PMDD

Premenstrual Dysphoric Disorder is a severe, sometimes disabling form of PMS affecting 3–8% of menstruating women. Unlike PMS, PMDD causes significant distress and interferes with daily functioning, relationships and work. It is recognised as a medical diagnosis in the DSM-5.

Severe mood symptoms: intense irritability or anger, marked depression, severe anxiety, feeling overwhelmed or out of control. Physical symptoms can also be severe. Symptoms occur in the week before menstruation and improve within a few days of bleeding starting.

Diagnosis requires tracking symptoms daily for at least two cycles. At least five symptoms must be present, including one mood-related symptom, causing significant impairment. A doctor or psychiatrist makes the diagnosis after excluding other conditions.

First-line: SSRIs (antidepressants) — can be taken continuously or just during the luteal phase. Hormonal treatments: combined oral contraceptives (especially those containing drospirenone), GnRH agonists for severe cases. CBT therapy is also effective. Lifestyle and supplements alone are usually insufficient.