What is PMDD, and how is it different from PMS?

PMDD (premenstrual dysphoric disorder) is a much more severe form of PMS. The symptoms are similar, but the NHS says they are much more intense and can have a much greater effect on everyday life, including feeling very anxious, angry, depressed or even suicidal in the weeks before a period. It is a recognised condition, and there are treatments that can help.

What is PMS?

PMS (premenstrual syndrome) is the name for symptoms that can come in the weeks before a period. The NHS says most women have PMS at some point. Common symptoms include:

• mood swings, or feeling irritable, low, upset, anxious or emotional
• tiredness or trouble sleeping
• bloating or cramping
• breast tenderness
• headaches
• spotty skin or greasy hair
• changes in appetite or food cravings

For most people these are annoying but manageable.

How PMDD is different

The NHS says a small number of women get the more severe form, PMDD. The mental health charity Mind describes it as causing a range of emotional and physical symptoms every month in the week or two before a period. It’s sometimes called “severe PMS”, but that can undersell it.

What sets it apart is how much it affects your life. Symptoms the NHS links with PMDD include:

• feeling very anxious, angry or depressed
• suicidal thoughts
• headaches, and joint and muscle pain
• overeating
• sleep problems

Mind notes that PMDD is listed as a mental health condition in the DSM-5, one of the main manuals doctors use to diagnose mental health problems.

Why the timing matters

PMDD follows your cycle. Mind explains that it happens between ovulation and the start of your period, known as the luteal phase, which lasts around 2 weeks for most people. You might have symptoms every day of that time, or just for a few days of it.

That pattern is the key clue. If your mood drops sharply at the same point every month, it’s worth tracking.

It isn’t fully clear what causes PMDD. The NHS says it has been linked to being very sensitive to changes in hormones, or to differences in the genes you inherit.

Getting a diagnosis

The NHS suggests keeping a diary of your symptoms for at least 2 menstrual cycles and taking it to a GP appointment. Note:

• the date your period starts each month
• each symptom and how strong it is
• how it affects your day, your work and your relationships

A clear diary showing symptoms that rise before your period helps your GP see the pattern. The International Association for Premenstrual Disorders (IAPMD), which focuses on PMS and PMDD, also has a symptom tracker and information on the steps to diagnosis.

Treatments the NHS lists

What helps varies from person to person. The NHS suggests starting with:

• regular exercise
• a healthy, balanced diet; some people find smaller meals every 2 to 3 hours better
• plenty of sleep
• ways to reduce stress, such as yoga or meditation
• painkillers such as ibuprofen or paracetamol for pain
• not smoking, and not drinking too much alcohol

If that isn’t enough, the NHS says a GP may suggest:

• hormonal medicine, such as the combined contraceptive pill
• cognitive behavioural therapy (CBT), a talking therapy
• antidepressants

If symptoms continue after trying these, you may be referred to a specialist such as a gynaecologist, psychiatrist or counsellor.

The NHS says there isn’t much evidence that complementary therapies or supplements work for PMS, and advises checking with a GP or pharmacist before taking regular supplements alongside other medicines.

Every treatment has pros and cons, so talk to your GP about what suits you before starting, stopping or changing anything.

What to do next

• Start a symptom diary today and keep it for at least two cycles. A free tracker app or a notebook both work.
• Book a GP appointment and bring the diary. Say plainly how much it affects your life. If you think it’s PMDD, use the word.
• Tell someone you trust about the pattern, so they understand what’s happening and can support you on the hard days.

If you’re struggling

If PMDD is making you feel hopeless or you’re having thoughts of suicide, you don’t have to wait for your next period to pass. The NHS says to call 999 or go to A&E if you have PMDD symptoms and are feeling suicidal. You can also talk to your GP, or call Samaritans free on 116 123, any time, in Ireland and the UK. In Ireland, you can call Pieta on 1800 247 247, or text 50808 to talk to someone by text. In the UK, text SHOUT to 85258. In an emergency, call 999 or 112.