PMDD: THE FACTS

Dr Narendra Pisal is a consultant gynaecologist at private clinic London Gynaecology and has over 10 years’ experience working in gynaecology across London hospitals

What causes PMDD?

PMDD is thought to be caused by the hormonal changes that occur during the menstrual cycle affecting neurotransmitters – particularly serotonin – in the brain. When women ovulate, the ovaries produce increasing levels of progesterone, and oestrogen levels go down, which is thought to affect the serotonin pathway in the brain, leading to the mood-related symptoms that sufferers like Emily endure.

Why is it important that people see PMDD as more serious than just someone’s ‘time of the month’?

I wasn’t surprised to read that family members used to ask Emily if she was ‘due on’ when she was experiencing severe symptoms. However, PMDD is very different from what most people experience when menstruating. It’s the most severe form of PMS and is characterised by significant mood symptoms – the feelings of anxiety and depression are more intense, and as in Emily’s case, some women may even feel suicidal. Behavioural changes that come with it can affect your work and relationships to a significant degree.

What should you do if you think you might have PMDD?

Discuss your symptoms with your GP, who can refer you to a specialist gynaecologist. Keep a diary of your symptoms, as their severity and cyclical nature are important to the diagnosis. Your doctor may suggest the contraceptive pill, which evens out hormone levels by blocking ovulation. Sometimes, interventions such as cognitive behavioural therapy and, for severe mood-related symptoms, SSRI (selective serotonin reuptake inhibitor) medication may be helpful. In very severe cases, your doctor may discuss the option of having a total hysterectomy (an operation to remove your uterus) with bilateral salpingo-oophorectomy (an operation to remove your ovaries and fallopian tubes). The aim of this surgery is to get rid of your PMDD symptoms by permanently stopping your monthly cycle. This is a life-changing decision, and one that shouldn’t be taken without first trying multiple other treatment options.

For help with managing the mental health symptoms of PMDD, go to mind.org.uk. To talk to someone, you can call Samaritans, any time, free on 116 123, or email jo@samaritans.org.