Understanding Premenstrual Dysphoric Disorder: When PMS Becomes More Serious

Amara Iwuoha

For many women, the days before menstruation bring familiar symptoms – cramps, fatigue, or irritability. But for others, these pre-period days spiral into something far more severe: uncontrollable mood swings, anxiety, and overwhelming sadness. This condition is known as Premenstrual Dysphoric Disorder (PMDD), a more intense and disabling form of premenstrual syndrome (PMS) that affects an estimated 3–8% of women of reproductive age.

PMDD is not just “bad PMS.” It’s a recognised mental health and hormonal disorder that can disrupt relationships, productivity, and emotional stability every month.

The Emotional Rollercoaster

Women living with PMDD often describe feeling like a different person in the days before their period. Symptoms may include extreme mood swings, anger, hopelessness, irritability, or difficulty concentrating. Some also experience physical discomfort such as bloating, breast tenderness, and joint pain.

These symptoms typically subside once menstruation begins, creating a recurring cycle of distress that can take a toll on mental health and self-esteem.

“It feels like a switch flips in my brain, one moment I’m fine, the next I can’t control my emotions,” shared one PMDD patient during a recent women’s health forum in Lagos.

What Causes PMDD?

While the exact cause remains unclear, medical experts point to hormonal changes that influence serotonin, a brain chemical responsible for regulating mood. Although hormone levels are normal in women with PMDD, their brains appear to react abnormally to these natural fluctuations.

Genetic factors, chronic stress, and underlying mental health conditions can also heighten susceptibility.

Diagnosis and Treatment

Doctors recommend keeping a daily symptom diary for at least two menstrual cycles to help identify consistent premenstrual mood patterns. This helps distinguish PMDD from depression or anxiety disorders.

Treatment options may include:

• Antidepressants (SSRIs): to regulate mood and relieve anxiety.
• Hormonal therapy or birth control pills: to balance hormone levels.
• Cognitive-Behavioral Therapy (CBT): to develop coping strategies.
• Lifestyle changes: such as regular exercise, a balanced diet, reduced caffeine and alcohol intake, and sufficient sleep.

Living Beyond the Disorder

Living with PMDD can be isolating, especially when people dismiss it as “just PMS.” Yet, recognizing the disorder and seeking medical help can significantly improve one’s quality of life. Support groups, counseling, and awareness also play crucial roles in breaking the silence around menstrual-related mental health struggles.

PMDD is not a sign of weakness it’s a medical condition that deserves understanding, compassion, and proper treatment.