Could your PMS be PMDD?

What is PMDD?

Most women go through a range of emotional, behavioural, and physical symptoms in the lead-up to their period. These changes are cyclical - meaning they come and go each month. While some women manage with mild PMS symptoms, others find them more demanding. 5-8% of women, however, experience moderate to severe symptoms that can have a major impact on their daily routine¹. In comparison to PMS, these symptoms can be debilitating. They are linked to a condition called Premenstrual Dysphoric Disorder (PMDD).

What is the difference between PMDD and PMS?

PMS is what we call the collection of symptoms women of childbearing age feel in the weeks before their period. They can be a common part of the menstrual cycle.

PMDD - formerly known as Late luteal dysphoric disorder (LLDD) - is the most severe form of PMS. PMDD symptoms closely mirror those of PMS, except they are more intense.

Dr Gowri Rocco, specialist in hormone balance and women's health says: "PMDD is an extreme version of PMS. PMS impacts more than half the female menstruating population with mild and uncomfortable examples of bloating, cramps, fatigue, and food cravings. PMDD affects roughly 10% of the menstruating female population and is extremely debilitating with intense and severe psychological and physical symptoms. PMDD interferes with work, social, and school life.”

The cause of PMDD isn't fully known. It may be due to an increased sensitivity to the normal hormone fluctuations that happen during your menstrual cycle. If you have a family history of PMDD, there's a higher chance of developing it yourself.

What are the symptoms of PMDD?

PMDD symptoms usually appear two weeks before your period (the luteal phase) and can seriously impact your life.

"People with PMDD experience debilitating psychological, gastrointestinal, and neurological symptoms that start after ovulation and last for two weeks before their period starts," Rocco explains. "They encounter an intense combination and variation of symptoms - all interfering massively with daily routines.”

Symptoms of PMDD typically include at least five of the following symptoms¹:

• Feelings of sadness, despair, or negative thoughts about yourself.

• Constant worry, tension and anxiety.

• Mood swings and emotional instability.

• Feeling angry, irritable and short-tempered.

• Finding it hard to be interested in activities you used to enjoy.

• Difficulty concentrating on tasks and feeling easily distracted.

• Lacking energy and feeling constantly tired.

• Craving food and overeating.

• Sleeping too much and finding it hard to fall asleep.

• Feeling overloaded or out of control.

• Physical discomfort such as breast tenderness, headaches, muscle aches, feeling bloated, and weight gain².

Is there a link between PMDD and ADHD?

According to Rocco, 45.5% of women with ADHD have PMDD compared to 28.7% of the general population³.

Attention Deficit Hyperactivity Disorder (ADHD) is a behavioural condition. People with ADHD have difficulty concentrating, often act on impulse and exhibit signs of restlessness.

It's thought that people with ADHD may experience a disruption in brain chemicals that carry signals between nerve cells (neurotransmitters.)

During the late luteal phase of the menstrual cycle, your oestrogen levels begin to decline. Because lower oestrogen levels affect these already impaired feel-good chemicals - dopamine and serotonin - ADHD symptoms can be more intense during this phase of your period⁴.

How is PMDD treated?

Since PMDD symptoms often overlap with depression and anxiety, diagnosing it is harder when these conditions are already present. In such cases, women might experience heightened emotional symptoms of existing mood disorders during their premenstrual period, rather than the PMDD itself. A doctor would usually recommend looking at your medical history and treating the underlying condition first before diagnosing PMDD. If symptoms persist - especially around the menstrual cycle - daily symptom tracking can help confirm the condition.

"PMDD is often treated with selective serotonin reuptake inhibitors (SSRIs) which are antidepressants," says Rocco. "Pain medicine, such as NSAIDS or ibuprofen - as needed for pain - also helps with symptoms. Because PMDD is believed to be caused by the cyclical rise and fall of hormone levels - oestrogen and progesterone - birth control pills have also been used to help improve symptoms. Some patients do worse with birth control, but this is up to you and your doctor to decide."

Referral to a specialist can offer other forms of treatment if the above doesn't help - such as inducing a "menopause" and giving back the hormones as HRT- hormone replacement therapy. However, this may not be suitable for everyone.

Chasteberry - a herb also known as Agnus castus - is believed to reduce symptoms of irritability, anger, headaches, and breast pain. However, it is not recommended if you're breastfeeding or trying for a baby⁵.

Talk therapy such as Cognitive Behavioural Therapy (CBT) can help control PMDD symptoms⁶.

If you think you're experiencing symptoms of PMDD, talk to your doctor to get a proper diagnosis and possible course of treatment. They will also discuss your medical history and lifestyle habits to see if they're connected to these symptoms.

The mental health charity Mind suggests tracking your symptoms for at least two months to help identify patterns and triggers. They also offer advice on where to find support for PMDD, along with self-care practices to boost your emotional wellbeing.

Further reading

1. Mishra et al: Premenstrual Dysphoric Disorder

2. Mind: Premenstrual dysphoric disorder (PMDD)

3. Dorani et al: Prevalence of hormone-related mood disorder symptoms in women with ADHD

4. Antoniou et al: ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period

5. Pearlstein et al: Premenstrual dysphoric disorder: burden of illness and treatment update

6. Weise et al: Internet-Based Cognitive-Behavioural Intervention for Women with Premenstrual Dysphoric Disorder: A Randomized Controlled Trial