PMDD: Severe premenstrual disorder affects 1 in 20 women as GPs remain largely unaware

PMDD, or premenstrual dysphoric disorder, affects as many as one in 20 women in the United Kingdom, according to clinicians and patient advocates. Yet many general practitioners remain unaware of the condition, which can trigger severe mood swings in the weeks before a period and sometimes drive women to seek help only after years of misdiagnosis. The trajectory is often misattributed to anxiety, depression, or postpartum illness, leaving many patients untreated until a specialist finally confirms PMDD.

PMDD is a distinct psychiatric diagnosis, separate from the broader umbrella of PMS, and is characterized by intense anxiety, anger, hopelessness and physical symptoms that disrupt daily functioning for a substantial portion of the menstrual cycle. Symptoms typically appear in the luteal phase—the two weeks between ovulation and the start of a period—when hormonal fluctuations occur. The brain’s response to rising and then falling hormones appears abnormal in PMDD. The condition was first recognised in 1994 and was added to the World Health Organization’s diagnostic manual in 2019. It affects up to 1 in 20 UK women, a figure experts say is likely an underestimate because awareness among both the public and clinicians remains limited. In recent years, high-profile figures have shared their PMDD struggles, drawing attention to a condition that many women still slip through gaps in care.

PMDD is often diagnosed only after years of symptoms and mislabeling as anxiety or depression. As Dr Milli Raizada, a practicing GP, recalls, her own cycle revealed the pattern only after years of seemingly unrelated mood changes. “I walked into the consulting room and immediately burst into tears,” she has said of the moment a specialist suggested PMDD. “After just a few minutes of explaining how I was feeling, the specialist told me that I likely had PMDD.” Raizada notes she had never encountered PMDD during medical training or practice, and she emphasizes how such gaps in education contribute to delayed diagnoses.

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Diagnosis remains challenging, and many patients are shuffled between gynecology and mental health services for years before PMDD is considered. At University College London Hospital, one of a handful of PMDD-focused clinics in the UK, clinicians say women arrive after a long journey through specialists who do not recognise cycle-related symptoms as a potential PMDD trigger. Dr Shirin Khanjani, a consultant gynecologist at UCLH, describes patients who arrive after a decade or more of referrals: “They tell me they don’t recognise themselves—they’ve been suffering in silence for years.” Some have been misdiagnosed with bipolar disorder and even detained under mental health legislation before PMDD is identified.

Public awareness remains limited. A British adult survey this year found that 40% had never heard of PMDD, while 28% had heard of it but did not know what it was. Alys Golding, a mother and office administrator from Swansea, describes how she mistook the condition for postpartum depression in the years after her first child: antidepressants did not help because her symptoms followed a monthly pattern more consistent with PMDD. “I began to think maybe I was bipolar,” she said, recalling how she rang clinics in tears after rage-driven episodes. It took years and a fifth GP before a clinician suggested PMDD, offering relief that she was not going crazy.

Treatment options vary and often begin with lifestyle measures: regular exercise, limiting processed foods, and ensuring adequate vitamin D and iron, as well as exposure to daily sunlight and reduced alcohol intake. Dr Shirin Khanjani notes that these adjustments can help regulate hormones. “Supplements such as vitamin D and iron, exposure to daily sunlight and minimizing alcohol intake can also be incredibly helpful,” she adds. When lifestyle changes are insufficient, medications are commonly used. Between 60 and 70% of patients respond to antidepressants, often in a luteal-phase–only pattern, a divergence from typical depression treatment that reflects PMDD’s unique hormonal drivers.

Some women seek hormone-based therapies to suppress fluctuations altogether, such as the combined oral contraceptive pill or gonadotropin-releasing hormone (GnRH) agonists, which suppress estrogen and induce a chemical menopause. These approaches can affect libido and mood and sometimes require hormone-replacement therapy. In rare cases, women opt for surgical options like ovarian or uterine removal, though many clinicians regard menopause as the ultimate cure. Dr Katie Marwick, a consultant psychiatrist and senior clinical research fellow at the University of Edinburgh, describes PMDD as an illness where mood disturbances are paired with physical symptoms, and where suicidality can be a real risk for some patients: “PMDD is related to PMS in the way that a major depressive episode is related to feeling a bit down.” She cautions that the spectrum of symptoms can include anger, concentration difficulties, fatigue and appetite changes, with a substantial portion of each month affected.

The recognition gap remains acute. Dr Raizada notes that many patients are told they are “being too sensitive,” and that even among medical professionals, PMDD does not always appear on essential resources. She argues that better training for primary care physicians and medical students is crucial, and that a dedicated NHS page would help ensure cycle-related mood changes are properly explored rather than overlooked. The UCLH clinic and other PMDD-focused centers exist to bridge the gap, but experts emphasize that requiring a patient to travel through multiple specialties before a PMDD diagnosis is reached is an inefficient and distressing path.

Public and professional education about PMDD is imperative, as is timely access to effective therapies. The goal is to ensure that women experiencing regular, severe mood changes in the weeks before their period can discuss their symptoms openly with their GP and receive comprehensive care that addresses both mental health and hormonal health. While medical science continues to explore the precise biological underpinnings of PMDD, clinicians say that recognition and appropriate management can markedly improve quality of life for many women—and that improved training could shorten the often long journey to diagnosis for hundreds of thousands of women in the UK.