Understanding PMDD: Symptoms, Causes and How To Navigate It

April 2026 is PMDD Awareness Month and at Lena we believe that it is one of the most important conversations in women's health right now. We want to bring much needed attention to this debilitating, under-researched condition that affects between 5-8% of women globally. We're unpacking everything you need to know about PMDD: symptoms, causes and how to navigate a diagnosis and treatment.

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is characterised by debilitating emotional, cognitive and physical symptoms that appear 7 and 10 days before your period, during the luteal phase of your menstrual cycle, and disappear a few days after menstruation begins. PMDD can make you feel like a completely different person. This could look like: 

• Very erratic moods
• Feeling angry or irritable
• A lack of energy
  
• Not enjoying things you normally would
• Difficulty concentrating
• Feeling depressed or anxious
• Feeling like you cannot cope
• Increased conflicts with those around you
• Suicidal thoughts
• Physical symptoms including "muscle aches, extreme fatigue, anxiety, brain fog, full-body aches, chills, tremors, higher heart rate, dizziness, and feeling heavy"

PMDD vs PMS: What Is the Difference?

Premenstrual syndrome (PMS) is the collection of symptoms occurring in the days before your period, caused by hormonal shifts. PMS includes mood swings such as increased irritability, low energy, breast tenderness, trouble sleeping, bloating, headaches and acne. Many women experience PMS (>90% will experience it at some stage in their life) in their luteal phase, but this typically does not stop them in their day-to-day activities. If you're curious to learn more about what to expect in your menstrual cycle, check out our blog post: Understanding Your Menstrual Cycle.

PMDD is a neuroendocrine disorder (a condition affecting the brain, nerves and hormones) which causes the brain to react abnormally to these hormonal changes (especially oestrogen and progesterone), leading to extreme mood disturbances such as depression and severe anxiety.

Both have physical and emotional symptoms, but PMDD causes extreme mood shifts that can disrupt daily life and damage relationships. PMDD is rarer than premenstrual syndrome, with estimates suggesting it affects 5-8% of women. However, this is likely an underestimate, as it is under-diagnosed and many women do not seek help, or are dismissed by doctors who say it is just PMS.

What causes PMDD?

Researchers are not entirely sure what causes PMDD, but it is linked to serotonin imbalances, neurotransmitter dysfunction, gut dysbiosis (poor gut microbiome health and function), histamine imbalance, and over-activation of the body’s stress response, typically caused by chronic stress and trauma. All of the above lead to a dysregulated nervous system, and a poor stress response.

When the body’s stress response is activated over and over again, it becomes dysfunctional and causes our bodies to feel like they are always unsafe. After this, even small inconveniences or problems can cause our nervous systems to become extremely dysregulated. It's really important to note that PMDD is not being hormonal or having unbalanced hormones (it's common for women with PMDD to have normal levels of progesterone and oestrogen) but rather it is the body's abnormal reaction to the change in these hormones. It's not just that time of the month.

Is PMDD becoming more common?

Herein lies a big debate in women’s health, not just with PMDD, but with all hormonal, gynaecological and cycle-related issues: are they becoming more common, or are women just finally able to talk about their health and wellbeing?

There is no research to suggest that PMDD is becoming more common, but as more (much needed) research has been carried out in women’s health, we’ve discovered that these extreme mood disruptions are in fact not normal, but rather belong to the condition of PMDD. As science advances, we’re able to understand the condition more and what it looks like at a cellular level. 

We still have a long way to go, but doctors and healthcare professionals are beginning to take women seriously and pay more attention to their cycles, which means more women feel confident to voice concerns and advocate for themselves.

PMDD Misdiagnosis: Why 1 in 4 Women Are Told They Have Bipolar

The International Association of Premenstrual Disorders (IAPMD) reported that 1 in 4 women with PMDD are misdiagnosed with bipolar, which carries enormous consequences.

The key difference between PMDD and bipolar is the cyclical nature of PMDD, i.e. the symptoms return at the same time each month, which can be inferred from symptom tracking and a closer look into the patient’s life. Medical professionals are failing women by failing to understand their biology and this condition, with just 10% of clinicians reporting that they feel confident diagnosing PMDD. In 2026, doctors need to do better. 

