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Premenstrual Dysphoric Disorder (PMDD) is a hormonal disorder that occurs in the second half of the menstrual cycle (the luteal phase), typically the two weeks before the period bleed AKA menstruation occurs. It goes beyond the typical mood swings and physical discomfort associated with PMS, causing severe emotional and physical symptoms that can interfere with daily life.
Whilst PMS and PMDD have similar symptoms, PMDD has a much more negative impact on everyday living. The symptoms are more intense and severe, affecting a person's whole quality of life.
The mild to moderate symptoms of PMS would include mood swings, irritability, bloating, and fatigue. PMDD, on the other hand, involves more serious emotional, physical and behavioural symptoms.
A GP would give a PMDD diagnosis. Firstly, it could involve tracking symptoms for at least two menstrual cycles to help them better understand a person's symptoms, look for a pattern or connection which may prompt them to ask further questions. Keeping a detailed symptom diary and including lifestyle and dietary key points is also beneficial. For example, if you exercise on a day and symptoms are worse or better, if you’ve had less water to drink or consumed alcohol and how that affects symptoms.
It may feel like a lengthy process and it can be frustrating if you feel you’re waiting a long time. Visit Mind’s self-care for PMDD for more.
There are various treatment options for PMDD that are proven to be effective, including medication and lifestyle interventions. Finding the most suitable treatment for you should take into consideration the severity of your PMDD symptoms and your personal preference, which would all be discussed with your doctor.
Some of the medication options are:
A type of anti-depressant shown to be effective in reducing the intensity of PMDD symptoms.
A hormonal birth control pill that may regulate hormonal fluctuations and reduce the severity of symptoms by stopping your period. The evidence for taking the combined pill as treatment for PMDD is mixed. Many people have found it reduces their symptoms whilst others feel it makes their symptoms worse. It is also not suitable if you are trying to get pregnant.
If you and your doctor agree this type of medicine may help it is likely you will usually a three month trial to see if it is right for you.
These may be recommended by your doctor to help reduce the physical symptoms and discomfort with PMDD such as headaches, joint and muscle pain.
Gonadotropin releasing hormone (GnRH) analogue injections bring on a temporary menopause and can be beneficial for some people in reducing PMDD symptoms.
In extreme cases, surgical options may be considered, particularly if other treatments prove ineffective. This would involve the removal of your uterus, ovaries and fallopian tubes to permanently stop your menstrual cycle.
There are also talking therapies and counselling options too, such as cognitive behavioural therapy (CBT).
Find out more information on the different treatment options.
There are a few supplements with some evidence of efficacy for PMDD, but the evidence is limited, and these would not be recommended as the main treatment for PMDD. It’s also important to note some of these may interact with other medications and should be discussed with your doctor or pharmacist first.
Calcium carbonate – may reduce some physical symptoms
Vitamin B6 – may relieve anxiety and mood swings however taking too much can lead to loss of feeling in your arms and legs (peripheral neuropathy)
Agnus Cactus – Also known as Chasteberry or Vitex, it’s a herb that may reduce irritability, anger, headaches and breast pain
Omega-3 fish oil – may help reduce depression and irritability
Building a healthy lifestyle including regular exercise, a balanced diet, getting plenty of sleep and managing stress levels can all help in reducing PMDD symptoms.
