Understanding the types of PMDD: pure, mixed, and beyond

Understanding the types of PMDD: pure, mixed, and beyond

Summary: Premenstrual Dysphoric Disorder (PMDD) is not a one-size-fits-all diagnosis. Some people experience symptoms isolated to the luteal phase, known as ‘pure’ PMDD, while others have a combination of PMDD and other mood disorders, known as ‘mixed’ PMDD. Understanding your subtype is key to getting the right support.


What is PMDD.

PMDD is a hormone-related mood disorder that affects around 3–8% of menstruating individuals. It’s often confused with premenstrual syndrome (PMS), but the difference lies in the severity and impact on daily life. PMDD symptoms usually begin after ovulation and subside shortly after menstruation starts.

According to the National Health Service (NHS), PMDD can cause mood swings, anger, depression, anxiety, fatigue, and physical symptoms such as bloating and breast tenderness. It’s recognised by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and classified as a depressive disorder. 

Explore the difference between PMS and PMDD.

 

Why PMDD subtypes matter

Not everyone experiences PMDD in the same way. Emerging research suggests that PMDD may manifest as different subtypes, each with distinct patterns and treatment needs. These variations can influence the diagnosis and make a huge difference in identifying the most appropriate types of support or interventions.

 

Subtype 1: Pure PMDD

This is the form of PMDD most people know about. Symptoms only appear during the two weeks before menstruation (the luteal phase) and completely disappear once bleeding begins. 

Key characteristics

  • Cyclical, predictable pattern
  • Symptoms limited to the premenstrual window
  • No co-occurring mood disorders
  • Responds well to hormone-sensitive treatments (e.g. selective serotonin reuptake inhibitors (SSRIs) or lifestyle adjustments)


Subtype 2: Mixed PMDD

In some cases, PMDD overlaps with underlying mental health conditions such as generalised anxiety disorder, major depression, or attention deficit hyperactivity disorder (ADHD). This makes symptom tracking and treatment more complex. 

Key characteristics

  • Symptoms intensify premenstrually, but mood issues persist outside the luteal phase
  • May require dual treatment strategies (e.g. antidepressants and cycle tracking)
  • Distinguishing symptoms from primary mood disorders is important

Tracking symptoms across the whole cycle is crucial to avoid misdiagnosis or dismissal of mixed PMDD as 'just anxiety'.

 

Subtype 3: Temporal variants

Some people experience variations in the timing of symptoms, rather than comorbidity. 

  • Early luteal onset: Symptoms begin right after ovulation.
  • Late luteal onset: Symptoms only appear in the days just before bleeding.

These variants can affect how symptoms respond to hormonal as well as nutritional treatments. 

 

Why it's important to know your type

Identifying your PMDD subtype can help you find the most effective management strategies:

  • Pure PMDD: The 'classic' form typically responds well to SSRIs taken only during the luteal phase
  • Mixed presentations: These cases may benefit from ongoing psychological support, alongside PMDD-specific care.
  • Temporal variants: This subtype could indicate different hormonal sensitivity patterns.

Clinicians often recommend tracking symptoms across at least two cycles using tools such as the Daily Record of Severity of Problems (DRSP).

 

Next steps

If you suspect you have PMDD or want to better understand your subtype: 

  • Track your symptoms: Use a structured diary for at least two cycles.
  • Try Super Regular®: Our clinically formulated supplement is designed to support hormonal balance without synthetic hormones. 

Shop Super Regular® - a foundational formula for real relief. 

 

In this article:

  • We explored what PMDD is and how it differs from PMS.
  • We unpacked emerging PMDD subtypes: Pure, Mixed and Temporal.
  • We offered guidance on symptom tracking and treatment pathways. 

 

Further reading:


Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.

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