Imagine feeling like a completely different person for two weeks out of every month - crippling anxiety, overwhelming sadness, and a sense of hopelessness that seems to come out of nowhere. Now imagine being told, “it's just PMS", or that you're overreacting. For millions of women worldwide, this isn’t just an inconvenience - it’s a debilitating condition known as Premenstrual Dysphoric Disorder (PMDD).
Despite its severe impact on mental and physical health, PMDD is often misunderstood, misdiagnosed, or dismissed altogether. Is it simply the medicalisation of normal menstrual symptoms, or is there more to this condition than meets the eye? Let's dive into the science, the stigma, and the fight for recognition.
From the title alone, this specific topic area carries a lot of misconceptions and false perceptions within today’s society. Whether this is due to the lack of research and understanding within gynaecological health entirely, or the reduced platforms for women to share health concerns in a way that they feel seen and heard, this is an issue that needs addressing urgently; PMDD is not simply the ‘medicalisation of normal menstrual symptoms’ (University Of Oxford, 2024).
As women, many of us suffer from a variety of symptoms prior to the beginning of our menstrual cycle, which collectively come under the umbrella term of Premenstrual syndrome (PMS). Whilst this does vary from woman to woman, it can involve experiencing symptoms such as bloating, headaches, pelvic/lower abdomen pain and increased sugary food cravings. Alongside these physical experiences we may suffer from, our mood and emotions can be affected including symptoms such as irritability, anger and increased emotional sensitivity. However, specific forms of PMS are seen to be more prevalent within today’s generation of women, particularly that of Premenstrual Dysphoric Disorder (PMDD).
What is Premenstrual Dysphoric Disorder (PMDD)?
PMDD exists as a severe form of PMS whereby you are still experiencing similar symptoms such as bloating, headaches and breast tenderness, but also experience extreme irritability, anxiety and depression. The difference between moderate PMS and that of PMDD, specifically, is that PMDD causes extreme mood shifts and increased emotional and physiological symptoms which can cause large disruptions in a woman’s daily routine that begin during a particular phase of their menstrual cycle. PMDD can be clinically recognised through psychological assessments carried out by your GP to determine the extent of the depression-like symptoms you experience as well as the onset of such symptoms.
Specific symptoms of the disease can be split into physical experiences (Cleveland Clinic, 2023) (MIND, 2024):
Pain in joints/muscles
Bloating
Fatigue
Food cravings
Headaches
Insomnia
Emotional experiences:
Feeling on edge/overwhelmed
Anxiety/ panic attacks
Depression and suicidal thoughts
Difficulty concentrating
Upset
Feeling hopeless
With PMDD, there are regular patterns in the occurrence of symptoms, happening a week or two before menstruation occurs and reducing after the first few days of menstruation (Cleveland Clinic, 2023). This one to two week time period, encompassing the time between ovulation and menstruation, is known as the Luteal phase of the menstrual cycle encompasses the time between ovulation and menstruation. Within the Luteal phase, an individual with PMDD may experience the aforementioned symptoms every day or very frequently within this time (MIND, 2024).
Why does PMDD occur?
Whilst the exact cause of PMDD is still an active area of research, multiple theories have been discussed that may help to explain why PMDD occurs and which biological mechanisms may underlie this detrimental condition.
Genetics
Genetic research into PMDD has suggested that the gene that encodes the serotonergic 5-HT1A receptor, as well as allelic variants of the oestrogen receptor alpha gene(ESR1), may be involved in the onset of PMS/PMDD in women (Sanskriti Mishra and Raman Marwaha, 2023).
Dysregulation in the serotonergic system
Another biological mechanism that may cause PMDD involves the brain serotonergic system. Ina PET study, it was found that the availability of the 5-H1TA serotonin receptor increases in the brainstem during the late luteal phase in controls, but not in individuals with PMDD (Cary and Simpson, 2024). This is particularly relevant as, during the late luteal phase, symptoms of PMDD can be heightened. As we explore various treatment options for PMDD later within this blog, this theory may be particularly relevant.
