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What is PMDD?

Premenstrual dysphoric disorder (PMDD) is considered a severe form of premenstrual syndrome (PMS). It is a chronic, debilitating disorder that affects the mental and physical health of around 5% of people who menstruate. 

People with PMDD experience symptoms that affect their ability to function normally in daily life and often need medical treatment. The symptoms of PMDD worsen during the week or two before the period starts when hormone levels begin to fall. PMDD is not considered a hormone imbalance but, rather, a severe reaction to the natural fluctuations of oestrogen and progesterone. 


What causes PMDD?

The cause of PMDD is not clear. However, some researchers have suggested that hormonal changes during the menstrual cycle may be a factor. Serotonin levels also fluctuate during the menstrual cycle and may contribute to PMDD symptoms. Further, a personal or family history of mood disorders, depression or postpartum depression is linked to a heightened risk of developing PMDD.


What are the symptoms of PMDD?

PMDD symptoms are similar to those of PMS; however, they are considered much more debilitating. The symptoms often begin during the week or two before a period and stop soon after a period starts. 

PMDD symptoms usually include five or more of the following:

  • feeling very depressed or hopeless or experiencing suicidal thoughts
  • anxiety, tension or panic attacks
  • marked changes in mood, including sudden crying or sensitivity
  • persistent or marked anger, irritability or interpersonal conflicts
  • reduced interest in daily activities and relationships
  • difficulty concentrating or thinking
  • difficulty sleeping, including insomnia or sleeping too much
  • fatigue or loss of energy
  • binge eating, food cravings or changes in appetite
  • feeling out of control or overwhelmed
  • physical symptoms such as cramps, bloating, breast tenderness, headaches and joint or muscle pain, swollen hands, feet and ankles or temporary weight gain.

The symptoms of PMDD can vary between people who menstruate. You may also experience other symptoms that are not on this list, including respiratory problems, eye complaints, skin problems and neurological difficulties.




How is PMDD diagnosed?

Because the symptoms of PMDD are similar to those of other conditions, a medical practitioner will rule out other conditions before making a final diagnosis. Diagnosis will involve a full health history and physical examination. Your doctor may use a symptom chart to determine the diagnosis. Keeping a diary of your symptoms will help with this process. Be sure to track your symptoms and when they occur during your cycle, any key personal information and any medications you’re taking.

Click here to learn how to chart your cycle with the seasons.

For a diagnosis of PMDD, five or more symptoms must be experienced, including one mood-related symptom. Additionally, the symptoms must:

  • be experienced for two or more menstrual cycles
  • occur at least a week before your period starts
  • interfere with your everyday life functions
  • improve within the first few days of your period.


How is PMDD treated?

Treating PMDD may seem overwhelming at first; however, the long-term benefits will far outweigh the challenges of seeking help. You may find that a combination of methods is the most effective way to treat your symptoms. This could include both pharmaceutical and holistic treatments. 

We are cyclical beings living in a linear world. Before considering medications for levelling out your hormones, we suggest trying to work with your cycle and supporting your body with holistic treatments. Pharmaceuticals shouldn’t necessarily be the first thing we try. 

If you find that holistic options aren’t helping, you can always discuss pharmaceuticals with your doctor. Choosing the best treatments for yourself is completely personal, and it’s important that you feel empowered to make your own decisions. 

You know what is best for you better than anyone else. 


The holistic treatment options for PMDD include:

    • Cycle Charting
      Keep track of it all! After charting for just two or three months, you will likely discover your own patterns. If you can start predicting when symptoms come and go, it can help you schedule the rest of your life. You can download PDF printable charts here.

  • Stress management

Stress can make PMDD worse, and finding ways to alleviate stress can help reduce symptoms. Practising relaxation techniques (e.g., meditation) and doing things that bring you joy is a great place to start. Other options for reducing stress include aromatherapy, warm baths and menstrual cycle awareness


  • Healthy eating

PMDD symptoms can be managed through a healthy diet. Eat healthy food and snacks regularly throughout the day to maintain your blood sugar levels. Decrease sugar, salt, caffeine and alcohol and drink plenty of water to help reduce bloating. 


