Why is PMDD so often misdiagnosed?

PMDD: The hidden hormonal disorder

Premenstrual Dysphoric Disorder (PMDD) is a severe, hormone-related mood disorder that affects 3–8% of menstruating individuals. Despite its debilitating and recurrent symptoms, PMDD is still widely misunderstood. Many people spend years seeking help, only to receive a diagnosis of depression or anxiety without any connection being made to their cycle.

According to the NHS, PMDD symptoms can include irritability, mood swings, fatigue, sleep issues, and suicidal thoughts. These symptoms tend to start after ovulation and ease once menstruation begins, a pattern not typically seen in major depressive disorder.

Read the full PMDD symptoms checklist.

 

Why is PMDD commonly misdiagnosed?

A range of factors contribute to the frequent misdiagnosis, and delayed accurate diagnosis, of PMDD.

1. Overlapping symptoms with mood disorders

PMDD shares symptoms with depression, anxiety, and bipolar disorder. These include low mood, irritability, and hopelessness. What sets PMDD apart is its cyclical nature, with symptoms occurring in the luteal phase (two weeks before menstruation) and resolving with menstruation.

Without careful cycle tracking, healthcare providers may fail to recognise the hormonal pattern and diagnose a generalised mood disorder instead.

2. Lack of education in medical training

Research from the International Association for Premenstrual Disorders (IAPMD) and other hormonal health organisations shows that most GPs receive limited education on PMDD. As a result, patients are often told they have PMS – or worse, are dismissed entirely.

According to clinical psychologist and PMDD researcher Dr Tory Eisenlohr-Moul, PMDD is not routinely screened for in primary care, despite affecting millions. As a result, many wait as long as up to 12 years for an accurate diagnosis.

3. Misattributing physical symptoms

Fatigue, headaches, bloating, and joint pain are common in PMDD, but doctors often treat these symptoms as isolated physical issues, rather than recognising them as part of a broader hormonal picture.

Explore the difference between PMS and PMDD

4. The stigma of menstrual mental health

Mental health symptoms linked to menstruation are often dismissed, with many people being told they’re overreacting, or that it’s “just PMS”. This cultural bias can hinder access to appropriate support and leave those struggling with the symptoms feeling unheard.

 

How to avoid misdiagnosis

1. Track symptoms by cycle

Use a structured diary like the Daily Record of Severity of Problems (DRSP) across at least two cycles to highlight the hormonal pattern of symptoms.

2. Take a holistic approach

If your emotional, physical, or cognitive symptoms return in a cyclical pattern -– typically worsening in the luteal phase and easing with your period –- it’s worth considering whether it could be PMDD. Tracking your symptoms over time, alongside other lifestyle changes or activities, can provide the clarity needed to distinguish PMDD from other conditions like anxiety or depression.

3. Use self-assessment tools

Tools such as the IAPMD’s Premenstrual Disorders Self Screen help you identify if your symptoms align with PMDD or PMS. They won’t give youIt's not a formal diagnosis but can guide you in understanding your cycle-related symptoms before talking to your healthcare provider. to distinguish PMDD from other conditions like anxiety or depression.

4. Educate your GP

If you can, prepare so that you can refer to reputable sources during appointments, such as clinical criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or research from the National Institute for Health and Care Excellence (NICE) or IAPMD.

What if you've been midiagnosed?

You’re not alone. Many in the Evelyn community have spent years navigating incorrect diagnoses. The key is recognising the pattern and seeking second opinions if that’s what it takes to get the right diagnosis. You can also start exploring non-hormonal support alternatives even if the formal diagnosis takes time.

Discover how Super Regular® supports PMDD symptoms without synthetic hormones. 

 

In this article:

• We explained why PMDD is often confused with other conditions
• We covered the common pitfalls in diagnosis
• We shared tools for accurate recognition and next steps

Further reading:

• Our complete guide to PMS and PMDD
• Types of PMDD: Pure, Mixed, and More
• PMDD vs PMD: how to tell the difference
• Super Regular ®: Evelyn's foundational PMDD supplement

Further reading:

• NHS: Premenstrual syndrome
• IAPMD: PMDD Research
• The PMDD Project Research

 

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.