PMDD (Pre-Menstrual Dysphoric Disorder) is a severe form of PMS where women experience mood, behavioural and physical symptoms that significantly disrupt daily life. According to NICE (National Institute for Clinical Excellence) in 2024 up to 90% of women of reproductive age experience at least one of the pre-menstrual symptoms that make up PMS (Pre- Menstrual Syndrome), and 5-8% of women (over 100 million) experience PMDD. Symptoms can vary from of suicidal ideation and depressive behaviour, to physical symptoms like severe abdominal cramping and migraines. Although many symptoms are thought to be common, studies suggest only around 29–53% of women with clinically significant symptoms seek medical help.
The lack of research into PMDD as well as the social stigmas around mental health and the menstrual cycle has meant women are often left to deal with this condition on their own, which can often exacerbate feelings of hopelessness and anxiety. In research, Halbreich et al found that on average women in the USA experience around 481 menstrual cycles- if on average women experience 6-7 days of PMDD symptoms each cycle this adds up to almost 8 years’ worth of PMDD symptoms. By continuing to research possible explanations for PMDD and spread awareness about it, we can help to put systems and practices in place that work with women’s menstrual cycles, rather than against them.
Why does PMDD occur
Most recently scientists have suggested that the reproductive patterns of hormones in women with PMDD are normal, but women have a heightened sensitivity to changes in hormone levels throughout the cycle. Some studies have suggested that the decrease in progesterone during the luteal phase cause central nervous system changes. Other theories suggest it is an early peak in oestradiol that causes hypersensitivity. However, this fails to explain why some women start to experience symptoms in ovulation whereas others only experience symptoms in their late luteal phase. Furthermore, there are theorised risk factors that can increase a likelihood of developing PMDD including past traumatic events, cigarette smoking and obesity.
How the NHS currently approaches PMDD
The East London NHS foundation Trust approaches treating PMDD first through life-style symptom control. This can involve reducing caffeine, regular food intake and exercise, educating family and friends and psychotherapy or counselling. Doctors also often use
SSRI’s, and other anti-depressant medication to help women deal with emotional symptoms. Hormonal manipulation for PMDD has also been suggested. HRT (hormone replacement therapy) can reduce hormonal fluctuation, and which can help with cyclical mood and physical symptoms and reduce mood swings, anxiety, irritability, fatigue and improve physical symptoms such as bloating and breast tenderness. Talking therapies (eg. CBT ) are also recommended to combat low mood, yet NHS waitlists for talking therapies can be as long as 18 months. Many people have wondered whether systematic changes in occupational and public health would prevent severe PMDD symptoms more effectively than case by case treatment.
A new attitude to PMDD
The International Association of Premenstrual Disorders UK (IAPMD UK) was launched in 2026 and aims to advance evidence led research and education on PMDD and PME (Premenstrual exacerbation) in the United Kingdom. In July 2021 the IAMPD conducted a virtual event in order to create a ‘strategic roadmap for advancing patient-centered outcomes in PMDD research and clinical care’. Their research has resulted in new recourses. Their publications centre on the idea that it is important ‘to bridge the gap between patient stories and the professionals with the tools, funding, and influence to conduct research and drive systemic change’. Hopefully by directly talking to women with PMDD and collating personal testimonies with clinical research we can create a more diverse and detailed picture of PMDD which can improve research as well as validate patients with PMDD – a condition that has been historically undermined and unresearched.