Suicidal because of your cycle: this is the unknown condition PMDD

Every month, women with PMDD ( Premenstrual Dysphoric Disorder ) temporarily lose control of their mental health. Anxiety, panic, sadness, or aggression overwhelm them, often so intensely that they no longer recognize themselves. As soon as menstruation begins, the air clears, and it's as if nothing had happened. But it was.

Metro speaks with Catherine Martens, director of Care for Women, the organization that focuses on hormonal problems in women.

PMDD affects an estimated 5 to 8 percent of women in the Netherlands, yet the condition often goes unnoticed. The symptoms are similar to PMS, but the impact is much more severe.

With PMS (premenstrual syndrome), physical symptoms usually predominate: back pain, migraines, water retention, breast tenderness, or hormonal migraines . This can also throw women completely off balance , Metro previously reported.

In addition, mental health issues such as mood swings or irritability can occur, but these are usually milder than with PMDD. With PMDD, however, women become significantly more mentally unstable. They experience anxiety attacks, sudden panic attacks, crying spells, outbursts of anger, and sometimes even suicidal thoughts.

"We know from research that about 30 percent of women with PMDD attempt suicide at least once," says Martens. "And that's not even counting the women who struggle daily with thoughts of suicide and self-harm."

The impact is therefore much greater than simply experiencing some 'hormonal issues.' Yet, many women don't receive adequate help or are misdiagnosed. "Women with PMDD are often not taken seriously. They're told it's stress, diagnosed with bipolar disorder, or prescribed antidepressants. But the real cause—an oversensitivity to rising and falling hormones—is rarely investigated," says Martens. PMDD is more than just mood swings; it's a cycle-related and neuroendocrine disorder.

PMDD symptoms usually arise in the second half of the menstrual cycle, between ovulation and the first day of menstruation. This is the phase in which both estrogen and progesterone levels drop rapidly. Although these hormone fluctuations are natural, some women are extremely sensitive to them.

"Hormones work like an orchestra," Martens explains. "A sharp drop in estrogen and progesterone, for example, can also throw other hormones out of balance. It can affect stress hormones like cortisol, but also sleep hormones, insulin, and even neurotransmitters like the happiness hormones serotonin and dopamine. Hormones are interconnected."

At the cellular level, PMDD involves changes in the brain, resulting in significant disruption. It's often ineffective to say, "It'll go away." This is emphatically not the case: PMDD isn't a temporary problem. It's often a chronic condition that worsens after pregnancy and only subsides around menopause .

According to Martens, the first and most important step in tackling PMDD is surprisingly simple: recognize and acknowledge your symptoms. Many women go years without realizing their symptoms are cyclical. Only when they see the severity and pattern on paper does it all click.

That's why Care for Women recommends keeping a daily record of your symptoms for two to three months. This includes not only whether the symptom is present, but also how severe it is: mild, bothersome, or downright disruptive.

This diary forms the basis for a possible diagnosis. It reveals patterns, for example, that symptoms always begin after ovulation or worsen with stress. And it helps distinguish between PMDD and other problems, such as burnout or depression. "We see women who say, 'I have depression, but it doesn't feel like depression.' And they're often right. It feels different because it truly is something else."

At Care for Women, we don't work with a single, fixed treatment protocol. Every woman is different, and so is the treatment. Sometimes the cause and severity of the complaint are clearly due to changing hormone balance, while other times nutrition, stress, or lack of sleep also play a role. That's why every treatment begins with understanding the bigger picture. Martens: "What does your cycle look like in relation to your complaints? Are you also dealing with nutritional deficiencies, such as vitamin D, B6, magnesium, or iron deficiencies? How does your stress system function? What is your sleep pattern and blood sugar balance?"

For serious mental health issues, such as depression or suicidal thoughts, a referral to a general practitioner or psychologist will be made for additional support. If hormonal sensitivity is the primary concern, targeted lifestyle changes will be implemented, along with supplementation and hormonal support.

"There's no magic pill," Martens emphasizes. "You have to work together, because the symptoms are too diverse. Some women, due to poor nutrition, don't have enough nutrients to produce sufficient hormones. Or, due to excessive stress, their body chooses to produce cortisol, which suppresses progesterone production and causes other systems to shut down."

That's why Care for Women offers the VitalFem program: a 12-week program in which women learn to understand their own hormonal system. Topics covered include nutrition, exercise, sleep, cycle awareness, stress reduction, and many practical tips to alleviate symptoms.

The power of such a program lies in self-awareness. Because those who understand how their bodies work are less likely to be overwhelmed by healthcare providers and are more confident.

Unfortunately, there are still persistent misconceptions about PMDD. It's dismissed as pretentious or even labeled "pharmaceutical marketing." Martens points out that this was also the case with PMS in the past, while it's now taken more seriously. Fortunately, that perception is slowly changing. Podcasts, information, and scientific research are raising awareness. Women are increasingly daring to say: "This isn't right. This isn't who I am."

For Martens, it's clear: "We have to stop saying, 'Just learn to live with it.' When you calculate how many days per year—or per lifetime—you're affected by this, you realize: this isn't normal. And you don't have to accept it as normal."

PMDD is a condition that requires professional guidance. The first step is simple: recognize the pattern. The second step is: seek help. And the third: take your body seriously. Martens: "You didn't make it up. It happens in your body. You just don't have control over it yet, but that can change."

Are you thinking about suicide? You are not alone. Contact 113 Suicide Prevention at www.113.nl or call 113 (local rate) or 0800-0113 (free).

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