What Is PMDD, and Why Is It So Often Misunderstood?

Premenstrual Dysphoric Disorder (PMDD) remains one of the most misunderstood menstrual health conditions. Though PMDD symptoms occur during the luteal phase of the menstrual cycle, they are frequently mistaken for common PMS or attributed to emotional instability, leading to misdiagnosis and delayed treatment.

What Is PMDD?

PMDD is a hormone-related mood disorder that occurs during the week or two between ovulation and the start of menstruation (the luteal phase). It causes a recurring pattern of intense emotional and physical symptoms that typically ease once bleeding begins.

These may include mood swings, anxiety, tearfulness, irritability, low energy, difficulty concentrating, and in some cases, suicidal thoughts. While it shares some features with PMS, PMDD is far more severe and can seriously disrupt daily life. It is a recognised medical condition that requires clinical attention.

What Are the Symptoms of PMDD?

While PMDD shares many symptoms with premenstrual syndrome (PMS), its effects are significantly more intense and disruptive. Each person’s experience with PMDD can vary widely, and some symptoms may not be included here. Below are the most common emotional and physical signs to watch for.

Emotional and Behavioural Symptoms:

• Severe mood swings and irritability

• Persistent sadness, hopelessness, or tearfulness

• Heightened anxiety or feeling constantly on edge

• Feelings of being overwhelmed or out of control

• Loss of interest in usual activities

• Difficulty concentrating

• Low energy and fatigue

• In severe cases, suicidal thoughts

  
  

Physical Symptoms:

• Breast tenderness

• Headaches or migraines

• Joint or muscle pain

• Bloating and abdominal discomfort

  
  

These symptoms significantly impair quality of life, affecting work, relationships, and everyday functioning. Early recognition and treatment are crucial for managing PMDD effectively.

What Causes PMDD?

The exact cause of PMDD is not fully understood. Research suggests that people with PMDD have an increased sensitivity to normal hormonal changes during their menstrual cycle.

Factors that may contribute or worsen symptoms include:

• Genetic predisposition (it can run in families)

• Smoking

• Stress and past trauma, such as emotional or physical abuse

  
  

PMDD is recognised as both a hormonal disorder and a mental health condition, as it can cause symptoms like depression and anxiety.

How Is PMDD Diagnosed?

Diagnosing PMDD involves several important steps, since there’s no single test. Your GP will likely:

• Track your symptoms over time: You’ll be asked to keep a daily diary or complete questionnaires for at least two menstrual cycles. This helps reveal a clear pattern of symptoms that occur before your period and improve once it starts.

• Meet specific diagnostic criteria: Diagnosis requires having five or more symptoms during the luteal phase in most cycles throughout the year.

• Rule out other conditions: Your GP will check for other health issues that could cause similar symptoms, such as depression, anxiety, or thyroid problems.

• Review your medical history: This includes any previous mental health concerns or relevant medical conditions.

• Assess lifestyle factors: Smoking, alcohol use, and body weight might also be discussed, as these can impact symptoms.

• Conduct a physical exam and blood tests: These help exclude other possible causes for your symptoms.

  
  

This process can feel slow or frustrating, but tracking symptoms carefully is crucial for an accurate diagnosis and to access the right treatment and support.

How Is PMDD Treated?

PMDD is a chronic condition that often requires a combination of approaches:

• Lifestyle changes: balanced diet, regular exercise, and stress management

• Supplements such as vitamin B6, calcium, and magnesium

• Anti-inflammatory medications

• Prescription treatments: selective serotonin reuptake inhibitors (SSRIs) and hormonal contraceptives

  
  

Treatment plans are tailored individually and may require adjustments over time.

Why Is PMDD Often Misunderstood?

PMDD is often dismissed as “just PMS” or mistaken for emotional instability, despite its severe, cyclical symptoms. Part of the confusion lies in its biological roots: a sensitivity to hormonal changes that science is only beginning to understand.

Although it affects an estimated 3–8% of women of reproductive age, millions of women worldwide, PMDD wasn’t officially recognised as a medical condition until 2013. Social stigma, outdated stereotypes about women’s emotions, and limited research into menstrual health mean diagnosis is often slow and support inconsistent.

Raising awareness, improving diagnostic tools, and challenging long-standing taboos are crucial to ensuring those affected get the care they deserve.

What Can You Do?

If you experience symptoms like those described, start tracking your cycle and symptoms carefully. Speak openly with your healthcare provider and advocate for thorough assessment.

With the right diagnosis and treatment, managing PMDD is possible, helping you reclaim control over your health and wellbeing.