What are the key facts?

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). It seems unclear exactly how many people who menstruate experience PMDD. But it seems to be about 5 to 8 in 100. Symptoms of PMDD can affect you physically, mentally or behaviourally. If you think you have PMDD, it is important to record your symptoms. This will help doctors diagnose you. There is no single cause of PMDD. PMDD can be treated by things like some antidepressants, talking therapy, the combined contraceptive pill, GnRN injections, and surgery. There are things you can do to help yourself.

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual syndrome (PMS) is the name for the symptoms you get in the weeks before your period. PMS is common for people who have periods. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. PMDD can affect your mental and physical health. This usually starts from 1 to 2 weeks before your period starts to a few days into your period. The symptoms can have a negative impact on your quality of life. They can affect your work, relationships and social life.

Is PMDD a mental illness?

ICD-11 and DSM-V are guidelines used by medical professionals. They help them decide if they think you are living with a type of health condition. ICD-11 stands for the International Classification of Diseases DSM-V stands for Diagnostic and Statistical Manual of Mental Disorders ICD-11 and DSM-V list premenstrual dysphoric disorder (PMDD) in different ways. ICD-11 lists PMDD under ‘endocrine, nutritional or metabolic diseases. Your endocrine system relates to your hormones. DSM-5 lists PMDD under ‘depressive disorders'. But the important thing is to get help if you think you have symptoms of PMDD. See the following sections below: 'What are the symptoms of PMDD?' 'What can I do if I think I have PMDD?'

It is unclear exactly how many people who menstruate experience PMDD. Some sources say about 5 to 8 in 100 people who menstruate experience PMDD in the US. Another study showed that around the world: less than 2 in 100 people who menstruate meet the strict guidelines to be diagnosed with PMDD. The study does say that many more people who menstruate might be experiencing PMDD. But their symptoms had not been measured over a long enough period. Which is a key part of diagnosing PMDD. See How is PMDD diagnosed? below for more information.

What are the symptoms of PMDD?

Symptoms of premenstrual dysphoric disorder (PMDD) can affect you: physically, mentally, known as psychologically, or how you behave. The most common symptoms of PMDD are: Physical symptoms Cramps Headaches Joint and muscle pain Tiredness Sleep issues Breast tenderness or swelling Bloating or weight gain Psychological symptoms Feeling very anxious Mood swings Feeling irritable Feeling hopeless, worthless, or guilty Feeling angry Feeling depressed Difficulty concentrating or thinking clearly Feeling suicidal Symptoms that affect how you behave Less interest in things in your life, like seeing your friends Changes in appetite, food cravings, or overeating Everyone’s experience of PMDD will be different. You might get some symptoms and not others. You might get some symptoms worse than others, or symptoms that are not shown above. You can find more information about the following things at the links below: Suicidal thoughts - How to cope Depression Anxiety disorders, and How can I improve my sleep?

What can I do if I think I have PMDD?

If you think you have premenstrual dysphoric disorder (PMDD) it is best to see your GP. If you do not have a GP, see our information on GPs and your mental health for how you can see one. Or you can call the NHS on 111 for help or go to their website at: https://111.nhs.uk You can record all your symptoms over a period of time. The longer the period, the better. You can take this information to your GP appointment. This is an important part of diagnosing PMDD. PMDD is not as well-known as conditions like depression. You might think your GP or another medical professional does not know much about PMDD. You can show them this Rethink Mental Illness information. On our webpage you can find more information about GPs and your mental health.

How is PMDD diagnosed?

