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Premenstrual Dysphoric Disorder: Understanding PMDD

As hormone levels begin to drop after ovulation, most women experience some changes in their physical and mental state such as tender breasts, bloating, or moodiness. Such symptoms are often linked with Premenstrual Syndrome, or PMS. For those of us who suffer from Premenstrual Dysphoric Disorder, or PDD, the symptoms—especially those having to do with emotions—are noticeably more severe.

Woman experiencing emotional symptoms of Premenstrual Dysphoric Disorder (PMDD) during menstrual cycle.

A wide variety of uncomfortable symptoms can appear in the premenstrual phase of the menstrual cycle, or 1–2 weeks before your next period begins. Decreasing levels of oestrogen and progesterone will inevitably cause some changes in your body; depending on your individual makeup, these symptoms may be annoying, tedious, or even debilitating. However, we no longer believe that experiencing severe PMS is an inevitable part of having a period.

The unpleasantness associated with PMS, along with the “dark mystery” of menstruation, are among the most common reasons why periods are such a troublesome subject and still taboo in many places around the world. Depictions of women overcome by pain, dramatic mood swings, and strange cravings contribute to unhelpful stereotypes that make menstruation seem mysterious and frightening, and menstruating women something to be avoided.

Although some discomfort is, unfortunately, normal, modern medicine recognizes that severe pain, mood disorders, and other menstrual-cycle-related symptoms that impair normal functioning, are not ordinary variations and should not be treated as such.


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You can track your period using WomanLog. Download WomanLog now:

Around 3–8% of women worldwide, roughly 1 in 20, are believed to suffer from Premenstrual Dysphoric Disorder. Symptoms of PMDD usually appear when a woman is in her mid-twenties and sometimes grow even more severe as she approaches menopause. 

What makes PMDD tricky to diagnose and to treat is the predominantly emotional nature of the symptoms. The most common symptoms of PMDD include:

  • Severely depressed mood
  • Fluctuating emotions
  • Severe anxiety and irritability
  • Anger
  • Difficulty concentrating and other cognitive impairments
  • Sleep problems
  • Fatigue or severe lack of energy
  • Changing appetite, binge eating
  • Severe physical symptoms

These symptoms may look innocuous. After all, pretty much everyone experiences some of them at some time in some form, even without having to deal with a menstrual cycle. But don’t be fooled. If any of these is experienced chronically, it can become severely debilitating.

To receive a diagnosis of PMDD, at least five of these symptoms must be present and reoccurring in the premenstrual phase of your cycle, they must affect your ability to function successfully in society, and they must appear regardless of external circumstances.

PMDD severely impacts a sufferers quality of life. It makes normal, everyday tasks and interpersonal communication at home and at work extremely difficult.

What causes PMDD?

There is no clear answer to this question. The menstrual cycle influences the functioning of the entire body as certain hormones, such as oxytocin, fluctuate from very low to very high levels and then drop back again. The hormones that regulate mood, such as serotonin, dopamine, and endorphins, can also fluctuate dramatically as a woman passes through the various phases of her cycle. Because each of us is unique in terms of genetic heritage and environmental conditions, your body may be particularly sensitive to changing levels of certain hormones or hormone interactions.

Some women have lower-than-average levels of mood-affecting hormones in circulation during the premenstrual phase or higher-than-average levels during ovulation, making the drop in oestrogen that follows in the luteal phase much more noticeable. Oestrogen is necessary for the production of serotonin and many women, even those who do not suffer from PMDD, experience the  “luteal blues”.

If you or someone in your family has experienced anxiety, depression (including post-partum depression), or a related mental health challenge, you are also more likely to develop PMDD.

Habits that deplete the body’s resources instead of providing nourishment, such as smoking and alcohol use, can also contribute to PMDD. Some studies include low socioeconomic status as a risk factor as women facing social and financial difficulties are also much more likely to experience additional challenges such as long work hours, poor diet, addiction, excessive stress, and other factors that have a cumulative draining effect on the body, which in turn can affect the functioning of the endocrine (hormone production and distribution) system, which will influence a woman’s menstrual cycle.