  • Exercise

Regular exercise will help with PMDD symptoms by decreasing inflammation in the body and improving your overall mood. It’s best to do both cardio and strength building exercises every week. Finding a hill near your home and just walking straight up that hill is an excellent way to start getting your heart rate up. 

Yoga is a soft and effective form of strength training, and you don’t need to buy any fancy equipment. Studies have shown that practising yoga effectively decreases menstrual pain, abdominal swelling, cramps and breast tenderness. It’s also great for improving your overall energy and physical and mental health. 


  • Menstrual products

It’s important to choose the right menstrual products for yourself, although it can be exhausting trying all the different options! Some products have been shown to worsen PMDD in some people. For example, tampons can cause cramping and abdominal pain, while pads might irritate the skin. Experimenting with different types of products can be so rewarding when you find something that works! I’ve settled on a menstrual cup/reusable pad/period panty triple-combo deluxe experience—but it’s taken years for me to find the right balance! 

It’s a good idea to organise your products before your PMDD starts. That way, it’ll all be ready for you when the bleeding starts and you’re too exhausted to consider any other options. Some possible menstrual products to experiment with include menstrual cups and discs, disposable or reusable pads and panty liners, tampons, period underwear and period-proof clothing. 

If you’ve never tried a menstrual cup before, Libby Cup may be perfect for you. It’s super soft and comes in a variety of sizes to suit different ages and bodies. You can find out more about our cups here.


  • Sleep

Improved sleeping habits will help with low moods, fatigue and pain sensitivity. Try going to bed at the same time and making enough time for 7 to 9 hours of sleep each night. Avoid caffeine, sugar and alcohol and turn off your screen at least an hour before bed. 


  • Acupuncture

Acupuncture can improve blood flow and the body’s self-healing process. It can reduce symptoms of PMDD and is a low-risk treatment option.


  • Supplements and herbal remedies

These include chasteberry extract, evening primrose oil, ginkgo, St. John’s wort, calcium, vitamin B6, magnesium and vitamin E. Always talk with your doctor before taking supplements or herbal remedies for PMDD and other disorders, especially if you’re taking other medications. 

  • Menstrual Medicine Circle Sessions
    MMC sessions are not therapy, but they are therapeutic. They provide a one-on-one, guided imaginary process to help you dive into your own natural cycle patterns. These sessions help people clearly visualise how their cycle flows and where the challenges lie. They function well as just a one-off session or as continuous work. You can book a session or contact Heather for more information: 


  • Talk therapy

Cognitive behavioural therapy can help you more effectively manage mood changes, anxiety, depression and pain. Seeing a psychologist can be challenging at first. However, with dedicated, regular sessions, the lasting benefits will improve your overall outlook and approach to life. 


The pharmaceutical treatment options for PMDD include:

  • Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) can change the serotonin levels in the brain and help with some PMDD symptoms. Please consult your doctor about the potential side effects of such medications.


  • Contraceptive pills

Various contraceptive pills may be used to manage hormonal fluctuations during the menstrual cycle. However, it is important to consider the potential side effects of these pills, and finding one that works for your body can be a lengthy process.


  • Over-the-counter pain medications

Painkillers may help relieve physical symptoms. These include ibuprofen, naproxen and aspirin.




Finding help

It can be difficult to ask for help when you’re living with a chronic illness. But, at the end of the day, looking after your own physical and mental health is the most beneficial thing you can do for yourself and others. 

If you’re nervous about seeing a medical practitioner, try speaking to a friend or loved one first. You could also reach out online through the various support groups (e.g., on Facebook or Instagram). 

As someone living with chronic illness, I know that every little act of self-love helps build a healthier, happier version of myself. Sometimes, it’s as small as turning my screen off at 10 pm; other times, I need to go for a run and listen to bad pop music—ultimately, you just need to take that first step. 

There’s a lot of information online, and it can be rather overwhelming! To help, we’ve scoped out some useful resources to get you started:




  • PMDD Awareness UK is a non-profit organisation actively raising awareness about PMDD in the UK.


If you think you could be struggling with other menstrual health issues, the following articles have some helpful information:


Written by Nina Giblinwright

Jun 20, 2021