King's College London

Premenstrual Dysphoric Disorder (PMDD) is a severe hormonal and mental health condition linked to the menstrual cycle. During the last 7 – 14 days of the cycle – the luteal, or premenstrual, phase – people living with PMDD tend to experience intense emotional, cognitive, behavioural, and physical symptoms, often including suicidality. This is due to a heightened sensitivity of normal hormonal changes in estrogen and progesterone across the menstrual cycle. The impact of PMDD is significant and widespread, meaning that the rest of the month can sometimes feel like you’re left picking up the pieces.^1-3

PMDD affects an estimated 1 in 20 (5–8%) women and people who menstruate, equating to around 824,000 people in the UK.⁴ To put that into context, there is probably at least someone you know living with PMDD – be it in your classroom or lecture hall, in your workplace, or in your social circle. Yet PMDD remains largely unknown. Why?

PMDD sits at the intersection of mental health and menstruation, two areas that have long been stigmatised. As a result, the condition is under-researched, poorly understood, and chronically underserved. Public awareness is low, political interest is limited, and historical resistance is persistent.^5-6 Even in schools, menstrual health education rarely extends beyond the basics of the cycle, leaving conditions like PMDD largely invisible.⁷ These gaps have serious consequences. On average, people with PMDD wait 12 years for an accurate diagnosis as people cycle through healthcare providers, and 90% of cases are initially misdiagnosed, most commonly as bipolar disorder.¹

An Interdisciplinary Approach to Change

At King’s College London, we are bringing together lived experience, clinical and social science, and policy and advocacy expertise to understand how we can improve outcomes for people affected by PMDD. An interdisciplinary approach is essential: PMDD does not fit neatly within disciplinary boundaries. Its mechanisms are biological; its symptoms psychiatric, emotional, and behavioural; and its impacts extend across wellbeing, relationships, education, work, and finances. The barriers to progress are also social and historical.

Our research focuses on how policy and practice can be shaped to improve outcomes and quality of life for people affected by PMDD. We are conducting foundational work, through an evidence review and mixed-methods fieldwork, to systematically identify gaps in existing approaches and opportunities for change.

Many of these opportunities are already well known to those affected by or working with PMDD, and some require addressing wider concerns across women’s health: improving access to timely diagnosis and care, improving clinical guidelines and informing the Women’s Health Strategy, embedding PMDD in medical education, and strengthening systemic support such as welfare provision. Our contribution is to assess such opportunities more closely, to explore which are most feasible and impactful, and to begin to understand how we can take steps towards making these opportunities a reality. Working alongside leading charities, The PMDD Project and Wellbeing of Women, we are also connecting lived experiences to the policy agenda.

Why Now?

This work comes at a critical moment. Public and policy conversations about reproductive and menstrual health are gaining momentum, alongside growing recognition that female biology is a fundamental determinant of health. The publication of the Women’s Health Strategy in 2022 was a welcome step in acknowledging longstanding health inequalities. However, its ambitions have yet to translate into effective clinical pathways, workforce training, or service standards for menstrual health. ^6-8

The recent renewal of the Women’s Health Strategy represents a welcome opportunity to close that gap. It is encouraging to see menstruation prioritised through commitments to streamline gynaecology pathways, reduce waiting times, amplify women’s voices in funding decisions, invest in menstrual education, and establish a Women’s Voices Partnership. The Strategy also adopts refreshingly honest language, explicitly acknowledging the role of medical misogyny in shaping women’s care.⁹

These signals are positive, but impact will depend on implementation. While conditions such as endometriosis and fibroids rightfully receive much-needed targeted attention, PMDD is mentioned only twice with no commitment to action or resources. As the Strategy moves into delivery, there is a clear need for sustained advocacy to ensure PMDD is not overlooked, and to embed it meaningfully within the commitments and reforms now being put into action.

What Comes Next?

Over the next six months, we are integrating interdisciplinary perspectives, connecting lived experience with policy, strengthening PMDD research at King’s, and identifying concrete opportunities for change. By designing research with applied policy in mind, we aim to generate the right evidence, and tell the right stories, to support meaningful progress.

We’ll also be sharing our journey through this blog series. We want to raise awareness of PMDD, be transparent with the PMDD community about how we make decisions in research, and learn from others working in this space. Strengthening PMDD research requires collaboration.

We see this foundational work as a stepping stone towards sustained research and policy impact. As the project develops, we will explore how the opportunities we identify can be taken forward through future PMDD research and policy initiatives. Ultimately, we hope this work contributes to effective care pathways, faster diagnosis, improved care and support, and wider recognition of PMDD – preventing people from falling through the cracks and supporting meaningful change for everyone affected.

If you would like to get in touch about our work, please contact us at pmdd-impact@kcl.ac.uk.

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
2. International Association of Premenstrual Disorders. https://www.iapmd.org/facts-figures
3. Eisenlohr-Moul, T. (2019). Premenstrual disorders: A primer and Research Agenda for Psychologists. Clin Psychol., 72 (1), 5-17.
4. Reilly, TJ., Patel, S., Unachukwu, IC., Knox, C., Wilson, CA., Craig, MC., Schmalenberger, KM., Eisenlohr-Moul, T., & Cullen, AE. (2024). The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. J Affect Disord, 349, 534-540. https://doi.org/10.1016/j.jad.2024.01.066
5. Gupta, S. (2024). The Cycle. Confronting the Pain of Periods and PMDD. New York: Flatiron Books.
6. Marwick KFM, Reilly, TJ., Allan, S., & Golightly, E. (2025). The menstrual cycle: an overlooked vital sign in psychiatry? BMJ Mental Health, 28, 1-4.
7. Women and Equalities Committee. 2026. Menstrual health of girls and young women. https://committees.parliament.uk/publications/51887/documents/287889/default/
8. Department for Health and Social Care. 2022. Women’s Health Strategy for England. https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england
9. Department for Health and Social Care. 2026. The Renewed Women’s Health Strategy for England. https://assets.publishing.service.gov.uk/media/69df6690a68b527bd9408e9a/renewed-womens-health-strategy-for-england.pdf