PMDD is a severe form in which mood worsens markedly before menstruation: intense sadness, irritability and anxiety. Symptoms ease once the period starts and, unlike ordinary PMS, they significantly disrupt daily life. In 2012, an expert group writing in the American Journal of Psychiatry recommended including PMDD in the DSM-5 as a separate disorder. It affects 2–5% of women before menopause.
Not hormone levels, but the brain’s response
In a classic 1998 New England Journal of Medicine study, suppressing ovarian hormones in women with severe premenstrual symptoms relieved their symptoms, and adding back estradiol or progesterone brought them back. In women without such symptoms, the same hormones did not change mood. The conclusion: the problem is an unusual brain response to normal hormonal changes. In a 2013 Cochrane review, SSRI antidepressants reduced symptoms more than placebo, although they also had side effects.
What this means for you
- Track your symptoms daily alongside your cycle days for at least two months.
- PMDD is a recognised and treatable disorder, so you don’t have to “just put up with it”.
- If you have thoughts of harming yourself before your period, seek help immediately.
Sources
- Epperson C. N., Steiner M. et al. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465–475. doi:10.1176/appi.ajp.2012.11081302
- Schmidt P. J., Nieman L. K., Danaceau M. A., Adams L. F., Rubinow D. R. (1998). Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. New England Journal of Medicine, 338(4), 209–216. doi:10.1056/NEJM199801223380401
- Marjoribanks J., Brown J., O’Brien P. M. S., Wyatt K. (2013). Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001396.pub3