PMDD symptoms
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What's the lowdown?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome
Symptoms usually present in the luteal phase of your cycle, which is 1 to 2 weeks before your period commences
This disorder can have a severe impact on a sufferer’s life, resulting in symptoms like suicidal thoughts, depression and a reduction in quality of life
What is PMDD?
Life is a rollercoaster. One week you’re crushing it at work, the next you’re crying at pictures of kittens because they are simply too cute!
Premenstrual symptoms can be annoying and sometimes come out of nowhere. If these just have a passing effect on your days then they are just symptoms that affect up to 90% of women before their period1. However, when these symptoms start affecting your ability to function then it is considered a syndrome or disorder.
Premenstrual dysmorphic disorder (PMDD) is a cyclical hormone-driven condition meaning it affects you every month. It is technically a diagnosis based on very specific criteria from the American Psychiatric Association, and in the UK, we may also refer to PMDD as severe premenstrual syndrome (PMS). You might hear the word PMDD and severe PMS used interchangeably here.
When does PMDD start in your cycle?
Our hormones determine the different phases of our menstrual cycle. We experience the follicular phase, ovulatory phase (where an egg is released), and luteal phase which is followed by your period.
PMDD happens during the luteal phase of your cycle when progesterone levels slowly rise. It is the week or two from ovulation to before your period arrives. From the onset of your period, the symptoms should slowly lessen and then disappear completely.
What causes PMDD?
No one knows exactly what causes PMDD. However, one theory is that it is a reaction to the body’s sensitivity to the changes of oestrogen and progesterone (female hormones) during our menstrual cycle. It is not a hormonal imbalance but a hormone sensitivity. Those with PMDD are believed to have an abnormal reaction to a substance formed when progesterone is broken down in the body, called allopregnanolone2, which should normally cause calmness. In PMDD, the opposite effect happens and leads to agitation, anxiety and depression.
A 2017 study found that PMDD sufferers and people with PMDD have different genes that process our sex hormones compared to those who don’t have PMDD.3 This could explain why other studies have shown that there is a genetic or inheritable component to PMDD4. The research around PMDD is still ongoing so we can further understand what causes this disorder.
PMDD symptoms
PMDD symptoms are similar to PMS symptoms but are more severe. They also encompass emotional, behavioural and physical symptoms.5
Physical symptoms:
- Breast tenderness
- Muscle pain
- Feeling bloated
- Headaches
Behavioural:
- Extreme exhaustion or fatigue
- Lack of interest in activities that normally bring you joy
- Concentration issues
- Increased cravings and appetite (binge eating can be common)
- Issues with sleep patterns like insomnia (trouble sleeping) or hypersomnia (sleeping too much)
- Feeling like you’re losing control or spiralling
- Anger and irritability causing issues in your relationship (work or personal)
Emotional:
- Low mood to the point of depression, hopelessness or helplessness
- Self-harm or suicidal thoughts
- Labile mood swings (quickly changing from happy to sad)
- Constant anxiety
For a diagnosis of PMDD, these symptoms need to be felt at certain times of your cycle, be severe and be a specific combination of symptoms. These feelings can get so intense and overwhelming that it has a major impact on someone’s quality of life. 5-8% of people in the UK are thought to struggle with these each month6.Â
PMDD and suicidal thoughts
Some sufferers experience extreme depression during this time which can lead to suicidal thoughts or an urge to self-harm. In fact, people with PMDD are 4x more likely to have suicidal thoughts and 7x more likely to attempt suicide than people who do not have a premenstrual condition7. These thoughts can obviously be very distressing to you and your loved ones.
If you have a support network, reach out to them and talk through how you feel. Try and get them to distract you or remind you that these feelings will pass when your period starts. The MIND mental health charity has dedicated pages on how to support yourself in a crisis or cope with suicidal feelings.
The NHS accident and emergency department (A&E) is always open 24 hours a day, 7 days a week, so if you need support go straight to them. Alternatively, you can call 111, the emergency services on 999 or the Samaritans charity on their free line 116 1238,9.
You do not have to go through this alone. If you feel yourself spiraling, know you’re not alone, other women have been through this and there is treatment available. Don’t think, just give those numbers a call or visit your nearest A&E.Â
Summary
As you can see, PMDD is a debilitating disorder that can steal over 6 days each month5 from a sufferer. You should not have to live with PMDD. If you can relate to the symptoms above please get help and reach out to your GP. We cover more on what a PMDD diagnosis entails, and how to speak to your doctor in our next blog.Â
Our Lowdown GPs, are also here to support you. We offer shorter waiting times and a safe space without judgment. If you would like to speak to a women’s health specialise GP, reach out to us.
Dr Fatema Dawoodbhoy
Fatema is currently training in London as an Academic doctor, with a special interest in Obstetrics and Gynaecology. She is passionate about championing women to understand their bodies better and prioritise their health. She understands the importance of clinically accurate articles and has been writing engaging and educative medical content for 5 years.
Our medical review process
This article has been medically reviewed for factual and up to date information by a Lowdown doctor.
