PMDD (dt.: PMDS) and Menstrual Health: A Hidden Crisis
- nick maissen
- 24. Mai 2025
- 4 Min. Lesezeit
How the taboo around menstruation and misogyny in medicine make a mental illness invisible
Do you know the feeling of completely falling out of your usual pattern just before your period starts? Of being suddenly overwhelmed by rage, hopelessness, or fear—so intensely that you no longer recognize yourself? And then, the moment your bleeding begins, you feel relieved—like nothing ever happened?
‘’i‘m not diagnosed, but I get really depressed a week before getting my period, to the point where i think about getting professional help. But as soon as i start my period i feel kinda invalidated by my own body bc it’s 'just hormones’.’’
anonymous submission I, 11.05.25
Maybe you’re already in therapy or were before, maybe you got told by society or by people directly that you’re just sensitive. And because of that, maybe you even started to believe it yourself, that your suffering isn't valid.
How is PMDD different from PMS?
PMS (Premenstrual Syndrome/ dt.: Prämenstruelles Syndrom) is a broad term for all cycle-related symptoms, physical and psychological.
PMDD (Premenstrual Dysphoric Disorder) / dt.: PMDS (Prämenstruelle dysphorische Störung) is the most severe form of PMS. It is classified as a depressive disorder and is listed in the DSM-5.
5 – 8% of the people who menstruate are diagnosed with PMDD, although the actual number is likely much higher due to a lack of diagnoses.
The psychological symptoms are deeply distressing and create a heavy emotional burden.
Symptoms related to PMDD:
Depressive moods and mood swings
Sleep disturbances
Anger or irritability
A sense of being "out of control"
Anxiety or panic
Suicidal Thoughts
Cravings and binge eating
Loss of libido
Difficulty concentrating
Physical and emotional tension
These symptoms can also resemble PMS but are much more intense, especially in terms of psychological distress.
‘’I already have pretty bad PMS (potentially endometriosis, but who knows) and every time I am about to have my period, nothing feels right anymore. it's like an out-of-body experience that is just not me, and the fact that I have to experience this causes me so so much emotional distress and pain’’
anonymous submission II, 11.05.25
‘’Crying at work, thinking my partner doesn't love me,
friends worried about me.’’
anonymous submission III, 11.05.25
‘’i am not diagnosed with it, but i have very dark, lonely and anxious phases before my period’’
anonymous submission IV, 11.05.25
‘’I don't know if I have it but every month a week before my period comes, I get depressed out of nowhere and think it's my usual depression but it could be pmdd.’’
anonymous submission V, 11.05.25
‘’extreme anxiety, depression for a few days before’’
anonymous submission VI, 11.05.25
‘’makes relationships unstable and insecure’’
anonymous submission VII, 11.05.25
And this every month – for 10 to 14 days.
Despite this burden, PMDS often remains unrecognized for years. This is because the causes lie not only in the body, but in the system.
Systemic Failure
Because of the ongoing lack of research in gender-specific medicine regarding bodies with a uterus, many illnesses (such as PMDD)—and the treatments related to them—remain undiscovered or underdiagnosed. Menstruation continues to be stigmatized and silenced by society and culture. This is one of the reasons why research into diagnostic and treatment methods continues to lag behind.
It has been normalized to see a certain level of suffering as “just part of it” or “not that bad.” This is illustrated by viral videos of men trying out period pain simulators: it takes the invention of a device before menstrual pain is taken even halfway seriously. And even then, the credibility of that pain is still questioned.
As long as cycle experience is not considered a serious medical issue, those affected are left to their own and often have to do their own research, deal closely with their cycle and determine their own strategies.
Due to a lack of education, symptoms are often not recognized—even by healthcare professionals—and are therefore identified late or misdiagnosed.
Biological Aspect
It’s assumed that people with PMDD have an increased sensitivity to the hormones estrogen and progesterone, which rise during the second phase of the cycle (luteal phase) after ovulation. Even the "normal" hormonal fluctuations throughout the cycle are experienced more intensely. Additionally, serotonin levels seem to drop in the second half of the cycle, which may contribute to PMDD, as serotonin deficiency is associated with depression, pain, and insomnia.
Life Impacts
Some experience uncontrollable rage during this phase—feelings they don’t recognize from the rest of their cycle. This can lead to serious challenges in relationships and work life. Strong depressive episodes marked by hopelessness, emotional numbness, low self-worth, and exhaustion are also common. Symptoms can last up to two weeks before menstruation and be severely limiting. Due to the intense emotional suffering, individuals with PMDD have an increased risk of suicidal thoughts or behavior.
Major life changes and stressors can also worsen PMDD symptoms. Some people may have coped with these symptoms in the past using certain strategies, but when time or capacity to maintain those strategies disappears, the symptoms become more apparent.
What You Can Do
To get a diagnosis, it is recommended to track your cycle and symptoms for at least two to three months in a symptom diary.
Talk to your gynecologist about PMDD and how to get evaluated. If you're in psychotherapy, bring it up there as well. Keep in mind: many healthcare professionals are still unaware of PMDD or do not include it in their diagnostic routine.
And most importantly: TALK ABOUT IT!
With your friends, online, offline, loud.
The louder and more people talk about PMDS and/or menstruation in general, the harder it becomes to ignore the issue and those affected. We need more research, more visibility, more education - and serious medical structures.
If your cycle pulls you into a dark hole every month - then this is not “normal” or should not have to be part of normality.
And if you’re personally affected by PMDD: You deserve support and know you’re not alone.
links:
*All anonymous submissions stem directly from a personal online form collected between 11.05.25-20.05.25.
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