Premenstrual dysphoric disorder (PMDD): symptoms, diagnosis and treatment

PMDD sits at the severe end of the premenstrual spectrum. The NHS describes PMS as the name for symptoms women can experience in the weeks before a period, with most women having it at some point. A small number of women have more severe symptoms known as PMDD, which are similar to PMS but much more intense and can have a much greater negative impact on everyday life.

It is a recognised condition rather than a failure to cope. The NHS says it may be caused by increased sensitivity to the natural hormone changes of the menstrual cycle, and an earlier NHS PMS page also links it to differences in genes inherited from parents.

The NHS says symptoms usually start 1 or 2 weeks before each period and usually improve a few days after it starts. The emotional symptoms it lists are feeling depressed, hopeless, anxious or worried, feeling angry or irritable, having less interest in things you normally enjoy, feeling overwhelmed or out of control, and having suicidal thoughts.

Physical symptoms include breast tenderness, joint and muscle pain, feeling more tired than usual, problems sleeping or sleeping too much, and bloating. The NHS PMS page adds headaches and overeating among the symptoms of PMDD.

The NHS says that if a GP thinks you might have PMDD they will ask about your symptoms and how they affect your life. They may diagnose PMDD if your symptoms happen every month around 1 or 2 weeks before your period and you have had symptoms for at least 2 months.

The NHS suggests keeping a diary of your symptoms for at least 2 menstrual cycles to share with your GP. There is no blood test described for the diagnosis. Because several other conditions can look similar, such as depression or thyroid problems, a GP may consider these too.

The NHS says treatment usually focuses on helping manage your symptoms. The main treatments a GP may offer are medicines for anxiety or depression, usually an SSRI antidepressant; painkillers or anti-inflammatory medicine such as ibuprofen or naproxen for joint or muscle aches; hormonal treatments such as the combined contraceptive pill; and talking therapies such as CBT.

If these treatments have not helped, surgery may be considered with the aim of stopping PMDD symptoms by stopping periods. It may involve removing the ovaries, fallopian tubes or womb (hysterectomy), and is not suitable if you want to get pregnant.

The NHS suggests exercising regularly, eating a balanced diet (smaller meals every 2 to 3 hours may help), getting plenty of sleep, trying mindfulness, taking ibuprofen or paracetamol for pain, trying to quit smoking and drinking less alcohol, avoiding more than 14 units a week.

For PMS, the NHS says complementary therapies and supplements such as vitamin B6, calcium, vitamin D and magnesium may help but there is not much evidence that they work, and you should check with a GP or pharmacist if you take other medicines.

See a GP if you think you might have PMDD, because treatment and support can help manage symptoms. The NHS says to call 999 or go to A&E if you have symptoms of PMDD and are feeling suicidal, and not to drive yourself there. For urgent mental health help short of an emergency, NHS 111 can advise.

Planning ahead in better weeks can help: tell someone you trust about the pattern and what helps, and share your symptom diary with your clinician.

The NHS notes that PMDD can be difficult to live with both physically and emotionally and signposts support groups, including Mind and The PMDD Project, and charity information including Rethink Mental Illness and a menstrual diary from the National Association for Premenstrual Syndromes. Family and friends can also get advice from charities such as Mind.

On the NHS, a GP can diagnose and treat PMDD, and may refer you to a gynaecologist, psychiatrist or counsellor if treatments have not helped. Private gynaecology, psychiatry and talking therapy services follow similar options. Whichever route you choose, bring your symptom diary so that the pattern around your cycle is clear.