Premenstrual Dysphoric Disorder (PMDD) is a cyclic, chronic, severe hormone based mood disorder.

During the menstrual cycle hormone levels rise and fall, and it is during the luteal phase (after ovulation) of the cycle that PMDD symptoms occur. Symptoms include fatigue, anger, irritability, weight gain, bloating, tender breasts and anger (Hylan et al., 1999), which cause distress and impact day to day life massively.

Generally speaking, the luteal phase lasts for two weeks (although this can differ for everyone), with PMDD symptoms lasting for at least 6 days (Raffi & Freeman, 2017) during this time.

Those with PMDD have an altered sensitivity to normal hormonal fluctuations - mainly estrogen and progesterone. It is not a hormone imbalance but a severe reaction to hormone changes in the body.

Brain function and structure has been shown to differ in women with PMDD (compared to those without) through brain imaging, with the main focus on the amygdala and the prefrontal cortex

Currently there is ongoing research into the cause of PMDD. Research has shown a heritability range of 30-80%, both my Mom and my sister have PMDD including myself so I can strongly agree with that outcome!

Trauma and stress exposure (Pilver et al., 2011) has also been associated with PMDD, with studies into stress hormones showing a heightened stress response in women with PMDD, especially during the luteal phase (Beddig et al., 2019).

There are numerous treatments with varying efficiency, which I’ll talk about in the next post.

If you suspect you may have PMDD why not download our free symptom tracker? Using this for three months will give you an insight into whether you are experiencing PMDD symptoms and help you create a plan to live life with an understanding of PMDD.

References

1. Hylan TR, Sundell K, Judge R. The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med. 1999 Oct;8(8):1043-52. doi: 10.1089/jwh.1.1999.8.1043. PMID: 10565662.

2. Raffi, E. R., MD, MPH, & Freeman, M. P., MD (2017). The etiology of premenstrual dysphoric disorder: 5 interwoven pieces. MGH Center for Women's Mental Health. https://womensmentalhealth.org/posts/etiology-premenstrual-dysphoric-disorder/

3. Pilver CE, Levy BR, Libby DJ, Desai RA. Posttraumatic stress disorder and trauma characteristics are correlates of premenstrual dysphoric disorder. Arch Womens Ment Health. 2011 Oct;14(5):383-93. doi: 10.1007/s00737-011-0232-4. Epub 2011 Jul 23. PMID: 21786081; PMCID: PMC3404806.

4. Beddig T, Reinhard I, Kuehner C. Stress, mood, and cortisol during daily life in women with Premenstrual Dysphoric Disorder (PMDD). Psychoneuroendocrinology. 2019 Nov;109:104372. doi: 10.1016/j.psyneuen.2019.104372. Epub 2019 Jul 23. PMID: 31357135.