable mood changes and suicidal thoughts. It is also possible that some mental health conditions can get worse during the luteal phase of your cycle too. This is called premenstrual exacerbation. As these conditions and PMDD can’t be easily tested for with a blood test or scan, it is left to the decision of your medical professional. This is why the more information you can offer your doctor, the higher the chances of getting the right diagnosis for yourself.

Summary

PMDD is a tough condition to live with and sufferers can experience symptoms for over 8 years of their life if you add up each menstrual cycle⁹.

Understanding what is happening to your body and seeking medical attention is the first step in getting the correct diagnosis and treatment to improve your quality of life. 

Please do not put off getting help. Your health and well-being is very important.

If you cannot wait, reach out to one of our Lowdown women’s health GPs. We will take our time in listening to your concerns, figuring out the right diagnosis and talking through the best treatments for you.