How do I get my partner to understand what I’m going through?

If you are struggling to get your partner, friends, family or colleagues to understand what you are going through, you are not alone. PMDD can be a very isolating experience, and many women do not feel supported by their partners, friends or families. 

The first step is understanding what PMDD really is, how it affects you as an individual and what your boundaries and needs are when you're not feeling your best. When you're informed, you can educate others around you about the condition, and give them the best advice on how to support you. 

Although it can be isolating, you are not alone in this and there are lots of charities and initiatives that have been set up to support you on this journey. The IAPMD have set up a peer support network, which can "reduce feelings of isolation, boost self-esteem, and empower individuals by sharing coping strategies and lived experiences. It also helps improve knowledge, attitudes, and beliefs about managing symptoms, fostering greater confidence and a sense of control." 

Their fantastic website also has resources for navigating diagnosis, symptom tracking and treatment pathways. Sharing these resources with your partner is a great way to educate them and help them to understand what you're dealing with.

Other charitable initiatives such as The PMDD project have been set up to advocate for new policy changes and research efforts, in an attempt to bring PMDD into the mainstream women's health conversation. 

PMDD Treatment Options: From Lifestyle Changes to Medical Support

The women's health community is beginning to understand more about PMDD and the ways in which we can manage it. Currently, treatment focuses on managing symptoms rather than trying to 'cure' the condition.

Lifestyle changes are strongly encouraged by doctors and practitioners. These are practices that will improve your physical and mental wellbeing, such as changes to your diet, reducing alcohol and smoking, reducing caffeine, improving sleep hygiene, increasing the amount or changing the type of exercise you do.

Talking therapies and counselling are the next stage of treatment, with tools such as cognitive behavioural therapy (CBT) showing good results in PMDD research. CBT aims to help patients understand how their thinking affects their mood. It teaches you to think in a more positive way about yourself and your life. Finding the right therapist is very important so you feel seen, heard and understood.

Some doctors advise the use of antidepressants for severe cases of PMDD, but this is not suitable or necessary for everyone. The antidepressant could be taken daily, throughout the whole month, or just during your luteal phase. Antidepressants can be a great tool, but they can carry risk for your physical and mental wellbeing, which is important to consider before starting them. If you’d like to learn more, speak to your doctor first and make sure you have all of the information you need from them to make an informed choice. 

Other treatments include painkillers, anti-inflammatory drugs, GnRH analogue injections (which bring on a temporary menopause) and surgery to remove your uterus, ovaries and fallopian tubes. The aim of this surgery is to stop your PMDD symptoms by stopping your monthly cycle. This is an extreme or last-resort option, which is not suitable or necessary for everyone.

There are exciting developments in the PMDD space with the use of transcranial Direct Current Stimulation (tDCS), which involves delivering electrical pulses to brain regions involved in mood regulation. Early studies by Samphire Neuroscience have shown promising results, and women with PMDD have reported improved symptoms. 

Supporting your community

At Lena, we want to encourage and empower every woman to understand their period, cycle and hormones so that they feel confident and comfortable speaking about any issues they could be facing. Normalising these conversations can make them less intimidating and foster a sense of community and support when you need it the most.

We believe that nobody should face PMDD alone, so we hope that in sharing knowledge and advocating for more awareness, we can all show more kindness to the women in our life who are battling it.

Stay tuned for the next part of our PMDD series, where we share interviews from women with PMDD that aim to understand the condition's impact across their health, relationships and menstrual cycle.

Written and edited by Dr Rachel Denham.

Dr Rachel Denham is a trained medic and Women's Health Practitioner, who has worked across the charity and humanitarian sector and now specialises in women's health. Rachel is the creator of Bloody Nora, a women's health and wellbeing zine that fuses storytelling, art and science. 

Sources:

https://www.samphireneuro.com/en-gb?srsltid=AfmBOoo_JPZWai2DEIe6r6JM4DIXVZYt2Mg0s3kr6oU7JInr8eE5IYuo 

https://www.iapmd.org/support 

https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/what-is-pmdd/ 

https://www.nhs.uk/conditions/pre-menstrual-syndrome/