Life with PMDD: ‘Like the Grim Reaper coming every month’

The morning after she attempted to end her life, Annika Waheed’s period began. The crushing despair that had consumed her vanished, and the "weight of the world," as she vividly describes it, lifted. "Did I really do that?" she whispered to her sister, who had stayed by her side, a comforting presence as Annika slept off the effects of an overdose. For two weeks out of every month, Annika found herself tormented by suicidal ideation. Then, as if a switch had been flipped, the darkness would recede the moment her period started, allowing her to "see and function again." "How can my hormones do this to me?" she questions, a poignant reflection of the internal battle she endures.

At 42 years old, Annika has been living with Premenstrual Dysphoric Disorder (PMDD) for over eight years. PMDD is a debilitating mental health condition that inflicts severe psychological and, at times, physical symptoms upon those affected. While it can manifest at any stage of a woman’s life, it often emerges during periods of significant hormonal shifts, such as puberty, childbirth, or the menopause. Resembling Premenstrual Syndrome (PMS), PMDD occurs in the one to two weeks preceding menstruation, known as the luteal phase, but its severity is vastly amplified. While PMS might induce fatigue, irritability, and bloating, PMDD can trigger profound anxiety, depression, and intense emotional distress. Physical manifestations like chronic fatigue, debilitating headaches, and joint pain are also common, but a formal diagnosis of PMDD necessitates the presence of at least one mood-related symptom.

‘There is nothing you can do about it’

The International Association for Premenstrual Disorders (IAPMD), a global research charity, estimates that over a million women in the UK may be affected by PMDD, yet a mere fraction have received a formal diagnosis. Suicide is an intricate issue, but emerging research suggests a heightened risk of suicidal thoughts and attempts among individuals with PMDD compared to the general population. "PMS can be really hard," Annika concedes, detailing her own experiences with physical symptoms including heart palpitations, severe backache, and significant bloating. "But this? This is something else. It is like the Grim Reaper coming for us every month. You can feel it, and there is nothing you can do about it."

It is understood that women with PMDD exhibit a severe and detrimental reaction to the natural hormonal fluctuations that occur in their bodies in the lead-up to their period. This response is primarily driven by shifts in progesterone levels, which peak, and oestrogen, which fluctuates, consequently triggering overwhelming feelings of despair, loss, and a profound lack of control. While the precise biological mechanisms behind PMDD’s onset remain largely elusive, researchers in Scotland have developed a groundbreaking suicide prevention tool designed to assist clinicians in identifying women exhibiting PMDD symptoms.

"For so long, women have lived with this condition and not had any idea what could be causing it," states Dr. Lynsay Matthews, from the University of the West of Scotland, who spearheaded the research. "Even though the menstrual cycle plays such a huge part in a woman’s health, it is often not brought up in doctors’ consultation rooms." Dr. Matthews suggests that incorporating questions about the menstrual cycle into medical consultations could help doctors and patients identify patterns and understand if their mental health is intrinsically linked to their cycle. The subsequent phase of this research involves assessing the tool’s effectiveness in aiding women, with the aspiration of its wider implementation across the NHS.

Dr. Helen Wall, a GP in Bolton with a specialisation in women’s health, acknowledges that healthcare professionals "still struggle to relate things to a woman’s periods." She emphasizes, "We have to listen to women’s stories and understand what is happening in the context of their hormones." However, she points out the inherent limitations of the healthcare system: "We get 10 minutes, 15 minutes maximum with a patient." She explains, "Many women with PMDD will present when they are in crisis, and they have nowhere else to turn. It is difficult to get a full history and understand the complexities in such little time."

The impact of PMDD is increasingly being shared on social media platforms, with #PMDD posts accumulating over 230 million views on TikTok alone. Among those documenting their experiences is Katie Cook, who received a PMDD diagnosis in 2025 at the young age of 21, following a decade of struggling with her physical and mental well-being. She believes PMDD began to manifest around the age of 12, coinciding with the onset of her periods, marking the beginning of "the battle in my mind." "It’s like I’m Jekyll and Hyde," she articulates. During her luteal phase, in the days leading up to her period, Katie describes her world as engulfed in darkness. Her body aches, she becomes hypersensitive to light and sound, and everything feels overwhelming. Yet, her GP initially attributed her severe mood swings to the normal process of growing up. Katie began meticulously documenting her fluctuating moods and other symptoms throughout the month, gradually discerning discernible patterns. It was during her first year of university that a GP inquired if Katie had heard of PMDD, and at that moment, "everything started to make sense."

The struggle to get a diagnosis

Securing a diagnosis can unlock access to various treatment avenues, but Annika highlights that simply "being understood" is a profoundly "validating experience in itself." One can only wonder if the work undertaken by Dr. Matthews to equip clinicians with the ability to identify PMDD signs earlier could have made a difference for Annika, potentially averting her descent into such a desperate state. "Absolutely," Annika affirms, "I wouldn’t have been gaslit by doctors. If doctors understand, then patients understand. I could have explained these suicidal thoughts to my friends and family, and I might have been able to safeguard me from myself."

A range of treatments are available for PMDD, often tailored to individual needs, but for many, including Annika, finding the most effective option can be a lengthy process of trial and error. Beyond antidepressants, women may be prescribed the contraceptive pill or other contraceptives such as the Mirena coil, which aids in hormone regulation. More extreme interventions exist, including chemical menopause and, in some severe cases, surgical removal of the ovaries to cease the natural hormone cycle. Annika is currently undergoing hormone-blocking injections to suppress her menstrual cycle as a treatment for her PMDD. However, she reports that within minutes of the medication’s effects waning, she can feel anger, fury, or despair resurfacing, depending on the stage of her cycle.

The profound impact of living with PMDD has rendered pregnancy and parenthood an impossibility for Annika. Furthermore, being in chemical menopause has eliminated any chance of her conceiving. There are moments when she contemplates an alternative life, one where she could have experienced motherhood, but she laments, "PMDD has snatched that from me."

At 31 years old, Lily Rose Winter, an active participant in the burgeoning online PMDD community, is contemplating undergoing a chemical menopause. It has taken Lily years to receive a PMDD diagnosis, and she has explored numerous treatments, none of which have yet yielded a significant improvement in the monthly symptoms she endures. "I am learning to reframe it," she shares. "Instead of trying to be positive and saying I should be feeling OK, I tell myself it’s OK that I don’t feel grateful to be alive today, and it will pass. I have to be patient."

The government has acknowledged that women with PMDD "have been failed for far too long." In a statement, a spokesperson for the Department of Health and Social Care declared, "Too often their symptoms are dismissed or normalised, and that has to change." They indicated that the revitalized Women’s Health Strategy aims to "ensure women are listened to and taken seriously from their very first appointment" and are referred to the appropriate healthcare professional "first time."