Progesterone and ALLO metabolite
Allopregnanolone is a brain chemical that comes from the progesterone hormone and helps to effectively control mood by acting as a neuromodulator of GABA-α receptors found within the brain (Cary and Simpson, 2024). It is usually found within the amygdala region of the brain where it helps to regulate the body’s emotional responses. Under normal conditions, it is seen to have mood-enhancing effects by affecting these receptors (Cary and Simpson, 2024). However, within PMDD, it is seen that allopregnanolone has the opposite effect, worsening mood symptoms, specifically during the luteal phase of the menstrual cycle; this is where PMDD has its greatest impact on women both mentally and emotionally.
Stress and Inflammation
As many of us may already know, extreme periods of stress can have a detrimental impact on our overall mental health and wellbeing. Researchers have explored how extreme levels of stress can cause the development of premenstrual conditions, including PMDD. A study of almost 400 women found that both trauma and post traumatic stress disorder (PTSD) were independently associated with PMDD (Cary and Simpson, 2024). As well as this, another study of approximately 300 women found that there was a strong correlation between the physical or emotional abuse they may have endured and moderate-severe onset PMS/PMDD (Cary and Simpson, 2024). Whilst the mechanism of how stress may be implicated in the development of PMDD is unclear, there is some speculation that it may be due to the involvement of the allopregnanolone.
In addition to this, inflammation has been considered as a predisposing factor for PMDD whereby one study has shown that there is a relative increase in inflammatory markers in women suffering from PMDD compared to the control group (Cary and Simpson, 2024).
The prevalence of PMDD
To commemorate Brain Awareness Week 2025, we want to raise awareness of some of the conditions that females face in today’s generation. Many of these issues are not widely spoken about within the scientific community, so in this blog post we are exploring PMDD. So, why PMDD compared to any other health condition that has significant neurological effects? Firstly, around 1.6% of women are suffering from PMDD globally, which is equivalent to around 31 million women and girls (University of Oxford, 2024b). Within this cohort, a high proportion of around 3.2% of females have had provisional diagnoses whereby their PMDD condition was suspected but their symptoms were not measured for a long enough period to meet the criteria for diagnosis. So, why is this the case? This is an issue that we, as female members of WiNUK, want to address; the lack of formal diagnosis for this condition is associated with the lack of recognition given towards women’s health within medicine, which is seen across many disorders and conditions. Limited training has been given to psychiatrists, medical students and other relevant stakeholders around PMDD, which causes patients to fall through the gap in clinical services across the UK (University Of Oxford, 2024b).
Diagnosis of PMDD
Upon reading this blog, if you are beginning to notice that you too suffer from similar symptoms associated with PMDD, aim to keep a diary during each phase of your menstrual cycle to document the symptoms you are experiencing. Make sure you include whether those are physical or emotional symptoms, which menstrual cycle phase you are in, and track these features for at least two months before you book a GP appointment (www.bupa.co.uk, n.d.). This would allow yourself and your GP to make sense of your symptoms, and notice any patterns in the timeframes that these symptoms are occurring. Whilst there is no formal test to specifically diagnose PMDD, your GP will aim to make a diagnosis based on your symptoms and other relevant medical history. Prior to a diagnosis of PMDD, your GP may need to rule out any other health concerns that could potentially explain your symptoms; this may involve a blood test to check for conditions such as thyroid issues, anaemia or perimenopause (www.bupa.co.uk, n.d.).
Ways to treat PMDD
Vitamins/supplements
Overtime, there has been a lot of research done to explore how various vitamins and/or supplements can help to reduce the symptoms of PMDD. It is important to note that, compared to pharmacological agents to treat PMDD, the research behind vitamins and supplements to reduce the symptoms of PMDD is at a much earlier stage. Please consult your GP or seek medical advice before you incorporate any of these vitamins into your routine, as they could interfere with ongoing conditions or medications you may be taking.
