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Women's Suicide Prevention Hub - premenstrual
Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS), characterised by intense emotional and physical symptoms that occur in the ‘luteal phase’, the week or two before menstruation starts. It is a serious and chronic mental and physical disorder that can be helped through medication and lifestyle changes.
Sexual violence ⏐ Menopause & perimenopause ⏐ Domestic violence ⏐ Perinatal ⏐ Postpartum ⏐ Childhood abuse ⏐ Eating disorders ⏐ Pre-menstrual
In partnership with the National Association for Premenstrual Syndromes
Professor Nick Panay, Chairman of NAPS
“Severe PMS or PMDD can have a devastating effect on personal, social and professional quality of life and is associated with a significantly increased risk of suicidal ideation, intent and attempts.
It is vital that it is taken seriously by the public and healthcare professionals and managed effectively with evidence-based treatments.
Patients with suicidal ideation or intent need effective mental health safety netting as well as urgent treatment.”
Are you struggling?
An estimated one in twenty women are affected by premenstrual dysphoric disorder (PMDD), so you are not alone. You may be experiencing extreme anxiety and depression and even having suicidal thoughts because the suffering feels too much.
Premenstrual Syndromes can seriously impact people’s lives and relationships. The exact cause of PMDD is not known, but research shows that it is the result of fluctuating hormone levels causing changes in your neurological pathways. It is believed that decreased levels of oestrogen and progestogen are what triggers often unpleasant and distressing symptoms that impact mental and physical health for up to two weeks. You may be feeling very unwell, unable to function properly, so you need to manage your PMDD and seek the right help.
PMDD is often misdiagnosed as a different mental health problem like depression or anxiety, rather than the combination of physical and mental disorder that it really is. If you struggle with these symptoms at all points in your menstrual cycle, it is more likely to be a different issue, but if the symptoms are only experienced in the two weeks before menstruation, it could be PMDD.
Understanding how your body and menstrual cycle work will help you. You should not be ashamed of struggling with your period, talking about it with other people, or finding support groups or specialists who deal with PMDD.
Stay Alive app
Download our NHS recommended app if you are struggling with suicidal thoughts or concerned about someone. There are over 800 resources to help you stay safe for now.
Samaritans
Contact the Samaritans if you feel you are in a crisis.
Contact your GP
NAPAC offer free, confidential support.
- Find your GP contact details
- If your GP practice is closed or unavailable, call NHS 111
- Visit the NHS 111 website
NAPS - webinar
Watch the NAPS and Hormone Health Webinar for more information and resources on PMDD.
Online community
Inspire is an anonymous online forum and non-social media messaging service and support group.
Are you supporting someone?
Research carried out by the BBC showed that 70% of women they surveyed said they felt suicidal in the days before their period, with 30% said they had tried to take their own lives. If you are supporting someone it is important to understand this disorder and how debilitating it is.
Pre-Menstrual Dysphoric Disorder (PMDD) affects 31 million people globally and 1 in 20 in the UK. Despite this, it is still widely misunderstood and often misdiagnosed as depression- and anxiety-related disorders. Globally, people with PMDD are seven times more likely to attempt suicide. There are currently no tests to fully determine whether or not a patient has PMDD, so it is important to analyse main symptoms alongside the menstrual cycle and include questions about physical aspects like bloating, aches and weight gain.
The more severe symptoms of PMDD include depression and suicidal ideation, a risk which should be taken very seriously. PMDD can also appear in combination with, or because of, other suicide risk factors like abuse, trauma and depression, making it harder to diagnose.
Many people find that their PMDD affects relationships with family, friends and coworkers, so it is important to be patient and understanding either as a family member or a healthcare professional. Asking the person you are supporting to keep a log of their periods, mood swings and other symptoms can help to pinpoint and understand their experiences.
Guidelines for professionals
NICE have put together guidelines on PMS and PMDD for healthcare practitioners.
Calls for research
The University of the West of Scotland has published a UK Research Agenda piece on why more attention is needed for PMDD.
Best practice
BMJ Best Practice guidelines are designed to help professionals make the best choices for their patients.
Helping someone you know
Mind have a section full of advice on helping someone with PMDD.
Related disorders
There is some research into related disorders and how they may present and affect people with PMDD.
Symptoms of PMDD
Emotional
- Depressed mood, sadness, or hopelessness
- Feelings of worthlessness or poor self-image
- Anxiety, tension, or nervousness
- Increased irritability or anger
- Mood swings or frequent tearfulness
- Emotional sensitivity or feeling easily upset
- Feeling overwhelmed or out of control
- Suicidal thoughts or feelings
Cognitive
- Self-critical thoughts or paranoia
- Difficulty concentrating or forgetfulness
- Confusion
- Slower reaction times
Behavioural & physical
- Conflict with others (family, coworkers, friends)
- Decreased interest in normal activities
- Fatigue, lethargy, or lack of energy
- Changes in sleep patterns (insomnia or excessive sleeping)
- Changes in appetite (binge eating, overeating, or cravings)
- Breast tenderness, headaches, joint or muscle aches
- Weight gain and bloating
Real stories
Vicky Pattison – Presenter and author
Vicky has described the terrifying experiences she had had leading up to her period that left her feeling out of control and impacting her whole life. She was often made to feel like she was making a fuss and was just being hysterical. She describes a cycle of despair, hopelessness, crippling anxiety, and even suicidal thoughts.
Vicky has expressed relief that she has been diagnosed with PMDD so she knows she isn’t going ‘insane’. She encourages other women to talk about what they are experiencing and go and see a doctor and not to be dismissed.
The importance of talking about difficult issues
Sophie Milner, a UK influencer, talks about her journey with symptoms of PMDD, her diagnosis and how she navigates daily life. She talks about noticing that her symptoms weren’t like other people’s experiences, and how she tracked her mental health and worked with healthcare professionals to find the right treatment.
Watch her inspiring story on YouTube.
Find advice and sources of support for other aspects of women’s mental health and suicide.
Learn more about how to have a conversation with someone at risk of suicide.