What guidelines do professionals use to help diagnose PMDD? Medical professionals use the following guidelines to help them decide if you are experiencing PMDD. International Classification of Diseases (ICD-11). Produced by the World Health Organisation (WHO). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Produced by the American Psychiatric Association. The guidelines tell them what to look for. What do the guidelines tell the professionals to look for? Both guidelines say you get a pattern of symptoms: in most of your menstrual cycles that begin several days before you start your period, that start to improve a few days after you start your period, and that become less troubling or go away in the week after your period has started. The menstrual cycle is the way your body gets ready for getting pregnant. If you do not get pregnant it ends with you having a period. The menstrual cycle lasts about one month. ICD-11 and DSM-V more or less agree on the pattern of symptoms you need to have to be diagnosed with PMDD. They are like those shown above. But there are slight differences. Both ICD-11 and DSM-V say that you only need to regularly show some of the symptoms. DSM-V says that you must have had the symptoms for most of your menstrual cycles in the last year. ICD-11 says your symptoms should be confirmed by a symptom diary. This should cover at least 2 menstrual cycles where you have had symptoms. The symptoms must cause you a lot of distress or have a big effect on your daily life. The symptoms must not be because of: another medical condition, or a prescription or non-prescription drug, treatment or substance. So, medical professionals might: ask you to keep a diary of your symptoms, ask you about your medical history, including your mental health, and do a physical health check, to rule out any other causes for your symptoms.

It is not known exactly what causes premenstrual dysphoric disorder (PMDD). Some research suggests you might develop symptoms if you are more sensitive to the changes in levels of certain hormones. Some of these hormones are oestrogen and progesterone. Other things that might make you more likely to develop symptoms of PMDD are: Past experience of depression Experience of stress or trauma If you smoke If you have a close relative with premenstrual syndrome or PMDD If you have put on weight On our webpages below you can find more information about: Depression Stress - How to cope, Physical activity and mental health, and Smoking and mental health: Understanding the link and finding support

What treatments are there for PMDD?

There are different treatments for symptoms of premenstrual dysphoric disorder (PMDD). The treatment medical professionals offer you will depend on your symptoms and choices. They must explain the treatment to you first.liii And you must agree to it. But some common treatments are shown below. Antidepressants - SSRIs SSRIs mean selective serotonin reuptake inhibitors. They are a type of antidepressant medication. Sometimes the symptoms of PMDD are like those of depression. Some studies show SSRI’s can be effective to treat PMDD. Especially if they are taken in the stage of the menstrual cycle called the ‘luteal phase’. This is the second half of your menstrual cycle, usually around day 14 of your cycle. On our webpage you can find more information about Antidepressants. Talking therapy CBT can be a useful type of talking therapy if you experience PMDD. It can help you respond better to your symptoms. CBT stands for cognitive behavioural therapy. You can find more information about CBT in our Talking therapies webpage. Combined contraceptive pill Contraception is used to stop you getting pregnant during sex. There are different types. One type is oral contraception. This is known as ‘the pill’. If you want to use oral contraception, your doctor may offer you the combined contraceptive pill for PMDD. It may help ease symptoms of Premenstrual syndrome (PMS). But you might not feel a benefit from it. Some people do and some do not. GnRN injections GnRH injections stands for gonadotropin releasing hormone analogue injections. You may be offered these if other treatments have not helped severe PMDD symptoms. These injections try to balance your hormone levels. You take them with hormone replacement therapy (HRT). This is to protect your bones from osteoporosis. Osteoporosis is a condition where your bones lose strength. This means you are more likely to break a bone. Surgery Surgery can be done to end your periods and your PMDD symptoms. This is only usually done if other treatments have failed. And you do not want children in the future. Other treatment Your doctor might offer you: water tablets to ease bloating or tender breasts, or an oestrogen patch to balance hormone levels If you are allowed, you can take painkillers like paracetamol or ibuprofen. But if you are unsure, check with a pharmacist.

What can I do to help myself?

