When Periods Become Unbearable: Understanding PMDD
A recent female guest on This Morning with Cat Deeley and Ben Shepherd talked candidly about experiencing “periods so extreme they’ve baffled doctors” . The interview has reignited an important conversation about Premenstrual Dysphoric Disorder (PMDD) — a severe and often misunderstood condition that affects around one in 20 women.
For many, PMS (premenstrual syndrome) brings mood swings, bloating or fatigue, but for those with PMDD, the symptoms can be completely life-altering. From severe anxiety and depression to physical pain and exhaustion, PMDD is more than “bad PMS” — it’s a complex hormonal and psychological disorder that can disrupt every aspect of daily life.
We spoke to Dr Punam Krishan, GP, broadcaster, and author, to understand what PMDD is, how it differs from regular PMS, and what support and treatments are available.
Image courtesy of Anthony Tran via Unsplash
What exactly is PMDD?
“PMDD is a more serious version of PMS,” explains Dr Krishan. “It’s an endocrine disorder, meaning it stems from an imbalance in hormonal regulation. But it also has profound psychological symptoms that can affect mood, relationships, and quality of life.”
Symptoms usually begin around ovulation and ease once a period starts. They often mirror those of depression and generalised anxiety disorder — mood swings, restlessness, tearfulness, hopelessness, fatigue, and loss of enjoyment in everyday life. “Physically, sufferers can experience headaches, gut issues, bloating, and body aches,” says Dr Krishan. “In extreme cases, the emotional impact can be devastating.”
When should you seek help?
If your symptoms are affecting your ability to function — at work, in relationships, or in daily life — it’s important to speak to your GP.
Dr Krishan advises keeping a symptom diary to help identify patterns. “Tracking your emotions, energy levels, and physical symptoms across several cycles helps doctors see whether there’s a clear link to your menstrual cycle, which is key to diagnosis,” she explains.
Because PMDD is a clinical diagnosis, there isn’t a single test. It’s about recognising recurring patterns and the timing of symptoms, distinguishing PMDD from other mood disorders.
How can PMDD be managed?
“Once you know what you’re dealing with, you can plan ahead for the times when symptoms are likely to peak,” says Dr Krishan. “It also helps to make sure you have support from those around you who understand what to expect.”
Treatment is highly individual but may include:
Lifestyle changes – Gentle exercise, yoga, meditation, and aromatherapy can all help boost mood and relaxation.
Dietary tweaks – Cutting down on caffeine, alcohol, and sugar while eating smaller, balanced meals can minimise bloating and discomfort.
Talking therapies – Cognitive behavioural therapy (CBT) or counselling can help you reframe thoughts and cope with emotional triggers.
The contraceptive pill – For some, hormonal contraception can help stabilise fluctuations, but this must be discussed with a GP.
Antidepressants – These can be effective in managing mood-related symptoms.
Hormone therapy – In severe cases, treatment to suppress ovulation may be considered under specialist care.
Why awareness matters
PMDD remains underdiagnosed, with many women being told their symptoms are simply “bad PMS” or “all in their head.” But as the latest reports highlight, these are very real, biological symptoms that deserve recognition and treatment.
“PMDD can start as early as adolescence and worsen through the perimenopause years,” Dr Krishan adds. “Awareness and early support make all the difference.”
If you think you may be experiencing PMDD, speak to your GP and ask for guidance. You can follow Dr Punam Krishan (@drpunamkrishan) for more information and practical advice on women’s health and hormones.