Imagine, for a moment, spending a few days each and every month feeling panicky, depressed, even suicidal. It happens so regularly, you can predict it to the day – but there’s little support available. In fact, many healthcare professionals won’t even know what you’re talking about, let alone be able to help.

Sounds miserable, doesn’t it? Yet this is the reality for millions of women and girls who struggle with premenstrual dysphoric disorder (PMDD). It probably won’t surprise you to learn that the condition is chronically misunderstood, under-researched and misdiagnosed, despite the fact that 72% of women with PMDD have suicidal thoughts, and one in three will attempt suicide.

However, things are starting to change. Charities such as the International Association For Premenstrual Disorders and the PMDD Collective are working to raise awareness of the debilitating condition and provide valuable support to sufferers. But there’s still a long way to go – so we’ve compiled this guide to PMDD, from symptoms of the condition to how to cope if you’re affected. 

First things first, it’s important to understand what PMDD actually is. According to the International Association for Premenstrual Disorders (IAPMD), a charity founded in 2013 by PMDD sufferers, PMDD is “a cyclical, hormone-based mood disorder with symptoms arising during the premenstrual or luteal phase of the menstrual cycle and subsiding within a few days of menstruation”.

The luteal phase of the menstrual cycle is the phase between ovulation and menstruation, which can last around two weeks. While many of us will experience mood changes and other symptoms during this phase, women with PMDD will have far more severe symptoms which can seriously impact their lives – something 34-year-old functional wellness and menopause coach Zoe Hindle knows all about.

“I suffered quite severely from PMDD in my 20s; looking back, I think I had it from my teenage years,” she tells Strong Women. “I struggled with phases of depression, anxiety and hopelessness, followed by spells of being very outgoing and loving life. I just thought it was the way I was wired, but I can definitely see the constant pattern whenever I look back now.”

The symptoms of PMDD are similar to those of PMS, but more severe, and can range from fatigue, brain fog, mood swings and irritability to suicidal thinking, feelings of overwhelm, anxiety and depression.

While everyone will experience PMDD differently, symptoms generally begin post-ovulation, lasting a few days or even a few weeks, until menstruation. But until you’re sure that you have PMDD, symptoms can be easily attributed to other causes.

Emotional and behavioural symptoms

“Throughout my 20s, I thought I had severe depression, or anxiety,” says Hindle. “One doctor even diagnosed me with Generalised Anxiety Disorder and I was prescribed anti-depressants on several occasions. I could tell within hours of ovulating that my hormones had shifted. My whole persona would change, I would become withdrawn, quiet, angry at the smallest of things, overwhelmed, emotional, and on bad days I’d have an overwhelming feeling of not wanting to be here. I would be very emotional and literally change overnight – it was really tough for me, but also for those close to me, to manage.”

Physical symptoms

Much like PMS, PMDD can also manifest physically, with symptoms such as bloating, breast tenderness, joint pain, headaches and sleep problems, to name just a few. 

PMDD has a huge impact on sufferers’ social lives, relationships and work – Hindle says while she was fortunate that her workplace was very understanding, her romantic life was in tatters.

“On the same day, like clockwork, each month I would have to leave work and go home, in floods of tears, for no real reason. PNDD definitely impacted my personal relationships, specifically romantic relationships; it was difficult for another person to deal with. I had some very, very dark days in the midst of it, and subsequently I broke up with my partner.”

While it’s very much an ongoing area of research, experts think that PMDD is a genetically inherited hormone sensitivity disorder, where sufferers are extra-sensitive to changes in hormone levels during the menstrual cycle. But other factors also play a part.

“Stress, histamine intolerance and food intolerances can all play a part in creating high levels of inflammation which can trigger PMDD,” explains Hindle. “All my hormone tests were normal (PMDD isn’t a hormone imbalance), so I knew that these factors were triggers for me.”

Currently, the only way to know if you have the disorder is to track your symptoms over the course of at least two menstrual cycles.

Additionally, a diagnosis of PMDD requires the presence of at least five common symptoms, one of which has to be a core emotional symptom.

Hindle first suspected she had the disorder in her late 20s.

“In my mid-late 20s I started to suffer with it really bad – it was impacting all areas of my life. At this time I wasn’t on the pill and I started to track my ovulation. It soon all clicked that this was hormone-related, and once I began to research my symptoms, I knew straight away that it was PMDD.

“I found a specialist hormone clinic in London, and they confirmed my PMDD, which I now believe was exacerbated by a stressful job, my then partner and my living circumstances.”

If you suspect you might have PMDD, it’s important that you don’t suffer in silence. There is advice and support available via The IAPMD here, and websites such as Mind and the NHS have helpful resources too.

If you’re keeping track of your symptoms, you’ll likely start to notice some of your triggers, too. For many women, stress plays a big role, as Hindle explains.

“For me, stress management has been key,” she says. “Stress can deplete your progesterone, which is vital to prevent Oestrogen dominance. While we can’t remove all the stress from our lives, I would strongly encourage women to sit back and think about what is causing them the most stress and how they can receive more support, tweak the scenarios or counteract them with more positives.”

This might look like speaking to your employer to make them aware of your situation, or getting your partner/family/friends to read up on PMDD. 

If you’re struggling with your mental health, you can call the Samaritans in the UK on 116 123 or email jo@samaritans.org. In a crisis, call 999.

Images: Getty