Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder. It’s linked to the menstrual cycle, but it’s more – often a lot more – than just feeling a bit sad or irritable before your period comes.
What is it?
According to the International Association for Premenstrual Disorders, “PMDD is a severe negative reaction to the natural rise and fall of estrogen and progesterone.”[i] It’s not a hormone ‘imbalance’. Rather, it’s about how your brain and body respond to certain hormones.
PMDD symptoms come on just after ovulation, usually around 2 weeks before the period starts. The symptoms of PMDD are gone by the week after the period. Some women with lived experience of PMDD describe it as a ‘a switch being flicked.’[ii] The symptoms of PMDD come on very suddenly, and predictably, they are then gone just as quickly.
What are the impacts?
For those who have periods, many of us will experience some premenstrual changes to our mood and body. Most of the time, we can take these things in our stride and they don’t impact our relationships and life too much.
For those of us with PMDD, the mood, cognitive and physical changes cause significant distress and interference with daily life. It can look different in different cases, but some of the things people with PMDD report include overwhelming depression, impulsive behaviours, debilitating ‘brain fog’ and increased thoughts of suicide and self-harm.[iii]
Who is affected by it?
It’s estimated PMDD will affect 5.5% of those of us who menstruate[iv], however there seems to be disagreement on numbers on this one! On average it takes around 12 years for someone to be diagnosed with PMDD.
How do you know if you have it?
There’s no medical test for PMDD, so it’s usually diagnosed by daily monitoring of what’s happening to your body, your mood and the impacts of this over two or more menstrual cycles.
Why does it happen?
It’s not clear why PMDD happens for some of us, so keep watching this space. Some research suggests it could be something you’re genetically predisposed to, but there’s a lot we don’t know.
Why haven’t I heard of this before?
Premenstrual Dysphoric Disorder was only added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, and very recently to the WHO International Classification of Diseases and Related Health Problems (WHO ICD) in June 2019.
We might also think about how fraught it can be, talking about periods and hormones. There’s often a lot of sexist stigma associated with PMS itself, let alone something as important as PMDD. Perhaps this stigma has also played a role in keeping PMDD and conversations about menstrual health hidden.
If this is ringing a bell for you, speak to your GP. For more information you can look at the International Association of Premenstrual Disorders website www.iapmd.org. This organisation was set up by people with lived experience of PMDD.
[i] International Association for Premenstrual Disorders 2020 ‘What is PMDD’
[ii] Michelle Henderson, ‘Like Someone Flicked A Switch’, The Guardian, 2019
[iii] Eisenlohr-Moul T 2019, ‘Premenstrual disorders: A primer and research agenda for psychologists’, The Clinical Psychologist, 72(1), 5.
[iv] Evelyn Lewis 2019, “It’s not PMS’, Shining a light on premenstrual dysphoric disorder, newsGP