Premenstrual Dysphoric Disorder (PMDD)
PMDD is a cyclical condition where emotional and physical symptoms intensify before your period and ease once menstruation begins.
What is premenstrual dysphoric disorder (PMDD)?
PMDD is a severe form of premenstrual mood disturbance that affects a woman’s emotional well-being, daily functioning and relationships. Unlike common premenstrual symptoms, PMDD can lead to intense mood changes that feel overwhelming and difficult to control.
Who is affected by PMDD?
While many women experience premenstrual syndrome (PMS), PMDD is different.
PMDD involves a significant emotional and physical symptoms that appear in the luteal phase (the week or two before the menstrual period) and improve shortly after menstruation begins. Symptoms tend to recur in a cyclical pattern each month.
PMDD affects an estimated 3-8% of women of reproductive age, including women in Singapore. Because the symptoms are cyclical, many women struggle for years without realising their experiences may be linked to PMDD.
What are the symptoms of PMDD?
PMDD symptoms can be emotionally intense and may disrupt work, relationships, and daily functioning. These symptoms typically improve once menstruation begins, and many women feel stable for the rest of the cycle. Symptoms often include:
Emotional symptoms
- Sudden mood swings
- Irritability or anger that feels out of proportion
- Anxiety or heightened worry
- Low mood or sadness
- Tearfulness
- Feeling overwhelmed or “on edge”
- Loss of interest in usual activities
- Difficulty concentrating
- Sensitivity to rejection
Physical & behavioural symptoms
- Fatigue
- Sleep disturbances
- Appetite changes or food cravings
- Breast tenderness
- Bloating
- Headaches
- Muscle or joint aches
Why PMDD happens?
The exact cause of PMDD is not fully understood, but research suggests that women with PMDD are more sensitive to normal hormonal fluctuations during the menstrual cycle. This sensitivity affects the brain’s mood-regulating systems, leading to emotional and physical symptoms.
Stress, lifestyle factors, past mental health conditions and genetics may also play a role.
Impact on daily life
PMDD can affect:
- Work performance, focus and decision-making
- Relationships with partners, children and colleagues
- Emotional resilience
- Sleep and appetite
- Self-esteem
- Overall well-being
Many women describe PMDD as “feeling like a different person” during the premenstrual phase. If these changes disrupt your life or feel unmanageable, it may be helpful to seek support.
How can we help?
Comprehensive assessment
Because PMDD is cyclical, diagnosing it accurately requires understanding the timing and pattern of symptoms. We take a thorough approach that includes:
- Reviewing your medical and menstrual history
- Mapping symptom patterns across your cycle
- Differentiating PMDD from PMS, mood disorders or anxiety disorders
- Identifying triggers or co-existing stresses
Psychological treatment (psychotherapy)
Psychotherapy is a core part of managing PMDD, especially for women who struggle with emotional reactivity, irritability or sudden mood shifts. The psychologists that we work with provide evidence-based therapies that can help you:
- Recognise early signs of emotional escalation
- Build coping tools to manage intense mood changes
- Improve communication and emotional regulation
- Address stress and lifestyle factors that may worsen symptoms
- Strengthen resilience throughout the menstrual cycle
Cognitive-Behavioural Therapy (CBT), mindfulness-based strategies and other therapeutic approaches can be particularly helpful.
Medication management
Medication may be considered when symptoms are severe, persistent or significantly impair daily functioning. Any decision to start medication is made collaboratively, based on your comfort level, overall health and symptom pattern.
Treatment options may include:
Antidepressants (SSRIs)
SSRIs such as sertraline, fluoxetine or escitalopram are commonly used to manage PMDD. They may be prescribed daily throughout the cycle, or only during the luteal phase depending on the severity and predictability of symptoms.
Hormonal therapy
For some women, hormonal therapy may help regulate the hormonal fluctuations that contribute to PMDD symptoms. This typically involves adjusting levels of estrogen or progesterone to stabilise mood across the menstrual cycle.
Because hormonal treatments fall under women’s health and require evaluation of medical suitability, this option is usually explored with a gynaecologist. They will assess factors such as your menstrual pattern, contraceptive needs, medical history and personal preferences.
Hormonal therapy is not necessary for everyone, but it can be a helpful consideration for women whose symptoms are closely tied to hormonal changes. If this option is relevant to you, we can coordinate care with your gynaecologist to ensure an integrated and safe treatment plan.
Medication for physical symptoms
In some cases, medications may be used to manage specific physical symptoms like cramps, headaches or sleep difficulties
Medication is never mandatory, it is simply one option that may help some women achieve more stability.
Lifestyle and supportive strategies
Many women benefit from incorporating supportive strategies such as:
- Regular exercise
- Improving sleep routines
- Stress management techniques
- Balanced nutrition
- Limiting caffeine or alcohol premenstrually
- Keeping a symptom diary to understand patterns
These approaches can complement therapy and medical treatment.
When to seek help?
You may wish to consult a psychiatrist if:
- Your mood changes are severe or disruptive
- You feel significantly different during the premenstrual phase
- Symptoms affect relationships, work or daily functioning
- You are unsure whether you have PMS, PMDD or another condition
- Self-help strategies have not provided relief
Early support can help reduce the impact of PMDD and improve your quality of life throughout the month.
Reach out towards recovery
You don’t have to cope alone.
PMDD is real, valid, and treatable. With the right support, many women experience significant relief and regain a sense of stability in their daily lives.
Our team at Connections MindHealth is here to help you understand your symptoms and guide you towards effective, personalised care.