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PMDD: understanding an overlooked condition

As a recent Masters Graduate who has studied Psychology since GCSE level, I was surprised when I started at the NCMH as a Psychology Assistant researching a Mood Disorder I have never heard of.

Unfortunately, not all diagnoses are treated equally when it comes to awareness or research.

This is why I am so proud to be working towards changing this, and as it is PMDD awareness month – this is the perfect opportunity to start the conversation about reproductive mental health.  

What is PMDD? 

Premenstrual Dysphoric Disorder (PMDD) is a mood disorder that is estimated to affect around 5.5% of women and people who experience periods. That’s around 80,000 people in the UK.

During the week before the onset of bleeding (known as the luteal phase of the menstrual cycle), these individuals experience severe mood and emotional changes including anxiety and low mood, a decreased interest in usual activities, difficulties concentrating and more. 

These symptoms start to improve within a few days after the onset of menstrual bleeding (the period).  

two hands holding moon cups

PMDD is directly linked to the menstrual cycle – however, it is not a result of a hormone imbalance but is believed to be a severe negative reaction to the natural fluctuations of oestrogen and progesterone that occur in the cycle.  

Diagnosing PMDD

The disorder was only added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.

Therefore, the disorder is not very well known and due to the presentation of symptoms only occurring for around a week – it can be tricky to identify or diagnose. 

In order to diagnose PMDD symptoms need to be tracked for at least two menstrual cycles, and at least five of the main symptoms need to be present.

There is currently no blood or saliva test to diagnose PMDD however these can be useful in ruling out other underlying disorder (e.g. hormone imbalances).  

image of woman with a cup of tea looking out the window refracted through glass

Now it is important to note that it is common for people to experience symptoms and/or Premenstrual Syndrome (PMS) during the week prior to menstrual bleeding – with recent research showing that 80% of people with periods report experiencing some premenstrual symptoms. 

Every individual’s premenstrual symptoms differ, and every experience is valid. 

However, in order to be diagnosed with PMDD, these symptoms need to be associated with extreme distress and interfere with ‘everyday’ functioning.  

What treatments are currently available?

There is a variety of treatment options for PMDD, ranging from dietary/nutritional changes to medications to help stabile mood.

The effectiveness of these treatments can vary, and it is important to find the best methods or combination of methods, to help manage your symptoms.  

Typically, the course of action recommended by GPs is a healthy diet, getting enough exercise, reducing stress and getting enough sleep – but of course, this is a lot easier said than done. 

woman walking in winter hat and coat in sand dune

Individuals who have been diagnosed with another mood disorder, such as major depressive disorder, panic disorder or persistent depressive disorder (dysthymia) – may find the symptoms associated with this disorder worsen during the week before menstrual bleeding

This is called Premenstrual Exacerbation (PME) which is distinguished from PMDD due to symptoms continuing throughout the full month.

Although PME is not currently recognised as an official diagnosis, it is still important to acknowledge and discuss in order to be direct to the right treatment and support. 

What are we doing to change this?

As part of Dr Arianna Di Florios Genetic Architecture of Sex Steroid-related Psychiatric Disorders (GASSP) research program, we are running the project PreDDICTPremenstrual Dysphoric Disorder- Indicators, causes & Triggers. 

The aim of the project is to improve understanding of how genetic and environmental factors can help to identify individuals at risk, with the long term goal of helping to improve the current approach to diagnosis, prevention, treatment and support for people experiencing PMDD.  

white person with a hand in their short light hair looking at the camera in front of a bright graffiti background

We are planning to start participant recruitment near the end of summer with the study being released online in the months following. 

We will be recruiting participants who are currently or have previously experienced PMDD/extreme PMS symptoms.

Participants will be asked to complete a 20-30 minute questionnaire which will ask questions about mental health, physical health, and your experience of PMDD.  

Although we are not currently recruiting, you are more than welcome to register your interest, and we will reach out to you when the study is starting.

Resources

If you think that you or someone close to you could be experiencing PMDD/PME then speak to a GP or other health professional. There is also a range of support networks and resources available.

If you want to learn more about PMDD:  

 Support

If you need to talk to someone immediately for emotional support:  

Chloe Apsey

Chloe is a Psychology Assistant for the NCMH working on the PreDDICT project.

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