More than 30 million women and girls around the world have Premenstrual Dysphoric Disorder (PMDD), according to the University of Oxford.
PMDD
Yet, like many women’s health topics, it is often misunderstood and overlooked. Benenden Health have found that searches for ‘what is pmdd’ have increased +22% over the last three months, while ‘pms or pmdd’ has increased +22% in the past year, as people confuse the two conditions.
Dr Fiona Warner, Female Health GP at Benenden Hospital, has offered insight into what Pre-Menstrual Syndrome (PMS) and Pre-Menstrual Dysphoric Disorder (PMDD) are and how to recognise if you’re suffering from either:
“Hormonal changes during the luteal phase, which is the 1–2-week period between ovulation and the start of your period, can affect women in various ways.
“A common misconception is that PMS is something every woman experiences. While every woman may experience PMS symptoms sporadically, a diagnosis of PMS requires 2-3 months of consistent and recurring physical and behavioural symptoms.
“This can then be seen at a more severe level with PMDD (Premenstrual Dysphoric Disorder), where similar symptoms to PMS are displayed but the severity level increases, leading to disruption of normal life.
“PMDD is comprised of both mental and physical symptoms, with the severity of the mental symptoms separating it from PMS. Daily life is altered by heightened anxiety and sadness that disrupts everyday activities.
“These symptoms are so severe it can induce extreme depression and suicidal ideation, which is not experienced in the same way outside of the luteal phase.
“Women may feel their symptoms aren’t severe enough or that menstrual cycle struggles aren’t valid for medical attention. However, they shouldn’t be taken lightly, and I would urge women to seek the help they deserve, as they would for anything that is affecting their life and wellbeing.”
To help identify whether a woman has PMDD, Fiona Warner has highlighted five common symptoms to be aware of:
- Experiencing strong and varied emotions
People with PMDD often notice intense mood swings in the week or two before their period. Emotions can shift quickly and feel overwhelming more intensely than usual.
For example, someone may feel deeply sad or hopeless in the morning, then irritable or angry later in the day, and anxious by the evening.
These emotional changes are stronger than typical premenstrual mood changes and can impact usual plans with work, relationships, and daily routines.
- Heightened anxiety and feeling unsettled
PMDD can cause a persistent sense of nervousness or inner restlessness. You might feel constantly ‘on edge’, as though everything carries a sense of dread or heightened nerves.
Small problems can feel far bigger and more overwhelming than they normally would. Many people describe feeling physically tense, with racing thoughts or even a sense of impending doom, despite there being no clear reason for it.
For those who already live with anxiety, these symptoms can become especially intense. Hormonal fluctuations can amplify anxious feelings, sometimes trigger panic attacks and make it difficult to manage everyday tasks or maintain normal routines.
- Lack of energy and no interest in usual life activities
A noticeable drop in motivation is common in your luteal phase. However, activities that usually bring enjoyment may suddenly feel exhausting or pointless.
This depletion in overall energy can make it difficult to concentrate, stay productive, or engage in activities you usually enjoy.
These symptoms mirror depression but follow a monthly pattern linked to the menstrual cycle, majorly intensifying during this luteal phase.
- Hypersomnia or insomnia
Sleep disturbances, such as insomnia or hypersomnia, are one of the DSM-IV-TR’s defining criteria for the diagnosis of PMDD and affects 70% of women with the disorder. During this phase, those with PMDD tend to produce lower levels of melatonin, which is the hormone that regulates sleep.
As a result, women with PMS or PMDD may experience increased insomnia, poorer sleep quality, and greater drowsiness in the days leading up to their period. Insomnia that reliably appears in the week before a period and improves soon after menstruation begins is often linked to hormonal fluctuations.
Conversely, PMDD can also cause hypersomnia, where you feel severe daytime sleepiness and an uncontrollable need to sleep during the day. This is the result of heightened sensitivity to the normal hormonal changes that happen right before your period because of hormonal fluctuations like progesterone dropping that can have a sedating effect.
- More intense or disruptive physical symptoms
Many of these physical symptoms are a common part of the menstrual cycle for most women. However, with PMDD, they often become more intense and occur alongside severe emotional and psychological symptoms, which can make them feel far more disruptive and distressing.
Physical symptoms can include breast tenderness or swelling, where the breasts feel sore, heavy, or particularly sensitive to touch. Some women also experience joint or muscle pain, describing a dull ache or stiffness in the body without any other obvious cause.
Bloating is a common symptom too, creating a sensation of fullness or tightness that can sometimes be visibly noticeable.
While these physical changes on their own can be manageable, the combination of the severe physical and mental symptoms intensifies the overall impact on daily life.
For more information on PMDD and the often disruptive symptoms of your menstrual cycle, head over to the Benenden Health Women’s Hub.
[1] https://www.ox.ac.uk/news/2024-01-30-new-data-shows-prevalence-premenstrual-dysphoric-disorder
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