PMS & PMDD: In Conversation with Dr Eveline Mu
This R U OK Day, we sat down with the incredible Dr Eveline Mu, from the Her Centre at Monash University, who is assisting research into PMS and PMDD. We asked the questions that so many of us have, from what these conditions actually are, to how they impact our mental health and what we can do to support ourselves and each other.
*Please note, this article discusses topics such as mental health, depression and anxiety.
Q. In simple terms, what are the key differences between PMS and PMDD?
A: Premenstrual syndrome, or PMS, is something many women experience. It involves physical and emotional symptoms like bloating, breast tenderness, irritability, and mood changes in the week or two before a period, and then these symptoms settle once the period begins.
Premenstrual dysphoric disorder, or PMDD, is much less common but far more severe. It’s not just feeling irritable or moody - it involves intense emotional symptoms such as severe depression, anxiety, or sudden mood swings that can significantly disrupt daily life, relationships, and work. The physical symptoms might be similar to PMS, but the emotional impact is what makes PMDD stand out.
Q. What are the most common symptoms, and how do they differ in severity?
A: The most common symptoms are mood-related (irritability, low mood, anxiety, and sudden mood swings). Many women also report physical symptoms such as bloating, breast tenderness, headaches, or changes in sleep and appetite.
What really differs is the severity. In PMS, these symptoms are uncomfortable but usually manageable, and they don’t significantly interfere with day-to-day functioning. In PMDD, the emotional symptoms are much more severe. Women can feel overwhelming sadness, hopelessness, or intense anger, often to the point where relationships and work are disrupted. Some women even describe feeling like a “different woman” during that phase of the cycle.
Q. Why do some people experience mild PMS while others develop PMDD?
Q. What does current research tell us about the link between hormones and mental health in PMS and PMDD?
As mentioned above, in PMS and PMDD, it’s not about “too much” or “too little” hormones, but how the brain responds to the normal cyclical changes. In PMDD, these fluctuations affect neurotransmitters like serotonin, which regulate mood and stress responses. This is why some women experience severe mood symptoms, while others with milder PMS are less affected.
There is also growing research linking trauma and PMDD. Early life trauma or significant stress can amplify a woman’s sensitivity to hormonal fluctuations, altering neurotransmitter systems and increasing the risk of emotional dysregulation during the luteal phase of the menstrual cycle.
To better understand and treat PMDD, we are currently conducting a head-to-head randomised clinical trial comparing the first-line treatments, antidepressants, with hormonal therapy. The rationale is that while antidepressants are effective for many women, hormonal therapy may offer a more targeted approach for symptoms driven by hormonal sensitivity. Recruitment is now open - women interested in participating can reach out to us at hercentreaustralia@monash.edu for more information.Q. Are there any breakthroughs or findings in PMDD research that give hope for better treatments?
A: Absolutely! Our research has shown that newer, more biochemically natural hormonal contraceptives, such as Zoely, which are better tolerated by the body, can help reduce PMDD symptoms. Alongside this, non-drug approaches like brain stimulation devices such as the Nettle headband, are showing promising results in relieving PMDD symptoms, including mood swings and menstrual pain.
Q. How does PMDD impact day-to-day life and overall mental well-being?
A: PMDD can have a profound impact on daily life and mental well-being. For women affected, the severe mood swings, irritability, anxiety, and depression that occur in the luteal phase can disrupt work, school, relationships, and social activities. Many describe it as feeling ‘unrecognisable’ or like a different person during this time, and often have to plan their lives around their ‘good days.’
The cyclical nature means women may feel trapped in a repeating pattern each month, which can take a toll on self-esteem, stress levels, and overall quality of life.
Q. What is the connection between PMDD and conditions like anxiety or depression?
A: PMDD is closely linked with anxiety and depression, but it’s distinct in that its symptoms are cyclical, occurring specifically in the luteal phase of the menstrual cycle and resolving after menstruation begins. Many women with PMDD experience intense mood swings, irritability, anxiety or depressive symptoms that can feel similar to a major depressive episode, but the timing and pattern are key.
These symptoms, along with their cyclical timing, can sometimes be misdiagnosed as bipolar disorder. That’s why it’s crucial for women and their treating team to take a detailed menstrual history to accurately link symptoms to specific phases of the cycle.
Q. How can loved ones better support someone experiencing PMDD?
A: The first step is understanding that these symptoms are real and biologically driven, not ‘just moodiness’ or something the person can control.
Practical support can include being patient during the luteal phase, helping to reduce stress, and assisting with daily responsibilities when symptoms are severe. Encouraging the person to track their cycle and symptoms can help both them and their healthcare team identify patterns and manage treatment effectively.
Emotional support is equally important! Listening without judgement, validating their experience, and being aware that PMDD can temporarily affect behaviour and mood can make a big difference.
Q. What changes would you like to see in healthcare to better support people suffering with PMDD?
A: I’d like to see greater awareness and education about PMDD among healthcare professionals. Many women are still dismissed or misdiagnosed, so it’s crucial that clinicians routinely ask about menstrual cycles and recognise the cyclical nature of symptoms. Specifically, I’d like to see PMDD understood as a hormone-brain condition, not just a reproductive issue, so that its profound effects on mood, stress and mental health are acknowledged.
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We'd like to extend thanks to Dr Eveline Mu for sharing her time, knowledge and insight with us. Conversations like these are so important in breaking down the stigma around PMS and PMDD, and serve as a reminder that our mental health deserves to be taken seriously, every day of the month.
To learn more about the wonderful work that Dr Eveline Mu and her colleagues are doing, you can explore the Her Centre for more information.