Quick answer: PMDD (premenstrual dysphoric disorder) is a severe form of PMS that brings intense emotional and physical symptoms in the one to two weeks before a period. It affects an estimated 3 to 8% of menstruating women. Diagnosis relies on tracking symptoms across two to three cycles; treatments include SSRIs, hormonal options, therapy and lifestyle support. If symptoms affect your daily life, please speak to your GP.
Hey, it's Aunt Julie, here to encourage you to take back the power when it comes to your own body and tuning in to understand what it needs. Now, I know it's not as easy as all that, and often we don't even know where to start getting the answers we need. I'm here to debunk the idea that women's health is as well researched and understood as it needs to be, and that goes not just for the medical system, but on a personal level too. Once we start to document our symptoms, talk about the taboo subjects and raise awareness about the illnesses we live with, access to support and education becomes a tangible change in our society.
What is PMDD, and who does it affect?
Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS) that affects women during their luteal phase, for up to two weeks before their bleed. Symptoms include severe depression, suicidal thoughts, fatigue, mood swings, bloating and joint pain.
PMDD affects women, girls and people assigned female at birth (AFAB) of childbearing age who menstruate. It's caused by a change in the way your body responds to the spike of progesterone after you have ovulated, causing your brain to process chemicals (specifically allopregnanolone) differently, leading to an increased sense of anxiety, irritability and depression.
Global research found that around 3.2% of women and girls globally (around 62 million) met the strict diagnostic criteria, while many more still go undiagnosed. Some research suggests a higher figure of about 7%, as symptoms are often mistaken for bad PMS.
How to get diagnosed, and treatment
According to DSM-5 criteria and NHS guidance, PMDD is diagnosed based on symptom timing and severity over multiple cycles. Because of the strict criteria, and because symptoms are so often mistaken for PMS, it's important to take detailed notes on your symptoms (or have some support in doing so) for a minimum of two months. To better understand the phases of your cycle and how to track them, you can read our recent Aunt Julie piece on cycle syncing and how it supports your menstruating life.
In the UK, diagnosis typically involves:
- Tracking symptoms for at least 2 to 3 menstrual cycles
- A consultation with a GP
- A possible referral to a specialist (for example, gynaecology or mental health services)
The following are common symptoms of PMDD:
- Depressed mood, sadness, hopelessness or feelings of worthlessness
- Increased anxiety, tension or feeling on edge all the time
- Mood swings
- Self-critical thoughts and increased sensitivity to rejection
- Frequent or sudden tearfulness
- Increased irritability or anger
- Conflict with family, colleagues or friends
- Decreased interest in normal activities
- Concentration problems
- Fatigue, lethargy or lack of energy
- Changes in appetite, such as binge eating, overeating or food cravings
- Changes in sleep pattern, such as sleeping too much or difficulty sleeping
- Feeling overwhelmed or out of control
- Physical symptoms such as breast swelling or tenderness, headaches, joint or muscle aches, weight gain and bloating
For a diagnosis, at least five symptoms typically need to be present in the final week before your period (the luteal phase), start to reduce within a few days of bleeding, and become minimal or absent in the follicular phase.
Why physical sensitivity increases
One topic that isn't talked about as much is how hormone changes can make you more physically sensitive, especially during the luteal phase. According to the NHS, premenstrual hormonal changes can lead to symptoms such as breast tenderness, bloating and skin discomfort, due to fluid retention and increased tissue sensitivity. This may include:
- Heightened breast tenderness
- Skin irritation or itchiness
- Discomfort from pressure, seams or tight elastic
- Increased sensitivity to synthetic fabrics
This is where clothing and fabric can make a difference. Clothing can't treat PMDD, but it can help reduce the extra discomfort that sometimes makes symptoms feel worse. Many women notice that during more sensitive phases, synthetic fabrics feel more irritating, tight underbands or wires feel more restrictive, and heat and sweat increase discomfort. Choosing softer, more breathable fabrics can help ease some of that physical discomfort.
This is one of the reasons brands like JulieMay Lingerie focus on natural fibres such as organic cotton and silk, smooth seams and low-friction construction, and avoiding harsh chemicals or synthetic-heavy fabrics. You can explore the comfort bra collection here. The goal isn't to fix PMDD, but to make things a little easier by removing extra discomfort when your body is already dealing with a lot.