There are things that you can do to help yourself to try to reduce the effect of the symptoms of PMDD. Everyone is different, so you can find out what works for you. You can: Try mindfulness and meditation . Eat healthy foods and have a balanced diet . Keep physically active Choose healthier drinks and make sure you are hydrated . Have enough sleep . Avoid alcohol, drinking only moderately or cutting down . Avoid smoking or cutting down . You can read more about how physical health and lifestyle changes below: Wellbeing and physical health. See www.rethink.org Physical and mental health . Can I get self-help online? There are websites which give information about how to manage your mental health. There are also websites which explain how you can use cognitive behavioural therapy (CBT) techniques to improve and manage your mental health. Some people find these useful. Public Health England – Every Mind Matters Get Self Help: CBT self-help Ieso: Online CBT. Only certain NHS trusts Live life to the Full: Online courses Psychology Tools How can I get emotional support? Talking about your mental health can have big benefits. And people who care about you like friends and family are usually happy to listen and support you. But you can also call emotional support lines to talk to trained listeners. You can talk about how you are feeling. You can find details of emotional support lines in the Useful contacts section. What are support groups? Support groups are where people with similar issues share experiences with others and get mutual support. You can search for local mental health support groups below: Rethink Mental Illness Local Minds There are also online support services: Side by Side 7 Cups Togetherall

Royal College of obstetricians and gynaecologists – Blog: Blog: Raising awareness of premenstrual dysphoric disorder (PMDD) Society of Endocrinology: You and your hormones Wellbeing of Women: Information on periods and menstrual health

National Association for premenstrual syndrome (NAPS) Provides information advice and support to people who experience premenstrual syndrome and their families. Email: contact@pms.org.uk Website: www.pms.org.uk International Association For Premenstrual Disorders (IAPMD) Information, and resources for anyone impacted by Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME). Website: https://iapmd.org/about The PMDD Project The UK’s first PMDD-focused charity. The organisation works towards greater PMDD awareness, offers emotional support, and supports PMDD research. Email: general@thepmddproject.org Website: https://thepmddproject.org Me v PMDD Symptom Tracker An app for tracking for PMDD symptoms. Website: https://mevpmdd.com

Premenstrual dysphoric disorder (PMDD) - Symptoms, causes, diagnosis, and treatment

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About mental illness
Mental health conditions
Premenstrual dysphoric disorder (PMDD) - Symptoms, causes, diagnosis, and treatment

Premenstrual dysphoric disorder (PMDD)

Symptoms, causes, diagnosis, and treatment

This content explains what PMDD is, its symptoms and what treatment is available. It is for people who are 18 + and affected by PMDD symptoms in England. It is also for their loved ones and carers and anyone interested in this subject.

Frequently asked Qs

- Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS).
- It seems unclear exactly how many people who menstruate experience PMDD. But it seems to be about 5 to 8 in 100.
- Symptoms of PMDD can affect you physically, mentally or behaviourally.
- If you think you have PMDD, it is important to record your symptoms. This will help doctors diagnose you.
- There is no single cause of PMDD.
- PMDD can be treated by things like some antidepressants, talking therapy, the combined contraceptive pill, GnRN injections, and surgery.
- There are things you can do to help yourself.
Premenstrual syndrome (PMS) is the name for the symptoms you get in the weeks before your period. PMS is common for people who have periods.

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS.

PMDD can affect your mental and physical health. This usually starts from 1 to 2 weeks before your period starts to a few days into your period.

The symptoms can have a negative impact on your quality of life. They can affect your work, relationships and social life.
ICD-11 and DSM-V are guidelines used by medical professionals. They help them decide if they think you are living with a type of health condition.
ICD-11 stands for the International Classification of Diseases

DSM-V stands for Diagnostic and Statistical Manual of Mental Disorders
ICD-11 and DSM-V list premenstrual dysphoric disorder (PMDD) in different ways.

ICD-11 lists PMDD under ‘endocrine, nutritional or metabolic diseases.

Your endocrine system relates to your hormones.

DSM-5 lists PMDD under ‘depressive disorders'.
But the important thing is to get help if you think you have symptoms of PMDD. See the following sections below:

'What are the symptoms of PMDD?'

