By: Dr. Anuradha G, Consultant Gynaecologist and Obstetrician, Miror
As the global conversation on gender equity intensifies, there are still critical aspects of women’s health that remain shrouded in silence. Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). Despite its clinical recognition, PMDD remains underdiagnosed due to overlapping symptoms with other mood disorders and limited awareness. As PMDD Awareness Month is observed this April, it is imperative to highlight the nature of this condition, the importance of early diagnosis, and the range of management strategies available.
Understanding the Symptoms and Root Causes
PMDD typically occurs in the luteal phase of the menstrual cycle, i.e., the 7 to 10 days before menstruation, and resolves shortly after menstruation begins. Unlike PMS, which may involve manageable discomfort, PMDD causes intense emotional and psychological distress. Common symptoms include irritability, anxiety, depressive episodes, mood swings, and a sense of being emotionally overwhelmed. Physical symptoms such as fatigue, breast tenderness, bloating, headaches, and appetite or sleep disturbances are also frequently reported.
The condition does not stem from abnormal hormone levels but from an increased sensitivity to normal hormonal changes, particularly involving estrogen and progesterone. These fluctuations influence neurotransmitter activity in the brain, especially serotonin, contributing to mood dysregulation in susceptible individuals.
Women in their late twenties to early thirties are most commonly affected, though symptoms can emerge earlier. A personal or family history of mood disorders may increase the likelihood of developing PMDD. Due to its cyclical nature and symptom overlap with conditions such as major depressive disorder or generalized anxiety disorder, accurate diagnosis requires careful tracking and clinical evaluation.
Diagnosis and Management
Diagnosis of PMDD is primarily based on symptom pattern and severity. Patients are often asked to monitor and document their symptoms daily over at least two menstrual cycles. A confirmed diagnosis requires the presence of at least five symptoms, one of which must be mood-related, that recur during the luteal phase and subside with menstruation. Distinguishing PMDD from other psychiatric conditions is crucial for effective management.
Treatment of Premenstrual Dysphoric Disorder (PMDD) involves a combination of pharmacological and non-pharmacological approaches tailored to the individual’s needs. First-line pharmacological treatments include selective serotonin reuptake inhibitors (SSRIs), which have strong evidence supporting their effectiveness when administered continuously or during the luteal phase of the menstrual cycle. Combined oral contraceptives (COCs), particularly those containing drospirenone and ethinyl estradiol, are also used, though evidence for their efficacy is less robust. For severe or treatment-resistant cases, ovarian suppression therapies such as gonadotropin-releasing hormone (GnRH) agonists may be considered.
Non-pharmacological interventions are recommended as foundational strategies and include lifestyle modifications such as regular aerobic exercise, a balanced and nutritious diet, limiting caffeine and alcohol intake, and ensuring adequate sleep. Psychological support, especially Cognitive Behavioral Therapy (CBT), has demonstrated effectiveness in managing emotional and mood-related symptoms associated with PMDD.
Overall, treatment should be individualized, combining lifestyle changes, psychological therapies, and medication as appropriate to optimize symptom management and improve quality of life. Emerging pharmacotherapies targeting neuroendocrine mechanisms are under investigation and may offer additional options in the future.
Pharmacological options include selective serotonin reuptake inhibitors (SSRIs), which may be used continuously or only during the luteal phase. Hormonal therapies, such as oral contraceptives that suppress ovulation, are also commonly prescribed. Some individuals benefit from nutritional supplements like calcium, magnesium, and vitamin B6. At Miror, we emphasize an integrative approach, combining clinical guidance with high-quality nutritional support. Our supplements, like Miror Bliss, which supports hormonal balance and alleviates mood swings, and Miror Revive, are designed to boost energy levels and reduce fatigue. In severe, treatment-resistant cases, more advanced options like gonadotropin-releasing hormone (GnRH) agonists or surgical intervention may be considered after thorough assessment.
The Need for Awareness and Early Intervention
If left untreated, PMDD can significantly disrupt personal relationships, parenting responsibilities, and professional life. The emotional burden, particularly when misunderstood or dismissed, may lead to feelings of isolation, frustration, and diminished self-worth. Early diagnosis and appropriate treatment can markedly improve quality of life and restore day-to-day functioning.
Greater awareness of PMDD can empower individuals to seek help and prompt clinicians to recognize the condition earlier. PMDD is real, diagnosable, and treatable. Increased understanding and timely intervention are essential in supporting those affected and ensuring their well-being.
At Miror, we are helping to change this narrative by championing comprehensive midlife health education for women, advocating for personalized healthcare, and fostering open conversations in society. Education is essential: it empowers women to manage symptoms, make informed decisions, and address long-term health risks, while also equipping healthcare professionals and employers to offer meaningful support.