Finding support
While some women report a hard road to getting a diagnosis, with persistence it is possible, and you are not alone in this journey. Through online forums and charities such as IAPMD Peer Support, people facing the same hurdles come together to share resources, stories and support, not only for you, but for the loved ones who may also be affected by the symptoms of PMDD.
While you may be experiencing PMDD, it's also possible you're experiencing PME, PMS or another hormonal change. You can take a quick self-screening through IAPMD that might give you some insight into what's most likely.
Supplements
- Chasteberry: one of the most well-studied herbal supplements for supporting menstrual symptoms.
- Magnesium: may help with physical symptoms such as breast tenderness and cramps, and with relaxing muscles.
- Chamomile: for relaxation and as a gentle aid to sleep.
- Vitamin B6: to help maintain a level mood and support brain function.
(Always consult a healthcare professional before starting any supplement, as some can interact with medication.)
Therapy
While talking to a therapist may not be accessible for everyone, it's worth remembering the power of speaking your feelings in a safe space, whether that's with a trained therapist, a friend, a family member, or people who can relate to your experiences in online spaces.
Talks and self-research
There are a number of resources and knowledgeable people who talk about women's health and hormones, such as psychiatrist Professor Jayashri Kulkarni, who shares her deep knowledge of women's hormones through talks and podcasts. Dr Louise Newson also sheds light on hormone fluctuations through menopause and other life stages.
Medical treatment
There are different medical treatments for PMDD, and in rare, severe cases, surgery such as a hysterectomy. Medical treatments may include:
- SSRIs (antidepressants)
- Hormonal treatments (for example, combined oral contraceptives)
- In severe cases, specialist interventions
Your GP can help you weigh up which options are right for you.
Helplines
If you experience extreme depression or suicidal thoughts, having a few helplines saved in your phone may help you step back from the feeling of isolation:
- You can contact Samaritans 24 hours a day, 365 days a year: 116 123.
- National Suicide Prevention Helpline UK, open 6pm to midnight: 0800 587 0800 (if you can't get through, try 0800 689 0880).
- Shout offers text-based mental health support 24/7 if you'd prefer not to talk on the phone: text SHOUT to 85258.
Community is crucial
As you start to understand and track your symptoms, it helps to share with the people in your life what you're going through. A support network of friends and family, and understanding in the workplace, can help reduce stress and misunderstandings, and lets you build frameworks that support your changing needs. By speaking up about our lived experiences, we pave the way for more understanding and empathy for those walking the same road.
About JulieMay
JulieMay Lingerie is a UK-based brand specialising in hypoallergenic, skin-friendly underwear designed for women with sensitive skin, hormonal changes and post-surgery needs. Unlike conventional lingerie, JulieMay focuses on destigmatising women's health, supporting changing bodies, using natural fibres (organic cotton and silk) to support delicate skin, cutting out harsh chemicals and synthetic materials that can trap heat or cause irritation, and smooth, low-friction construction to reduce pressure points. You can see our garments at juliemay.co.uk.
JulieMay talks about women's health because so often women feel alone and neglected when they're experiencing life changes. By noticing patterns, finding support and learning about the biology of PMDD, you can move from feeling confused and alone to feeling clearer and more supported. You're not making it up, and you're not alone.
With bountiful boldness, Aunt Julie x
Please note: this article is for general information and isn't a substitute for medical advice. If PMDD symptoms are affecting your daily life, please speak to your GP. If you're having thoughts of suicide or self-harm, please contact your GP, call 999, or reach out to the Samaritans free on 116 123 at any time.
Frequently asked questions
What's the difference between PMS and PMDD?
PMDD is a much more severe form of PMS. It involves intense emotional and physical symptoms, including depression, anxiety and sometimes suicidal thoughts, in the one to two weeks before a period, which then ease once bleeding begins.
How is PMDD diagnosed in the UK?
By tracking symptoms across at least 2 to 3 cycles, a GP consultation, and sometimes a referral to gynaecology or mental health services. A symptom diary is key, as diagnosis depends on the timing and severity of symptoms.
What treatments are available for PMDD?
Options include SSRIs, hormonal treatments such as combined oral contraceptives, talking therapies, lifestyle support and, in rare severe cases, specialist surgical options. Some people also find supplements and comfortable, breathable clothing helpful. Your GP can guide you.
Where can I find support for PMDD?
Charities such as IAPMD offer peer support and a self-screening tool. In a crisis, contact your GP, call 999, or reach the Samaritans on 116 123 at any time.
Last updated: June 2026.
