Mood swings, irritability and a change in libido are all symptoms of premenstrual syndrome (PMS). It’s estimated that around 30% of us have moderate-to-severe PMS, struggling with monthly bloating and sluggishness. But if you also struggle with feeling out of control in the run up to your period, as well as experiencing despair and perhaps even suicidal thoughts, you might be one of the 8% of women who live with premenstrual dysphoric disorder (PMDD).

PMDD symptoms typically occur during the luteal phase of a menstrual cycle – the time between ovulation and your period. On average, this phase lasts for two weeks, and it’s during this fortnight that many people feel like they’ve transformed into another person and pushed a self-destruction button. Almost overnight, you start to experience drastic mood changes that put a strain on relationships, careers and education.

“Living with PMDD is incredibly challenging, as it significantly impacts both mental and physical well-being,” says Sandi MacDonald, co-founder and executive director of International Association for Premenstrual Disorders (IAPMD). “As the luteal phase approaches, some individuals may experience a deep sense of dread, knowing that their symptoms are about to escalate. This makes living with PMDD a complex and often difficult experience.” 

In more recent years, we have become aware of PMDD thanks to social media, with celebrities like Vicki Pattinson sharing the raw truth behind what they experience in the lead up to their period. PMDD has 45.9 thousand posts on TikTok, with GPs, nutritionists and psychiatrists explaining its severity, while women candidly share their personal experiences. Some talk about how, in the weeks before their period, they struggle with extreme, intrusive thoughts, while others describe the intense rage and complete lack of motivation. And that’s made worse by the fact that we still don’t know much about this chronic condition. In fact, it was only in 2013 that PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders – 26 years after a formal diagnosis criteria was first proposed.

Daniel Glazer, clinical psychologist and co-founder of UK Therapy Rooms tells Strong Women: “As mental health professionals, we have to own up to the fact that women’s health issues – especially those tied to menstruation – have historically been under-researched and too often brushed aside.” Glazer suggests that the complexity of hormonal, neurological, and psychological factors “makes PMDD an inherently tough nut to crack.”

PMDD is a disorder that still remains a mystery for many. It’s often misdiagnosed as bipolar disorder or depression, and some still believe that it’s caused by a hormone imbalance when in actual fact, it’s a severe neurological reaction to the monthly rise and fall of oestrogen and progesterone.” 

“The high variability in how PMDD manifests from woman to woman, combined with symptom overlap with other mood disorders, further muddies the waters in terms of understanding, recognizing, and properly diagnosing this condition,” explains Glazer. “It’s a layered issue without any simple solutions.”

Some PMDD symptoms cross over with PMS (some physical), making it yet more tricky to diagnose. But there are a few clear differences between the two. In order to get a diagnosis of PMDD, at least five symptoms must be present, with one being regarded as a “core emotional symptom”. That might be mood swings, irritability and anger, depressed mood and anxiety or tension. If you think you might have PMDD, you’ll be assessed based on your pattern of symptoms, and in lieu of blood tests or screenings (neither of which exist for PMDD yet), your doctor is likely to run different tests to rule out other medical conditions that can cause similar symptoms, like thyroid disorders.

So, what are these key differences? Below are the red flags that could be a sign of PMDD. If you recognise that you experience a few of these on a regular basis, it’s time to talk to your GP. 

Severe mood swings

While mood swings are common with PMS, PMDD mood swings are more severe. It’s not just about feeling low during your luteal phase, but tearful and super sensitive. And that sadness might then give way to feeling manic. You might have an overwhelming feeling that the world is against you and that there’s no light at the end of the tunnel, and that can get in the way of work and relationships.

Irritability or anger

Loads of us are irritable just before our periods but if you find that you’re experiencing anger and rage over nothing – and that anger becomes all-consuming – then you might want to talk to your GP. Uncontrollable rage can have a long-term, negative impact on work, friendships and home life.

Depressed mood

Again, we’re not talking about temporary low mood here; PMDD often involves feelings of hopelessness, worthlessness and guilt. In severe cases, women may feel suicidal and struggle to get out of a dark hole; it’s thought that at least 15% of people with PMDD regularly experience suicidal thoughts.

Anxiety or tension

Studies show that there is an association between generalised anxiety and PMDD, and that during the luteal phase, these worries can be heightened. It’s common to experience an all-consuming feeling of paranoia and restlessness.

Body aches and pains

Beyond the regular sore boobs and back ache, PMDD can cause joint and muscle pain and headaches – often to a severity that interferes with daily tasks. 

Fatigue and lack of motivation

Fatigue is another stand out factor for PMDD. It’s not normal to need a nap umpteen times a day, just to get through a regular eight hour shift, so if that’s how you feel in the run up to your period, it’s worth getting checked out. 

Decreased interest in usual activities

If you find yourself wanting to put your phone away, cancel plans, shut the curtains and totally switch off but also feel bored, frustrated and confused, you may have PMDD. It’s not uncommon to find yourself waiting for the day to end because you don’t want to engage in the usual activities that make you happy; that only exacerbates feelings of guilt and sadness.

Weight changes and gastrointestinal issues

PMDD can come with extreme bloating, and MacDonald explains that this can “often be accompanied by noticeable water retention and weight gain that is more pronounced than in PMS.” Gastrointestinal issues are also associated with PMDD; nausea, diarrhoea, vomiting and constipation can be more severe and can have a knock-on effect on appetite.

Confusion over relationships

Ever felt like, overnight, you want to leave your long-term partner (who’s done nothing wrong)? When you have PMDD, your fight or flight response is constantly activated and it’s not uncommon to focus on the person closest to you as the main source of stress. Of course, the moment you’re out of the luteal phase, you go back to loving your partner again. That isn’t a normal part of PMS, and it’s something that can put a huge amount of stress on your both.  

Sleep problems

Studies show that some women with PMDD experience insomnia, memory problems, difficulty maintaining focus and fatigue in the run up to their periods. If you don’t have insomnia, you might experience hypersomnia – needing to sleep all the time. Unfortunately, a lack of a healthy sleep routine only exacerbates other symptoms.

Skin issues

Skin changes are a classic sign of PMS, but women with PMDD can also suffer with acne, skin inflammation and itchiness. Histamine can affect neurotransmitters in the brain, which can not only contribute to your low mood during your cycle, but can cause itchy skin all over the body. 

Vision changes, respiratory problems and allergies

Some women have even reported changes in vision and eye infections that arise during the luteal phase, along with breathlessness and the development of new allergies or increased sensitivity to pre-existing ones. 

If you think that you’re living with PMDD, MacDonald advises keeping a track of your emotional and physical symptoms across at least two cycles. Read up on PMDD ahead of your GP appointment and then go in (armed that your data) prepared to ask for referral to a mental health specialist. These referrals are often necessary in order to rule out other medical conditions and mental health problems.

Organisations IAPMD and The PMDD Collective offer invaluable resources for understanding PMDD and navigating a path ahead.

As research on PMDD continues to evolve, dots are joined up that point toward other symptoms. Glazer says: “Some studies point to PMDD sufferers also experiencing brain fog and hypersensitivity to lights and sounds”. He also flags that as PMDD is an extremely nuanced condition, doctors “have to stay on top of the latest findings while holding space for the highly individualised way PMDD can present.”

If you, or someone you know, is struggling with their mental health, you can find support and resources at mental health charity Rethink Mental Illness or access the NHS list of mental health helplines and organisations here.

If you are struggling with your mental health, you can also ask your GP for a referral to NHS Talking Therapies, or you can self-refer.

You can also call the Samaritans in the UK on 116 123 or email jo@samaritans.org for confidential support.

Images: Getty