Premenstrual dysphoric disorder (PMDD)

Explains what PMDD is and explores issues around getting a diagnosis. Also provides information on self care and treatment options, and how friends and family can help.

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What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS), which can cause many emotional and physical symptoms every month during the week or two before you start your period. It is sometimes referred to as 'severe PMS'.

While many people who are able to have periods may experience some mild symptoms of PMS, if you have PMDD these symptoms are much worse and can have a serious impact on your life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal thoughts.

"The best way for me to describe it is that – once a month – I decided to press my own ‘self-destruct’ button and literally let my life (my normally very happy and satisfying life...) implode around me. Then when the dark thoughts lifted and completely cleared, I spent the next 2 weeks trying to pick up the pieces."

What are the symptoms of PMDD?

If you have PMDD, you might find that you experience some of symptoms listed below. But it's different for different people, so you might also experience other kinds of feelings which aren't listed here.

Emotional experiences

mood swings
feeling upset or tearful
feeling angry or irritable
feelings of anxiety
feeling hopeless
feelings of tension or being on edge
difficulty concentrating
feeling overwhelmed
lack of energy
less interest in activities you normally enjoy
suicidal feelings

Physical and behavioural experiences

breast tenderness or swelling
pain in your muscles and joints
headaches
feeling bloated
changes in your appetite such as overeating or having specific food cravings
sleep problems
finding it hard to avoid or resolve conflicts with people around you
becoming very upset if you feel that others are rejecting you

You will typically only experience these symptoms for a week or two before your period starts. The symptoms follow your menstrual cycle, so you might find they start to get better when you get your period and will usually have disappeared by the time your period is finished.

"In the depths of my PMDD I tend to just retreat to my bed – I get very depressed and my anxiety goes sky high. I get hugely fatigued and can’t keep my eyes open – I sleep for about 18 hours a day."

PMDD and suicidal feelings

Some people find that one of their monthly symptoms is thoughts about suicide. This is can feel very distressing.

If you're experiencing suicidal feelings and are worried you may act on them, you can call 999, go straight to A&E or call the Samaritans for free on 116 123 to talk. You can also scroll to the top of this page and click the yellow 'I need urgent help' button, which can guide you through more options for keeping yourself safe. (See our pages on how to cope with suicidal feelings for more information.)

What are the causes of PMDD?

The exact causes are still not fully understood but some possible factors are:

Being very sensitive to changes in hormone levels. Recent research suggests that PMDD is associated with increased sensitivity to the normal hormonal changes that occur during your monthly menstrual cycle.
Genetics. Some research suggests that this increased sensitivity to changes in hormone levels may be caused by genetic variations.

Some other research has shown that in some cases PMDD may be linked to stressful and traumatic past events (such as emotional or physical abuse), but there's no evidence to explain how or why.

"It very much got worse as I went into my 30s and by my mid-30s I was losing 3 days going downhill, a week in a depression feeling like I was going through a bereavement, and then a few days to recover and feeling like I’ve been chewed up and spat out. It’s exhausting to know that once it passes you have to brace yourself for it all to happen all over again in a couple of weeks' time."

Is PMDD a mental health problem?

PMDD is commonly defined as an endocrine disorder, meaning that it is a hormone-related disorder. But as well as physical symptoms, people with PMDD also experience a range of different mental health symptoms such as depression and suicidal feelings. For these reasons, it has recently been listed as a mental health problem in the DSM-5 (one of the main manuals that doctors use to categorise and diagnose mental health problems).

It's important to remember that ultimately, how you understand your symptoms and experiences is up to you. The most important thing is that you get the support you need and deserve to help you manage the effects that they have on your life.