Recognising PMDD: more than ordinary PMS

For a few days a month you feel like a different person: low, on edge, or so irritable that your relationships suffer. And as soon as your period begins, it fades and you are yourself again. That tight rhythm is the hallmark of PMDD, and it is precisely why it is so often missed.

I think PMDD has been dismissed for far too long as fussing or coping badly with stress. It is a recognised, cycle-linked condition, and you do not have to carry it silently for years.

PMDD (premenstrual dysphoric disorder) is a severe form of PMS where the emotional complaints in particular disrupt your daily life. It affects an estimated 3 to 8 percent of menstruating women. The big difference from ordinary PMS lies in the severity: the low mood, irritability or anxiety are so strong that your relationships or work suffer.

What is the difference between PMS and PMDD?

The difference lies mainly in the severity and the nature of the complaints. PMS often gives a mix of physical and mild emotional complaints. PMDD revolves around severe mood and anxiety complaints that genuinely affect your functioning.

The hallmark stays the cycle: the complaints come in the second half and fade with your period. It is precisely that rhythm that makes it recognisable. Unsure about the milder form? Then read our article on PMS symptoms and what helps.

Which signals point towards PMDD?

• Strong low mood or a feeling of hopelessness
• Intense irritability or anger, often directed at loved ones
• Anxiety or tension that you find hard to let go of
• The feeling of losing control or being overwhelmed
• Complaints that affect your relationships or work a few days a month

What causes PMDD?

The cause is not fully known, but a raised sensitivity to the normal swings of progesterone and oestrogen seems to be central. It is not about abnormal hormone values, but about how your brain responds to the fluctuations. After ovulation the balance between oestrogen and progesterone changes, and in PMDD the brain responds more strongly to that.

How is PMDD established?

PMDD is not established with a blood test, but by tracking your complaints over a number of cycles. A doctor looks at whether the complaints are truly linked to your cycle and whether they are heavy enough. A symptom diary is the most important tool here.

So a hormone test does not establish PMDD. A blood test can help to rule out other causes, such as a thyroid problem that resembles mood complaints. The Hormones Women panel maps the hormones that steer your cycle. According to the NHG guideline on PMS, the cyclical pattern is leading, not a single blood value.

Unsure whether your complaints belong to your cycle? Then read our pillar on irregular periods and which hormones to test.

When should you seek help?

Seek help if the complaints disrupt your life every month, or if you have low thoughts that worry you. PMDD is well worth discussing with the GP, and there are more treatment options than many women think. Get in touch in any case if you recognise this:

• The complaints affect your relationships, work or daily functioning
• You have low or dark thoughts in the week before your period
• You feel like a different person for a few days a month

If you have thoughts of harming yourself, do not wait and contact your GP or a helpline straight away. You do not have to keep sitting with this alone.

Frequently asked questions

Is PMDD the same as depression?

No, even though the complaints resemble each other. The difference is the timing: with PMDD the complaints come in the second half of your cycle and fade after your period. A doctor can help make this distinction.

Can you test for PMDD with blood?

Not directly. You recognise PMDD by the cyclical pattern, which you best record in a diary. A blood test can rule out other causes if your complaints are unusual.

Does PMDD go away on its own?

The complaints can differ per cycle and change around big hormonal transitions, such as menopause. But as long as you menstruate, PMDD can return. That is why it is worthwhile to seek help for it.

References

1. NHG. NHG-Standaard Premenstrual syndrome (PMS). Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
2. Thuisarts.nl. I have PMS (complaints before my period). Dutch College of General Practitioners. Available via thuisarts.nl.
3. NHG. NHG-Standaard Vaginaal bloedverlies. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.