Frequently asked Qs

• What are the key facts?

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

  • It seems unclear exactly how many women, or those who are assigned female at birth, 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?’
• How common is PMDD?

  It is unclear exactly how many women, or those who are assigned female at birth (AFAB), experience PMDD. 

  Some sources say about 5 to 8 in 100 women, or people who are AFAB, experience PMDD in the USA. 

  Another study showed that around the world: 

  • less than 2 in 100 women, or people who are AFAB, meet the strict guidelines to be diagnosed with PMDD.

  The study does say that many more women and people who are AFAB 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 below for more information on how PMDD is diagnosed. 

• 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.

  See our following webpages for more information:

  •    Suicidal thoughts - How to cope
  •    Depression
  •    Anxiety disorders
  •    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.

  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. 

• 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.
• What causes PMDD?

  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 

  See our following webpages for more information:

  •    Depression
  •    Stress - How to cope
  •    Physical activity and mental health
  •    Smoking and mental health

• 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.  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. 

  See our webpage on antidepressants for more information.

  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.  

  See our webpage on talking therapy for more information.

  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:

  • Practise mindfulness and meditation
  • Eat healthy foods and have a balanced diet
  • Keeping physically active
  • Have enough sleep
  • Avoiding alcohol, drinking only moderately or cutting down
  • Avoiding smoking or cutting down

  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 some 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:

  •    Clic
  •    Side by Side
  •    7 Cups
  •    Sane
  •    Togetherall

• Further reading

  Royal College of obstetricians and gynaecologists – Blog: Raising awareness of premenstrual dysphoric disorder (PMDD)
  
  

  Society of Endocrinology - You and your hormones

  
  Wellbeing of Women - Information on periods and menstrual health   

• Useful contacts

  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 

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

  Website: https://mevpmdd.com

  Emotional support lines

  Samaritans
  Can be contacted by telephone, letter, email and online chat. There's also a face-to-face service, available at their local branches. They are open 24 hours a day, every day of the year.

  Phone: 116 123
  Email: jo@samaritans.org
  Website: www.samaritans.org

  Mood Swings
  Aimed at anyone affected by a mood disorder, including friends, families and carers.
  
  Phone: 0161 832 37 36
  Email: info@moodswings.org.uk
  Website: www.moodswings.org.uk

  Sane Line
  Work with anyone affected by mental illness, including families, friends and carers. They provide a free text-based support service called Textcare and an online supportive forum community where anyone can share their experiences of mental health.

  Phone: 0300 304 7000
  Textcare: www.sane.org.uk/what_we_do/support/textcare
  Support Forum: www.sane.org.uk/what_we_do/support/supportforum
  Website: www.sane.org.uk

  Support Line
  They offer confidential emotional support to children, young adults and adults by phone, email and post. They work with callers to develop healthy, positive coping strategies, an inner feeling of strength and increased self-esteem to encourage healing, recovery and moving forward with life.

  Phone: 01708 765200
  Email: info@supportline.org.uk
  Website: www.supportline.org.uk

  Papyrus UK
  A UK charity dedicated to the prevention and the promotion of the positive mental health in young people.

  Phone: 0800 068 41 41
  Email: pat@papyrus-uk.org
  Website: www.papyrus-uk.org

  C.A.L.M. (Campaign Against Living Miserably)
  CALM is leading a movement against suicide. They offer accredited confidential, anonymous and free support, information and signposting. The provide this to people anywhere in the UK through their helpline and webchat service.

  Phone: 0800 58 58 58
  Website: www.thecalmzone.net

  The Mix
  If you’re under 25 and need help but don’t know where to turn, call the Mix for free. They’ll explore your situation with you and find organisations that may be able to help you further.

  Phone: 0808 808 4994
  Email: www.themix.org.uk/get-support/speak-to-our-team/email-us
  Webchat: 1 to 1 chat service: www.themix.org.uk/get-support/speak-to-our-team
  Website: www.themix.org.uk

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  • You can watch a short video about Recite here.