PMDD is a cyclical mood disorder that directly relates to normal hormonal changes within your menstrual cycle. It is often described as severe PMS but this does not give justice to the severity of how your quality of life can be affected.

Up to 40% of women experience some form of physical and emotional symptoms linked to the rising and falling of normal hormones (Oestrogen and Progesterone), but in 2-8% of women these symptoms are severe enough to disrupt their daily life, work or school, and interpersonal relationships. Symptoms of PMDD vary for each woman but can include:

Physical

  • Sleep disruption
  • Headaches
  • Memory and concentration difficulties
  • Breast tenderness or swelling
  • Muscle and joint stiffness
  • Bloating and irritable bowel
  • Increase or decrease in appetite
  • Fatigue
  • Acne
  • Increase or decrease in libido

Emotional and behavioural

  • Mood swings that may be extreme and volatile
  • Irritability
  • Anger or rage
  • Depression, tearful, easily distressed
  • Feelings of being constantly on edge
  • Heightened anxiety
  • Suicidal and/or self-harming thoughts and actions
  • Binge eating
  • Feeling overwhelmed
  • Difficulty in concentration and focusing
  • Social anxiety, isolation or avoidance

PMDD is a long-term condition that can affect women and those assigned female at birth from the onset of puberty until the menopause. It is an illness that often worsens over time or may start spontaneously after a traumatic event or after a hormonal disruption such as pregnancy. It is important to know that PMDD is not caused by a hormone imbalance, but rather how the body and brain responds to the normal fluctuations of female sex hormones.

The severity of the ebb and flow of symptoms can cause lasting damage to a woman’s life. It is common for PMDD to be misunderstood by friends, families and partners with many affected women socially isolating themselves and withdrawing from relationships. PMDD sufferers have unique needs and providing them with high quality support and information is fundamental to them being able to manage their condition.

PMDD in more scientific terms and detail

During a woman’s childbearing years she will biologically undergo a complex timeline of physical, endocrine and psychological changes. These changes are both anticipated and paradoxically unpredictable. Scientific and medical knowledge can inform us of when and how a girl and those assigned female at birth will begin to experience a menstrual cycle, become physiologically mature to safely bear children, and at the other end of the spectrum will undergo the menopause. The challenge within this is that each woman through both nature and nurturing influences will have a unique experience of this process.

It is estimated that 80% of women will experience a form of Premenstrual Syndrome (PMS). PMS is a commonly heard term, often used to dismiss offhand a woman’s irritability and behaviours leading up to her period. The important distinction here is that PMS does not interfere with a woman’s quality of life, relationships or ability to undertake her usual activities. Whereas for 2-8% of the population, symptoms are so severe that they may be classified as PMDD which exists as a spectrum from mild to severe and require treatment. Due to the severity of the symptoms and impact on quality of life, PMDD is the only reproductive mood disorder to be classified within the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Research into the causes of PMDD is providing some exciting findings over recent years. Put simply, the main theory indicates that PMDD is an “abnormal response to normal hormonal changes”.

Evidence has shown that PMDD is heritable with an up to 80% chance of the condition running in the female side of families. Because of this it is undeniable that it has a physical root cause. What is interesting is that there are many different ways in which the body may present this pathology. This can be viewed as a jigsaw puzzle of the following pieces:

  • The way in which the brain responds to progesterone and subsequent becomes tolerant (insensitive) to the release of our natural calming, anti-anxiety chemicals (ALLOs)
  • The structure of the oestrogen receptor, meaning that women with PMDD have a different chemical, cognitive and emotional response to normal oestrogen levels than those without PMDD.
  • An overall increase sensitivity to female hormones (oestrogen and progesterone) as a result of the genetic influence PMDD has on the thinking process within the cells of our bodies
  • The physical structure and amount of grey matter in the brain of a woman with PMDD is related to the function of the prefrontal cortex, which influences the behaviours relating to depression and creating depressive-like symptoms (the ‘Dysmorphia’ element of PMDD)
  • The relationship between other inflammatory disorders (gingivitis, irritable bowel, and rheumatology) suggests that there may be a link in how progesterone is processed in the body.

What we know and learn about this debilitating condition is expanding faster than ever before. As of 1stJanuary 2018 there were 21,497,906 females aged 15-64 in the UK. This means there are up to 1.7 million women living with, or been affected by PMDD at any given time. The medical community have started to sit up and take notice, making this a very exciting time in PMDD treatment possibilities.

The information presented in this article is based on the data published by the references below and is a highly condensed account of the existing literature, research and theories surrounding PMDD.

For more information about PMDD, its causes, effects, interactions with co-morbidities and where to access further support visit The International Association for Premenstrual Disorders.

References

Epperson et al (2012) Premenstrual Dysphoric Disorder: Evidence for a New Category for DSM-5. American Journal of Psychiatry. 169(5) 465-475

The International Association for Premenstrual Disorders

The Royal College of Obstetrics and Gynaecology Green Top Guideline no. 48 Management of Premenstrual Syndrome (2017)

MIND (2018) Premenstrual Dysphoric Disorder

Women’s Mental Health Organisation: The Etiology of Premenstrual Dysphoric Disorder: 5 Interwoven Pieces

United Kingdom Population Data based on the latest United Nations Data (2018)