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Premenstrual dysphoric disorder (PMDD) is a similar health concern to premenstrual syndrome (PMS). The primary difference is that PMDD is more severe and often goes undiagnosed. Unlike PMS, PMDD symptoms are both emotional and physical, interrupting your daily life. It's common to experience mood swings, bloating, irritability, fatigue, and more.
It's estimated that around 1 in 10 women will be diagnosed with PMDD at some point. If left untreated, it can affect work, relationships, and social life. PMDD treatment is often symptom-specific, focused on the week or two before your period.
In this guide:
Common Symptoms of PMDD
PMDD symptoms begin 7 to 10 days before the start of your period – depending on the person, it can be a little earlier or later. Usually, women experience a combination of physical and mental symptoms; however, it can lean one way or the other, depending on the person.
1. Severe Mood Swings & Irritability
One of the characteristic symptoms of PMDD is a profound drop in mood. Women often complain of intense emotional fluctuations, going from their normal state to suddenly experiencing feelings of sadness, anger, or hopelessness.
These emotions can flip within a few minutes, swapping from intense anger to sudden despair. Women may also experience crying spells, thoughts of suicide, moodiness, and more.
2. Depression & Anxiety
Depression and anxiety are specific terms that describe mental health conditions. These are defined as:
Depression is a mental health condition characterised by persistent sadness, hopelessness, and a loss of interest or pleasure in activities.
Anxiety is a mental health disorder marked by excessive worry, nervousness, and a heightened sense of fear or apprehension about everyday situations.
It's important to remember these definitions as women with PMDD aren't simply a "bit down" or "on edge" they're experiencing severe sadness, panic attacks, feelings of being out of control, unable to enjoy their usual life, and much more.
This differentiates the condition from PMS, where the symptoms are primarily physical. Indeed, women with PMS might feel down about their condition, but it doesn't qualify as a mental health problem.
3. Fatigue & Sleep Disturbances
During the week or so before a period, a common PMDD symptom is unexplained tiredness and difficulty sleeping. Obviously, a lack of sleep and tiredness are connected. However, fatigue is a symptom in numerous conditions, from hypothyroidism to anaemia. Your doctor will want to review your health to ensure it's related to your PMDD.
Often, women with PMDD complain about a severe lack of energy. This can be exacerbated by depression or low mood, which affects a person's motivation. Combined, they can lead to a sudden withdrawal from social or work life.
4. Physical Symptoms
It's not just your mental health that's affected. Like PMS, PMDD symptoms cover several physical complaints. Usually, the physical symptoms of PMDD are diffuse and systemic. This can include:
Bloating, abdominal pain, and weight gain
Headaches
Joint or muscle pain
Breast tenderness
If you notice any of these symptoms, it's sensible to keep a diary. Look for a pattern in your symptoms and if they're related to your period.
5. Changes in Appetite
Appetite changes are another frequent PMDD symptom. Women either experience increased cravings and overeating or else lose their appetite as part of the disorder. This can be related to the condition itself. However, other symptoms, like a lack of sleep, can fuel a desire for overeating and calorie-dense processed foods. On the other hand, depression can cause people not to feel hungry, as can intense anxiety.
It's crucial to separate the change in appetite from other PMDD symptoms. Only by treating the underlying cause can you return to normal.
How Does PMDD Differ from PMS?
PMS and PMDD are often conflated. It's not hard to see why. Both conditions cause symptoms in women prior to their period. However, the obvious difference is in the severity and type of symptoms.
PMS is more common, affecting approximately 75% of women during their reproductive years. Symptoms are generally mild and manageable, including bloating, headaches, mood swings, and irritability. The condition is often managed successfully with over-the-counter painkillers and hormonal treatments (e.g., birth control pills).
PMDD, in contrast, is much rarer (3-8% of women) and more severe than PMS. Similarly, women experience symptoms like bloating, headaches, mood swings, and more. The difference is that they're dialled up significantly for PMDD sufferers. Women feel severely depressed, hopeless or extremely angry and anxious – the range of emotions can be exhausting for those affected. In fact, the condition requires more aggressive management, including antidepressants, specific hormonal treatments, and sometimes therapy.
How is PMDD Tested?
Managing PMDD begins with getting diagnosed. If you suspect you have PMDD, it's important to speak to your GP. They can perform a thorough evaluation of your symptoms and organise any tests. If your GP suspects PMDD, they may ask you to keep a diary of symptoms. You can also start keeping a symptom diary before speaking to your GP to confirm the connection between your period and symptoms and speed up the diagnostic process.
PMDD cannot be diagnosed by a specific test. However, as PMDD symptoms are often vague and systemic, your GP may want to rule out other conditions. Usually, this means having a blood test to check for thyroid problems, anaemia, and perimenopause (the early stage of menopause). If these tests come back negative and there's a link to your period, your GP will work with you to create an effective treatment plan.
PMDD Treatment
PMDD treatments involve lifestyle changes, talking therapies, and a combination of medications. Similar to treating a mental health condition, like depression or anxiety, managing PMDD begins with lifestyle changes. This could include:
Being more active
Eating a balanced diet rich in whole foods
Ensuring you have a supportive social network
Reducing alcohol and caffeine consumption
Avoiding sugary snacks
Limiting exposure to stress
Maintaining a healthy sleep schedule
Developing a routine is crucial. It allows you to follow a set pattern when your PMDD symptoms begin to arise while minimising their potential severity.
Talking therapies such as cognitive behavioural therapy (CBT) are another effective option. These therapies target the emotional symptoms of PMDD, working to change how you think, feel, and behave regarding your condition. When combined with lifestyle changes, it can help you recognise negative thought patterns, replacing them with positive habits and thoughts.
Of course, medication is sometimes necessary. The first-line medication for PMDD is usually an antidepressant. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline or fluoxetine, are commonly prescribed to tackle any low mood or anxiety.
The physical symptoms of PMDD often benefit from oral contraception. It will stop your periods when taking it, thereby easing any severe PMDD symptoms. However, it's not effective for everyone. Another option is gonadotrophin-releasing hormone (GnRH) analogues, which are prescribed if SSRIs and the contraceptive pill prove unsuccessful.
Get Checked for PMDD
Suspect you've got PMDD? Given the similarity of the symptoms to other conditions, it's crucial to get a comprehensive review of your overall health. It won't diagnose PMDD. But it can detect any conditions behind your symptoms or exacerbate the condition.
The Well Woman Check is a trusted screening service for issues related to hormonal imbalances, reproductive health, and well-being. Specifically, it tests your full blood count, vitamin B12 and vitamin D levels, folic acid and iron, thyroid function, calcium and phosphate, diabetes, kidney function, and liver function. It's like an MOT for the body, giving you peace of mind.
Book your Well Woman Check with Health Klinix today. We'll organise your blood test and provide a detailed explanation of your results within 1-3 working days. We're here to support you.
References:
Written by:
Dr Joseph Nightingale, MBBS, MSc
Approved by:
Dr Ravi Gowda, Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
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