Calcium
Scientific evidence suggests that cyclic fluctuations in blood serum calcium levels may contribute to why some individuals with PMS suffer from specific symptoms; there is some evidence that calcium supplements can be useful in alleviating mood disorders associated with PMS, such as PMDD (Arab et al., 2020). Subsequently, it has been shown that when oestrogen levels fluctuate in women, which specifically occur within the luteal phase of the menstrual cycle, serotonin receptor availability, binding and neurotransmission could be altered, which can result in premenstrual mood disorders such as PMDD (Arab et al., 2020). It is believed that taking calcium supplements can increase calcium levels inside cells, which may help improve the balance of mood-related chemicals like serotonin and correct serotonin imbalances(Arab et al., 2020).
Vitamin B-6
Randomised, placebo-controlled trial studies have been conducted to explore the use of vitamin B-6 as a treatment option for PMS symptoms. One study concluded that women treated with vitamin B-6 experienced significant relief in overall PMS symptoms compared to those in the control group (Wyatt et al., 1999). It was also found that there were no neurological side effects when a 50mg/day dosage was administered, however, this method of treatment was not recommended as a central mode of action to treat PMDD. Vitamins alone will not effectively treat the condition, but may provide some relief for individuals suffering from PMDD symptoms (Wyatt et al., 1999).
Magnesium
Within a double-blinded placebo-controlled trial, it was shown that the combination of magnesium (Mg) and vitamin B-6 was more effective in lowering the mean score of PMS symptoms than each of the individual supplements alone (Nahid Fathizadeh et al., 2010). However, to see therapeutic benefits, the combination of both Mg and vitamin B-6 must be taken for at least two months. With a focus on Mg alone, it was also seen in another study that individuals who received Mg experienced a significant reduction in the severity of PMS symptoms such as depression, craving and anxiety compared to that of the placebo group (Nahid Fathizadeh et al., 2010).
Diet and lifestyle changes
Regular exercise
Regular exercise, without a specific focus on which activities, is known to positively impact your mental health and wellbeing. With the reduction of PMDD symptoms in mind, it has been shown that regular aerobic exercise such as walking, swimming and biking can help to improve mood and energy levels of those suffering from PMDD (Harvard Health Publishing, 2009).
Consumption of complex carbohydrates
Common dietary recommendations for women suffering from PMDD include having an increased consumption of complex carbohydrates such as white and sweet potatoes, peas, corn, beans, lentils and whole grains. This is because they help to maintain steady serum glucose levels to help reduce PMS food cravings, as well as increase the availability of an amino acid known as tryptophan in the brain, allowing for increased serotonin synthesis (Pearlstein and Steiner, 2008). This is a significant benefit for women with PMDD as reduced brain serotonin and precursors for serotonin are associated with worsening of the symptoms within premenstrual dysphoria (Eriksson et al., 2006).
Mindfulness techniques
Another way to effectively manage symptoms of PMDD is to incorporate relaxation techniques such as mindfulness practises. This may allow individuals to be fully engaged within the present moment, consciously choosing how to respond to emotions and ease the feelings of overwhelm and anxiety within PMDD. An example of a method to incorporate mindfulness techniques into your routine may be through taking a ‘Mindful Walk’, which is where you go on a walk but take extra notice of the feelings and sensations around you. These can be feelings such as the cold wind blowing on your face, or the ‘crunch’ of the leaves you walk on (Mosunic, 2023). Another example of a mindfulness technique is the ‘5,4,3,2,1’ technique which is where you notice five things that you can see, four things that you can feel, three sounds that you can hear, two things that you can smell and one thing you can taste. Both techniques can be used to help ground you and ease your mind during periods of intense emotion within PMDD (Mosunic, 2023).
