At Henpicked, we’re passionate about shining a light on women’s health topics that have too often been left in the shadows. Menopause, menstruation, menstrual health, these are not taboo subjects here. And that’s why we’re talking about PMDD.
Our colleague, Sally Leach, Director at Henpicked, recently joined a session to help demystify this misunderstood and often misdiagnosed condition. As Sally says, it’s only by raising awareness that we can ensure those affected by PMDD get the understanding and support they deserve, both in and out of the workplace.
So, what exactly is PMDD?
PMDD stands for Premenstrual Dysphoric Disorder. You may have heard of it, or perhaps it’s completely new to you. PMDD is considered a severe form of premenstrual syndrome (PMS), but its symptoms go far beyond what many people expect.
While PMS can cause physical, emotional, and behavioural symptoms in the lead-up to a period, PMDD brings with it very significant — and often debilitating — psychological and psychiatric symptoms. These occur in the second half of the menstrual cycle, known as the luteal phase, after ovulation and before a period starts. For most people with PMDD, symptoms ease dramatically once their period begins.
But PMDD doesn’t look the same for everyone. Some may experience symptoms throughout the luteal phase, others may have them in waves — around ovulation and again before their period starts. The key takeaway? PMDD is different for everyone, but the impact can be life-changing.
PMDD vs PMS — what’s the difference?
It’s easy to confuse the two, especially as PMS is widely talked about (even if often brushed off). But PMDD is not ‘just bad PMS’. It’s a distinct condition with specific criteria.
While PMS affects up to 30% of women, girls and people who menstruate — and even more report symptoms linked to their cycle — PMDD is thought to affect around 5.5%. That may sound small, but it equates to over 200 million people worldwide experiencing severe symptoms each month.
The most noticeable difference? PMDD centres around psychological and psychiatric symptoms, including:
✔️ Severe mood swings
✔️ Intense feelings of sadness or hopelessness
✔️ Anxiety, tension, or feeling on edge
✔️ Anger or irritability
✔️ Difficulty concentrating
✔️ Fatigue or low energy
✔️ Changes in appetite or sleep
✔️ Feeling overwhelmed or out of control
It’s also important to note that PMDD is not linked to heavy bleeding or period pain — if those symptoms are present, it may suggest another menstrual health condition is also at play.
Myths and misunderstandings
As with many aspects of menstrual health, PMDD is shrouded in myths. Here are some of the most common:
🚫 It’s just bad periods — False. PMDD isn’t simply about heavy or painful periods; it’s a severe reaction in the brain to natural hormonal fluctuations.
🚫 It’s caused by a hormone imbalance — False. PMDD isn’t due to too much or too little of any hormone. It’s about how the brain reacts to the normal rise and fall of hormones during the cycle.
🚫 It’s rare — False. With over 200 million people potentially affected globally, PMDD is far from rare.
Why is PMDD so often missed or misdiagnosed?
The simple truth is, we don’t talk about menstruation enough. Period pain, emotional ups and downs, they’re normalised to the point that many people suffer in silence, believing there’s no alternative.
Even when people seek help, they’re often dismissed. Misdiagnosis is common, PMDD is sometimes mistaken for bipolar disorder due to the extreme changes in mood and behaviour that some experience in different phases of the cycle.
Sally shared a powerful quote from someone living with PMDD:
“Once a month, I press my own self-destruct button… When the dark thoughts lift, I spend the next two weeks picking up the pieces.”
This highlights the severe emotional toll and why tracking symptoms is so essential.
Getting a diagnosis — where to start
Diagnosing PMDD requires careful tracking of symptoms against your menstrual cycle, ideally for at least two cycles. To meet the clinical criteria, symptoms must:
– Be present only in the luteal phase (the two weeks before your period)
– Subside within a few days of your period starting
– Include at least one core mood symptom (severe depression, anxiety, irritability, or mood swings)
– Total at least five symptoms overall
Keeping a daily journal or using an app can help, but it’s vital to record not just symptoms but how they impact your life — physically, emotionally, socially, and at work.
Seeking support from your GP
Going to your GP prepared with your symptom tracker makes a huge difference. They may:
✔️ Review your symptoms and medical history
✔️ Run blood tests to rule out other causes (such as vitamin deficiencies)
✔️ Refer you to a specialist, such as a gynaecologist or mental health expert
Don’t be afraid to ask questions about treatment options, potential side effects, and what’s right for you. PMDD is highly individual, and treatment should be too.
What treatments are available?
Treatment for PMDD focuses on reducing symptoms and improving quality of life. Options may include:
– Lifestyle changes — Diet, exercise and stress management can all play a role. Anti-inflammatory, fibre-rich diets are often recommended.
– Talking therapies — Cognitive behavioural therapy (CBT) is commonly used to help manage the psychological impact.
– Medication — Antidepressants (often SSRIs) may be prescribed daily or just during the luteal phase.
– Supplements — Some evidence suggests benefits from B6, vitamin D, magnesium and calcium.
– Surgery — In severe, treatment-resistant cases, surgery such as oophorectomy or hysterectomy may be considered.
Sally emphasises that these are significant decisions, it’s essential to explore all options, ask the right questions, and make informed choices.
You are not alone and knowledge is power
At Henpicked, we believe in empowering people with knowledge, for themselves and for those around them. If you or someone you care about is experiencing severe symptoms, please know support is available.
Resources like The PMDD Project offer toolkits and practical advice. Apps can help track symptoms but journals capturing how symptoms impact daily life are just as valuable.
Most importantly — talk. Raise awareness. Normalise the conversation.