Woman contemplating mental health and functionality in relation to Premenstrual Dysphoric Disorder (PMDD)

The social aspect 

Given that many of the symptoms related to PMDD are psychological, and their severity is determined by fuzzy metrics such as “being able to function in society”, questions arise about what that really means. Socialization and other people’s perception of women are inevitably part of the equation.

To feel at home in ourselves we must perceive and respect the signals our bodies give us. Menstrual cramps, fluctuating body temperature, mood swings, and other cycle-related symptoms can be intense, and your body will appreciate it if you can take things a little easier until they pass. If your community is dismissive of perceived “weakness”, you might be criticised for mentioning even regular premenstrual symptoms. Each of us must find a balance between speaking our truth at home and in the workplace, regardless of where you are in your cycle, and not sharing more than is necessary with people who can’t or won’t understand.

All people experience hormonal changes; the menstrual cycle is just one of many natural processes that influence a person’s hormones and affect mood.

More and more women worldwide are now “embracing the menstrual cycle” in all its phases to live in greater harmony with the body’s changing needs and capabilities. However, this is a much greater challenge for those who suffer from PMDD.

If you are experiencing severe symptoms of PMS or have been diagnosed with PMDD, embracing anything becomes incredibly difficult. The symptoms brought on by cycle-related disorders such as severe cramping, mood-swings, and trouble concentrating are very real, can have a negative effect on all aspects of your life, and may lead to dangerous complications if ignored.

PMDD makes interpersonal relationships and common daily tasks very tough to manage. Trying your best generally won’t be enough to overcome a condition that messes with your emotions and twists your thoughts.

When you are experiencing severe mood swings, avoid acting on impulse but don’t repress or dismiss your feelings. Your experience is valid even though you are dealing with the additional burden of PMDD.

To recognise the difference between a “normal” emotional response and PMDD-influenced behaviour you will need to take deliberate action to gain some perspective. A therapist can help you understand the way you communicate and plan your day so you can interact more positively with others and with yourself.


Treatment options for PMDD

PMDD cannot always be cured as there is still a great deal we don’t know about this condition, but it can be managed successfully. Some non-medical treatments include:

Relaxation and other stress-management techniques such as meditation, breathing exercises, mindfulness, or journaling might seem trivial for someone experiencing severe symptoms of PMDD, but they really can improve your mental health significantly.

Self-care practices such as taking a warm bath, listening to relaxing music, getting a massage or an acupuncture treatment, or doing self-massage can contribute greatly to your inner peace. Find ways to soothe and support your body as it goes through challenges.

Being gentle to your body also means choosing a health-supporting lifestyle:

  • Eat foods that contain complex carbohydrates, sufficient protein, and micronutrients
  • Cut down alcohol and other intoxicants
  • Exercise regularly
  • Maintain a healthy sleep regime
  • Establish routines that simplify your life

Medical treatments for the symptoms of PMDD include:

Over-the-counter pain killers and anti-inflammatory drugs help manage premenstrual cramps and other types of physical pain. Even if pain is a frequent occurrence in your body, you should not let it stay unchecked indefinitely, as it always harms your body, especially long-term.

Antidepressants are often prescribed to combat the depression and anxiety that are often associated with PMDD. Given the link between PMDD and abnormal changes in serotonin levels, selective serotonin reuptake inhibitors (SSRIs) are often prescribed to counteract severe mood swings and other mood-related symptoms.

Cognitive behavioural therapy and other forms of psychotherapy can also address the psychological symptoms of PMDD and help sufferers establish ways to manage or reduce them.

Hormonal birth control and other types of hormonal therapy that suppress ovulation can also help reduce the negative symptoms of PMDD.

If you are suffering from PMDD, consult a medical professional to determine the best options for treating your symptoms.

You will need support to successfully navigate your condition. Talk about your PMDD symptoms with your general practitioner, your gynaecologist, and any other specialised doctors you visit, for the best chance of finding a treatment that addresses your unique constellation of symptoms.

When facing a complex, chronic condition such as PMDD, consider how the symptoms you are experiencing fit into the overall picture of your health and wellbeing. Make sure your bloodwork is up to date and be on the lookout for related illnesses that might also explain dramatic mood shifts, such as thyroid disease or depression.

Our bodies are complex organisms governed by many discrete and interactive biological processes all taking place simultaneously. Pay attention to the signals your body sends and ask for help when things get out of whack.

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