SSRIs
The usage of Selective Serotonin Reuptake Inhibitors (SSRIs), or more widely known as antidepressants, can be used as a pharmacological agent to combat the symptoms within PMDD. SSRIs work by inhibiting the absorption of serotonin, boosting the availability of serotonin within the brain and enhancing mood (Marjoribanks et al., 2013). Originally, SSRIs were used to treat disorders such as anxiety and depression, with a treatment period of at least four to eight weeks needed to see clinical efficacy. However, when treating PMS syndromes like PMDD, SSRIs are reported to be effective even after a few days of usage, which could be due to the cyclic nature of the disorder. There is minimal support and resources available for women suffering with PMDD due to the lack of awareness surrounding the condition. However, as this condition becomes more widely spoken about amongst the scientific community, there are improvements in the development of useful resources and support for those suffering. An example of this is through a UK organisation known as the ‘National Association for Premenstrual Syndromes’. Whilst this organisation does not focus on PMDD specifically, it acts as a safe platform for members to discuss the issues they face within premenstrual syndromes such as PMDD through the in-person events they conduct, the expert advice on the condition that they are able to share, and the resources they provide (such as a template of the menstrual diary, as previously mentioned). These resources may aid the diagnosis of PMDD and help people to better understand how to manage their symptoms.
Conclusion
To conclude, whilst scientific research surrounding PMDD and treatment interventions are still emerging, there is a lot yet that needs to be uncovered about the disorder. However, by sharing the current research that is available and raising awareness amongst the STEM community, I hope that we are able to build a bigger and better platform for women suffering from PMDD. It is so important to allow women across the world to feel seen and heard, highlighting the detrimental impact this condition has on their quality of life. Further education and research around this disease which improve outcomes for all women affected, and progress our community in the fight to tackle this disorder!!
References
University Of Oxford (2024). New data shows prevalence of Premenstrual Dysphoric Disorder | University of Oxford. [online] www.ox.ac.uk. Available at: https://www.ox.ac.uk/news/2024-01-30-new-data-shows-prevalence-premenstrual-dysphoric-disorder.
Cleveland Clinic (2023). Premenstrual Dysphoric Disorder (PMDD). [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/9132-premenstrual-dysphoric-disorder-pmdd.
MIND (2024). What is PMDD? [online] Mind.org.uk. Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/what-is-pmdd/.
Sanskriti Mishra and Raman Marwaha (2023). Premenstrual Dysphoric Disorder. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532307/.
Cary, E. and Simpson, P. (2024). Premenstrual disorders and PMDD - a review. Best Practice & Research Clinical Endocrinology & Metabolism, [online] 38(1), p.101858. doi:https://doi.org/10.1016/j.beem.2023.101858.
University Of Oxford (2024b). New data shows prevalence of Premenstrual Dysphoric Disorder | University of Oxford. [online] www.ox.ac.uk. Available at: https://www.ox.ac.uk/news/2024-01-30-new-data-shows-prevalence-premenstrual-dysphoric-disorder.
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Arab, A., Rafie, N., Askari, G. and Taghiabadi, M. (2020). Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. International Journal of Preventive Medicine, [online] 11. doi:https://doi.org/10.4103/ijpvm.IJPVM_243_19.
Wyatt, K.M., Dimmock, P.W., Jones, P.W. and Shaughn O’Brien, P.M. (1999). Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ, [online] 318(7195), pp.1375–1381. doi:https://doi.org/10.1136/bmj.318.7195.1375.
Nahid Fathizadeh, Ebrahimi, E., Valiani, M., Tavakoli, N. and Yar, M.H. (2010). Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iranian Journal of Nursing and Midwifery Research, [online] 15(Suppl1), p.401. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3208934/.
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This article was written by Riya Verma and edited by Lauren Wallis, with graphics produced by Lilly Green. If you enjoyed this article, be the first to be notified about new posts by signing up to become a WiNUK member (top right of this page)! Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch.
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