by Dr Amanda Sabel – 23rd September 2026
PMDD can feel like becoming a completely different person for part of every month. Irritability, anxiety, anger, tearfulness, depression and feeling overwhelmed can appear before your period and then improve when your period arrives.
PMDD stands for premenstrual dysphoric disorder. It is more than typical PMS. The key difference is the severity of the psychological symptoms and the impact they have on everyday life, relationships, work and wellbeing.
Symptoms typically occur after ovulation, worsen before your period and improve shortly after menstruation begins.
Why does PMDD happen?
PMDD does not usually mean your hormone levels are abnormal. Instead, some women appear to be particularly sensitive to the normal hormonal changes that occur after ovulation.
I often describe PMDD as hormone sensitivity rather than hormone deficiency.
How do I know if I have PMDD?
The timing of your symptoms is extremely important.
With PMDD, symptoms generally:
Appear after ovulation → worsen before your period → improve when your period starts → settle for the rest of the month.
I recommend tracking your symptoms every day for at least two menstrual cycles. This can help establish the pattern and distinguish PMDD from conditions such as premenstrual exacerbation, where an underlying condition is present throughout the month but becomes worse before your period.
Is there a blood test for PMDD?
No. There is no blood test that can diagnose PMDD. The diagnosis is primarily based on your symptoms, their timing and prospective symptom tracking. Blood tests may sometimes be useful to rule out other causes of similar symptoms.
What treatments are available?
Treatment depends on your symptoms, medical history, age and whether contraception is also required.
Lifestyle measures such as regular exercise, adequate sleep, balanced nutrition and reducing alcohol or caffeine where appropriate can help, particularly with milder symptoms.
SSRIs, including sertraline, fluoxetine and escitalopram, are among the most established treatments for PMDD. Some women take them continuously, while others use them only during the luteal phase of their cycle.
Hormonal treatments can also be helpful because they work by suppressing ovulation or reducing hormonal fluctuations. Options may include certain combined contraceptive pills, drospirenone, or transdermal oestradiol in appropriate circumstances.
For women with a uterus using oestradiol, adequate progesterone or another form of endometrial protection is essential.
When should I see my GP?
If your premenstrual symptoms are regularly affecting your relationships, work, parenting, sleep, mental health or ability to function normally, I encourage you to speak with your GP.
Bringing at least two months of symptom tracking to your appointment can be extremely helpful.
PMDD is real and treatable. You do not have to simply accept losing one or two weeks of every month to your menstrual cycle.
At Health by Nurture, my team of qualified and experienced GP’s can help assess your symptoms, establish whether they fit PMDD, PMS, premenstrual exacerbation or perimenopause, and discuss appropriate treatment options with you.
Disclaimer: This information is general education and does not replace individual medical advice. Treatment needs to take into account your medical history, medications, contraceptive requirements and individual risk factors.