Premenstrual dysphoric disorder (PMDD)
Explains what PMDD is, including possible causes, symptoms and how to access treatment and support. Includes self-care tips for helping yourself, plus guidance for friends and family.
How is PMDD diagnosed?
To get a diagnosis of PMDD the best place to start is visiting your doctor. To help them understand your symptoms your doctor may:
- Ask you to keep a detailed record of your symptoms for at least two months, to see if your symptoms have a pattern over time. This may be in your diary or they may give you some daily questionnaires to fill out.
- Ask you about your medical history, such as any history of mental health problems.
- Ask about your lifestyle, such as if you smoke, drink alcohol or are overweight.
- Give you a physical examination along with some blood tests, so that they can rule out other medical problems.
When you're asked to keep a record of your symptoms over several months, getting a diagnosis can feel like a very slow process. This can be frustrating if you're having to wait a long time to get treatment. Our page on self-care for PMDD has some ideas you can try in the meantime.
I tracked my symptoms over three months, and saw that there was a direct correlation between my monthly cycle and my mental health.
What if I'm struggling to get a diagnosis?
Some people find getting a diagnosis of PMDD can be really difficult. This might be because it can take a long time to realise that your symptoms follow a cycle and that they are linked to your period. It can also be because PMDD is not very well known, even amongst health professionals. It can be really upsetting and frustrating if you feel like your doctor is overlooking something, or not taking you seriously. There are things you could try though:
- Keep your own detailed record of your symptoms over time. You could do this in a diary, or you can download mood charts from the internet. The more information you collect over a long period of time, the better prepared you'll be to explain your symptoms to you doctor.
- Take the PMDD treatment guidelines with you to your GP appointment. The National Institute for Health and Care Excellence (NICE) and the National Association for Premenstrual Syndrome (NAPS) both provide detailed, step-by-step guidelines on the diagnosis and treatment of PMS . These include severe PMS, which is another term for PMDD. You can download these from their websites.
- Ask at your GP surgery if you could speak to a doctor who specialises in mental health, gynaecology or endocrinology. Gynaecology is the branch of medicine that deals specifically with the female reproductive system, and endocrinology deals with hormones.
- Consider finding an advocate. An advocate is someone who can come to appointments with you and help make sure people listen to you. See our pages on advocacy for more information.
PMDD and my lightbulb moment
I would say to anyone suffering with mental health issues, please do consider your monthly cycle as the possible cause of them. Talk to your doctor (and if they don’t listen, ask for a different doctor) and remember that there is help out there.
When the suicidal feelings became unbearable, I realised I had to take action. I decided I had to explain it properly to the doctor as my life depended on it, so I brought my mum with me and told the whole story. I got referred to a gynaecologist and now that I'm under hormonal treatment my symptoms are much better.
Your doctor might consider whether you have premenstrual exacerbation (PME) rather than PMDD. This is when existing mental health problems are made worse during the luteal phase of your menstrual cycle. In PME, your symptoms will continue even after your period but at a lower intensity. This is why tracking your symptoms throughout your cycle is important so that you get the right diagnosis.
The International Association for Premenstrual Disorders (IAPMD) has more information on PME on their website.
I saw five different (male) GPs before they accepted my suggestion that my problems were connected to my cycle and I eventually came away with a factsheet about 'PMS' in my hand. It wasn't until recently that I sat in front of a doctor who didn't look at me as if I was mad when I said that my menstrual cycle was driving me insane.
This information was published in August 2021. We will revise it in 2024.
References and bibliography available on request.
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