What is PMDD?

What is PMDD?

What does PMDD stand for? PMDD is an acronym for pre-menstrual dysmorphic disorder.

PMDD is a diagnosis based on an American classification which is similar but has very slight differences from the UK diagnosis of severe pre-menstrual syndrome (PMS). Premenstrual symptoms affects 90% of women with 5-8% of these women suffering from symptoms so severe it interferes with day-to-day functioning during the last 2 weeks of your menstrual cycle¹. This is a cyclical hormone-driven condition that starts 1-2 weeks before your period (which is called the luteal phase) and decreases in intensity as your period starts. 

PMDD symptoms 

Symptoms of PMDD are similar to PMS symptoms but more intense and severe. The symptoms can be broken down into physical, behavioural and emotional symptoms²:

Physical symptoms:

• Sore and tender breast
• Muscle aches and pain
• Bloating
• Headaches

Behavioural:

• Extreme tiredness
• Losing interest in activities that you normally find enjoyable
• Difficulty concentrating
• Changes to appetite 
• Trouble sleeping or sleeping too much or hypersomnia 
• Anger or irritability

Emotional:

• Depression
• Self-harm
• Suicidal thoughts
• Quick changes to mood
• Severe anxiety 

How to get diagnosed with PMDD

To get a diagnosis of PMDD, there is a specific criterion you need to fulfil. The American Psychiatry Association criteria for PMDD diagnosis is very specific. 

American Psychiatric Association criteria³:

• A minimum of 5 symptoms for 7 days before your period starts
• Symptoms improve a few days after your period commences
• Symptoms should be minimal or disappear a week after your period stops 
• Symptoms severely affect your daily activities and relationships

The 5 symptoms must include: 

• A minimum 1 of these symptoms:
  • Mood swings, sudden emotional outbursts
  • Anger or being irritable
  • Depression, low view of self-image
  • Anxiety or frustration
• Any other additional symptoms:
  • Lack of interest in hobbies
  • Concentration issues
  • Fatigue/lack of energy
  • Changes to eating patterns or cravings
  • Changes to sleep pattern
  • Feeling overwhelmed or out of control
  • Tender breasts
  • Joint/muscle aches
  • Gaining weight and bloating 

Severe PMS is a term which may be used interchangeably with PMDD, but is diagnosed based on different guidance. Severe PMS diagnostic criteria are⁴:

• Any symptoms should only be present 1-2 weeks before your period starts
• Symptoms are severe enough to interfere with the ability to function and maintain relationships 
• Symptoms improve as your period gets closer
• No symptoms are present after a week after your period starts 
• Cyclical in nature (happens with every menstrual cycle)

How to treat PMDD

Treatments for PMDD aim to lessen the severity of symptoms or relieve them altogether. They aim to regulate hormone levels and prevent fluctuations of hormones which contribute to the symptoms. 

The treatments of PMDD can include⁵:

• Lifestyle & diet changes
• Medications:
  • Antidepressants 
  • Hormonal contraception to stop your menstrual cycle
  • Injections to stop your menstrual cycle
  • Hormone replacement therapy to stop your menstrual cycle
  • Analgesia (painkillers)
• Therapy
• Surgery:
  • Hysterectomy (removal of uterus)
  • Oophorectomy (removal of ovaries)

We look more into the rationale behind each treatment option in our PMDD treatment article. What works for you might not work for someone else. Sometimes, to achieve symptom relief, you might need to use a combination of multiple therapies. 

PMDD FAQs:

Do I have PMDD?

If you have read this article and feel like you can relate to the symptoms of PMDD, start by recording what you experience and when they happen in relation to your menstrual cycle. Try keeping a symptom diary for 2-3 months so there is enough information to establish a pattern. 

“The Daily Record of Severity of Problems” is a useful questionnaire to assist you in tracking your symptoms⁶. 

When does PMDD start?

PMDD presents during the luteal phase of our menstrual cycle. This is the phase 1-2 weeks before your period. During the luteal phase, your progesterone levels slowly rise, which thickens the womb lining, preparing for pregnancy. The true cause of PMDD is unknown but is thought to be due to progesterone and oestrogen sensitivity. Some research has found that PMDD might be linked to our genes and hence can be inherited⁷. 

Difference between PMDD vs PMS

PMS and PMDD are similar conditions but their main difference is the severity of symptoms and how much they can affect your functioning. PMDD is the extreme form of PMS. 

Is PMDD a disability 

Recently, PMDD was added to the UK Equality Act 2010⁸. PMDD can qualify as a disability if:

• It substantially affects your daily living by interfering with relationships and impacting everyday activities
• It is chronic which means a long-term condition, lasting over a year

PMDD is a debilitating condition and studies have shown that women lose up to 8 years combating these symptoms⁹. It is great to see that this condition is recognised as a disability. 

How to help PMDD?

The first step in getting support for PMDD is to get some medical advice. Please book an appointment with your GP where they will discuss your symptoms, medical history and family history with you. They will also likely do a blood test or scan to rule out any medical conditions that can mimic PMDD symptoms. Once a diagnosis is reached, they can help you find the right treatment to alleviate your symptoms. 

We understand that PMDD is a tough condition to live with and more light needs to be shone on this chronic condition. Our Lowdown GPs are amazing supportive clinicians who will listen patiently and work together with you to find the right treatment to improve your quality of life.