Imagine going about life with everything going relatively smoothly and then waking up the next day to find yourself suddenly feeling extremely low, highly irritable and overwhelmed by the simplest task. You almost feel like a completely different person, as if a switch was flicked and you’re no longer able to recognize yourself. And then, almost as suddenly as it began, a week or so later the switch is flipped back and you return to inhabiting your usual self. The transformation is as unnerving to you as it is to those close to you.

For people with premenstrual dysphoric disorder (PMDD), this is a very familiar reality that frequently occurs in the last two weeks of the menstrual cycle. Some of the most commonly reported symptoms include fatigue, bloating, depression, anxiety and irritability, along with other typical symptoms of premenstrual syndrome (PMS). But unlike PMS, symptoms of PMDD are severe enough to affect functioning in everyday life; they might interfere with one’s ability to work or study, or may cause problems in interpersonal relationships. It is believed to be caused by a sensitivity to fluctuating levels of hormones such as progesterone and estrogen that may in turn affect neurotransmitters in the brain that control things like mood and the stress response.

The recognition of PMDD as a distinct and diagnosable mental health disorder is not without controversy, since some believe that it pathologizes the normal experiences of women and people who menstruate. However, others cite the importance of distinguishing between normal PMS, which the majority of menstruating people experience, and PMDD, which affects only around 3-8% of those individuals. For many people in the latter group, it is helpful and empowering to find a label for their more severe PMS, as it can increase their understanding of their experiences and help them access treatment options.

If you think you might have PMDD, speaking to a medical or mental health professional can help you make sense of your experiences, rule out other diagnoses and offer treatment options that may include medications and psychotherapy. There are also a number of online resources such as support groups, websites and podcasts for those who live with PMDD that can help you feel less alone.

Esztella Vezer, M.A., is a Registered Psychotherapist (Qualifying) and is currently completing her clinical residency at CFIR as part of her doctoral degree in clinical psychology. She works with individuals and couples experiencing a wide range of issues, including depression, anxiety, trauma, low self-esteem and relationship difficulties. She also provides fertility counselling and sex therapy, and helps couples who are looking to renew or restore emotional, physical or sexual intimacy, or to repair ruptures related to emotional injuries and interpersonal conflicts. Esztella takes an integrative approach to psychotherapy, drawing on a number of modalities such as emotion-focused therapy (EFT), accelerated experiential dynamic psychotherapy (AEDP), cognitive-behavioural therapy (CBT), psychodynamic psychotherapy (PDT), acceptance and commitment therapy (ACT) and mindfulness-based therapies.