Many of us know what PMS feels like. But for some, symptoms go far beyond the usual monthly ups and downs. This is PMDD – premenstrual dysphoric disorder – and it can affect mood, energy, relationships and everyday life.

Sally Leech, Director of Henpicked spoke with Phoebe Williams, CEO and founder of The PMDD Project, to explore what PMDD is, how it differs from PMS and the practical steps that can make a real difference.

What do we mean by PMDD?

Henpicked: Lots of us have heard of PMS. How is PMDD different?

Phoebe: PMDD sits on the same spectrum as PMS but at the severe end. 

It’s debilitating and, for many, life-altering. Symptoms happen in the luteal phase of your cycle – the week or two before your period – and often lift once bleeding starts. For some, it can be so impactful that it meets disability criteria under equality law. We estimate at least 1 in 20 people may be affected but lack of awareness means many go undiagnosed.

“It can feel like an unwelcome visitor has taken over my brain – dictating my thoughts, feelings and behaviour for those two weeks. Then my period arrives, and I feel like me again.” — Phoebe

Signs and symptoms: what might you notice?

Henpicked: What are the common symptoms?

Phoebe: Everyone’s different, but typical symptoms include:

• Severe anxiety, low mood or depression
• Loss of interest in usual activities; social withdrawal
• Irritability, overwhelm, intrusive negative thoughts
• Brain fog, poor concentration, insomnia or broken sleep
• Physical symptoms: bloating, breast tenderness, headaches, aches

Crucially, PMDD is cyclical. If these symptoms recur before your period and ease when it starts, that pattern is a key sign.

“Is it PMDD, PMS or something else?”

Henpicked: Why is PMDD often missed?

Phoebe: Two reasons. First, symptoms overlap with depression and anxiety, so people can be misdiagnosed. 

Second, the personality shift can look like bipolar. The difference with PMDD is timing. Track your cycle and you’ll see the same window, month after month. That luteal-phase pattern is what sets PMDD apart.

Phoebe’s story

Henpicked: How did you realise it was PMDD?

Phoebe: I’ve likely had it since my mid-teens. At university I could see my friends managed their periods, while I became unbearably anxious and low every month. I was nearly labelled bipolar at one point. Things escalated after uni when suicidal thoughts appeared in that pre-period window. 

My mum and I started researching, found a personal blog that matched my experience exactly and I took that to a new GP. I tracked my symptoms and finally got the diagnosis.

I use SSRIs which reduce severity (they don’t erase symptoms), and I’ve made lifestyle changes: no caffeine/alcohol/sugar in my luteal phase, planning exercise around my cycle, and listening closely to what my body needs.

Getting a diagnosis

Henpicked: What’s the recommended route?

Phoebe: Be persistent and be your own advocate. Many clinicians weren’t taught about PMDD in training. Ask for someone with women’s health or gynaecology expertise if needed.

• Track daily for at least two full cycles – not just your bad days. Note mood, sleep, energy, physical symptoms.
  
• Bring your tracker to your appointment and ask about DSM-5 criteria for PMDD.
  
• If you don’t feel heard, seek a second opinion.

Treatment options: what can help?

Henpicked: What are the main approaches?

Phoebe: It’s individual, but options include:

• SSRIs (e.g. fluoxetine). You can use continuous dosing or luteal-phase dosing (just in the run-up to your period) – discuss what’s right for you with your GP.
  
• Hormonal approaches to dampen fluctuations (specialist advice is important).
  
• Therapy (CBT, trauma-informed therapy) – helpful where trauma or stress are triggers.
  
• Lifestyle and supplements (some find magnesium, B6, calcium helpful) – always check with a clinician first.

The message is: help exists. You don’t have to push through alone.

Everyday strategies that make a difference

Henpicked: What can people start doing this month?

Phoebe:

1. Track and plan

Know your “danger window.” If you can, plan demanding work or social events outside it. Build in rest during the luteal phase.

2. Steady your basics

Prioritise sleep. Eat balanced meals (complex carbs + protein + healthy fats) to avoid blood sugar dips. Choose gentle movement like walking or yoga.

3. Reduce triggers

Many find caffeine, alcohol and high sugar raise anxiety in the luteal phase. Experiment with cutting back then.

4. Create a support kit

On tougher days, have a “luteal box” ready: easy meals, favourite films, soothing bath salts, a comforting jumper, notes from people who love you, a short list of calming actions.

5. Tell your people

Share your cycle pattern with someone you trust. Let them know what helps and what doesn’t. If you’re a parent, prepare ready-to-go activities for kids when you need quiet time.

PMDD across life stages

Henpicked: Can PMDD start later? What about perimenopause?

Phoebe: Yes. Some develop PMDD after childbirth, others in their 30s. There’s also a strong link with hormonal sensitivity, and we’re learning more about overlaps with neurodiversity.

Perimenopause can be especially challenging because hormones become more erratic. The core strategies still help: track, steady your basics, reduce triggers, and seek support.

If you’re struggling right now

Henpicked: What would you say to anyone feeling hopeless?

Phoebe: Please reach out. PMDD can feel isolating, but you’re not alone and you didn’t “cause” this. If you’re in crisis, contact emergency services or a crisis helpline straight away. Tell someone you trust. You deserve care and support.

If you experience thoughts of self-harm or suicide, seek urgent help from your GP, NHS 111/999, or Samaritans on 116 123 (free, 24/7 in the UK).

About The PMDD Project

Henpicked: Tell us about your charity’s work.

Phoebe: We support people directly affected and those around them – families, clinicians, employers and schools. We focus on:

• Support: resources, peer groups and practical tools (with more coming soon).
• Awareness & training: for healthcare professionals, businesses and communities.
• Research: we back studies to improve understanding and treatment.

You can find resources and ways to get involved on our website.

Practical takeaways

• Track daily for at least two cycles and bring your notes to your GP.
• Plan around your luteal phase where possible; protect rest and recovery.
• Balance meals, prioritise sleep, keep movement gentle on tough days.
• Reduce triggers (caffeine, alcohol, sugar) when symptoms spike.
• Build your kit and tell your people what helps.
• Ask for help – treatment and support are available, and they work.

Final word from Phoebe:

“PMDD isn’t ‘just bad PMS’. Recognising the pattern is powerful. With the right support and a plan that fits you, things really can get better.”