'What can I do if I think I have PMDD?'
It is unclear exactly how many people who menstruate experience PMDD.

Some sources say about 5 to 8 in 100 people who menstruate experience PMDD in the US.

Another study showed that around the world:
less than 2 in 100 people who menstruate meet the strict guidelines to be diagnosed with PMDD.

The study does say that many more people who menstruate might be experiencing PMDD. But their symptoms had not been measured over a long enough period. Which is a key part of diagnosing PMDD.
See How is PMDD diagnosed? below for more information.
Symptoms of premenstrual dysphoric disorder (PMDD) can affect you:

physically,

mentally, known as psychologically, or

how you behave.

The most common symptoms of PMDD are:

Physical symptoms

Cramps

Headaches

Joint and muscle pain

Tiredness

Sleep issues

Breast tenderness or swelling

Bloating or weight gain

Psychological symptoms

Feeling very anxious

Mood swings

Feeling irritable

Feeling hopeless, worthless, or guilty

Feeling angry

Feeling depressed

Difficulty concentrating or thinking clearly

Feeling suicidal

Symptoms that affect how you behave

Less interest in things in your life, like seeing your friends

Changes in appetite, food cravings, or overeating

Everyone’s experience of PMDD will be different.

You might get some symptoms and not others. You might get some symptoms worse than others, or symptoms that are not shown above.

You can find more information about the following things at the links below:

Suicidal thoughts - How to cope

Depression

Anxiety disorders, and

How can I improve my sleep?
If you think you have premenstrual dysphoric disorder (PMDD) it is best to see your GP.

If you do not have a GP, see our information on GPs and your mental health for how you can see one.  Or you can call the NHS on 111 for help or go to their website at: https://111.nhs.uk

You can record all your symptoms over a period of time. The longer the period, the better. You can take this information to your GP appointment. This is an important part of diagnosing PMDD.

PMDD is not as well-known as conditions like depression. You might think your GP or another medical professional does not know much about PMDD. You can show them this Rethink Mental Illness information.

On our webpage you can find more information about GPs and your mental health.
What guidelines do professionals use to help diagnose PMDD?

Medical professionals use the following guidelines to help them decide if you are experiencing PMDD.
- International Classification of Diseases (ICD-11). Produced by the World Health Organisation (WHO).
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Produced by the American Psychiatric Association.
The guidelines tell them what to look for.

What do the guidelines tell the professionals to look for?

Both guidelines say you get a pattern of symptoms:
- in most of your menstrual cycles that begin several days before you start your period,
- that start to improve a few days after you start your period, and
- that become less troubling or go away in the week after your period has started.
The menstrual cycle is the way your body gets ready for getting pregnant. If you do not get pregnant it ends with you having a period. The menstrual cycle lasts about one month.

ICD-11 and DSM-V more or less agree on the pattern of symptoms you need to have to be diagnosed with PMDD. They are like those shown above. But there are slight differences.

Both ICD-11 and DSM-V say that you only need to regularly show some of the symptoms.

DSM-V says that you must have had the symptoms for most of your menstrual cycles in the last year.

ICD-11 says your symptoms should be confirmed by a symptom diary. This should cover at least 2 menstrual cycles where you have had symptoms.

The symptoms must cause you a lot of distress or have a big effect on your daily life.

The symptoms must not be because of:
- another medical condition, or
- a prescription or non-prescription drug, treatment or substance.
So, medical professionals might:
- ask you to keep a diary of your symptoms,
- ask you about your medical history, including your mental health, and
- do a physical health check, to rule out any other causes for your symptoms.
It is not known exactly what causes premenstrual dysphoric disorder (PMDD).

Some research suggests you might develop symptoms if you are more sensitive to the changes in levels of certain hormones. Some of these hormones are oestrogen and progesterone.

