While it is normal for people who menstruate to feel more down or sensitive in the days leading up to their period (known as PMS), some may experience severe psychological symptoms in that premenstrual phase of their cycle.

These changes happen due to declining estradiol and progesterone levels, which affect the transmission of neurochemicals like serotonin and GABA known to be involved in anxiety and mood regulation.

What is PMDD?

PMDD affects 3-8% of people who menstruate and is characterised by marked symptoms of depression, anxiety, emotional sensitivity, and/or irritability, that occur exclusively in the 5-7 days prior to the onset of menstruation. This can include mood swings, rejection sensitivity, self-criticism, anhedonia, changes in sleep and appetite, and even suicidality and self-harm.

Importantly, these symptoms improve substantially, to the extent that they are minimal or absent, following the onset of menstruation.

Some people report feeling and thinking like a different person during the premenstrual phase of their cycle.

Premenstrual worsening of symptoms

Up to 60% of those with an existing psychological disorder experience more severe symptoms during that premenstrual phase.

For example, someone with panic disorder having more panic attacks, or someone with depression having more suicidal thoughts, in the week leading up to their period.

This is not limited to anxiety and depression, research has also found premenstrual worsening of PTSD, eating disorders, psychosis and borderline personality disorder.

The key difference between this population and those with PMDD is that their symptoms persist outside of the premenstrual phase.

Treatment

Collaborative care between GPs and mental health professionals is recommended in either case, with a focus on treating the underlying condition, whether it is PMDD or PTSD.

Treatment may include:

• SSRI medication.
• Psychological therapy, with a focus on emotion regulation skills (e.g., CBT or DBT).
• Lifestyle changes (e.g., planning and preparing for the premenstrual psychological changes).

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Our therapists at the Institute for Healthy Living are skilled at providing collaborative treatment in this area.

Our Bondi Junction practice is open after hours & on Saturdays.

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