Other things that might make you more likely to develop symptoms of PMDD are:
- Past experience of depression
- Experience of stress or trauma
- If you smoke
- If you have a close relative with premenstrual syndrome or PMDD
- If you have put on weight
On our webpages below you can find more information about:
There are different treatments for symptoms of premenstrual dysphoric disorder (PMDD).

The treatment medical professionals offer you will depend on your symptoms and choices.

They must explain the treatment to you first.liii And you must agree to it.

But some common treatments are shown below.

Antidepressants - SSRIs

SSRIs mean selective serotonin reuptake inhibitors. They are a type of antidepressant medication.

Sometimes the symptoms of PMDD are like those of depression.

Some studies show SSRI’s can be effective to treat PMDD.  Especially if they are taken in the stage of the menstrual cycle called the ‘luteal phase’. This is the second half of your menstrual cycle, usually around day 14 of your cycle.

On our webpage you can find more information about Antidepressants.

Talking therapy

CBT can be a useful type of talking therapy if you experience PMDD. It can help you respond better to your symptoms.

CBT stands for cognitive behavioural therapy.

You can find more information about CBT in our Talking therapies webpage.

Combined contraceptive pill

Contraception is used to stop you getting pregnant during sex. There are different types.

One type is oral contraception. This is known as ‘the pill’.

If you want to use oral contraception, your doctor may offer you the combined contraceptive pill for PMDD.  It may help ease symptoms of Premenstrual syndrome (PMS).

But you might not feel a benefit from it. Some people do and some do not.

GnRN injections

GnRH injections stands for gonadotropin releasing hormone analogue injections.

You may be offered these if other treatments have not helped severe PMDD symptoms.

These injections try to balance your hormone levels.

You take them with hormone replacement therapy (HRT).  This is to protect your bones from osteoporosis. Osteoporosis is a condition where your bones lose strength. This means you are more likely to break a bone.

Surgery

Surgery can be done to end your periods and your PMDD symptoms. This is only usually done if other treatments have failed. And you do not want children in the future.

Other treatment

Your doctor might offer you:
- water tablets to ease bloating or tender breasts, or
- an oestrogen patch to balance hormone levels
If you are allowed, you can take painkillers like paracetamol or ibuprofen. But if you are unsure, check with a pharmacist.
There are things that you can do to help yourself to try to reduce the effect of the symptoms of PMDD.

Everyone is different, so you can find out what works for you.

You can:
You can read more about how physical health and lifestyle changes below:
- Wellbeing and physical health. See www.rethink.org
- Physical and mental health.
Can I get self-help online?

There are websites which give information about how to manage your mental health. There are also websites which explain how you can use cognitive behavioural therapy (CBT) techniques to improve and manage your mental health. Some people find these useful.
- Public Health England – Every Mind Matters
- Get Self Help: CBT self-help
- Ieso: Online CBT. Only certain NHS trusts
- Live life to the Full: Online courses
- Psychology Tools
How can I get emotional support?

Talking about your mental health can have big benefits. And people who care about you like friends and family are usually happy to listen and support you.

But you can also call emotional support lines to talk to trained listeners. You can talk about how you are feeling.

You can find details of emotional support lines in the Useful contacts section.

What are support groups?

Support groups are where people with similar issues share experiences with others and get mutual support.

You can search for local mental health support groups below:
- Rethink Mental Illness
- Local Minds
There are also online support services:
National Association for premenstrual syndrome (NAPS)
Provides information advice and support to people who experience premenstrual syndrome and their families.

Email: contact@pms.org.uk
Website: www.pms.org.uk

International Association For Premenstrual Disorders (IAPMD)
Information, and resources for anyone impacted by Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME).

Website: https://iapmd.org/about

The PMDD Project

The UK’s first PMDD-focused charity. The organisation works towards greater PMDD awareness, offers emotional support, and supports PMDD research.

Email: general@thepmddproject.org

Website: https://thepmddproject.org

Me v PMDD Symptom Tracker
An app for tracking for PMDD symptoms.

Website: https://mevpmdd.com