Premenstrual dysphoric disorder severely affecting up to one in five Australian women
Alannah Bercys can sleep up to 13 hours a day and can hardly string a sentence together for half the month. Here’s her story.
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‘It’s like leading two different lives.”
That’s how Alannah Bercys describes living with premenstrual dysphoric disorder (PMDD).
For about half of every month, the 27-year-old descends into a fog of fatigue, depression, paranoia and pain.
“I basically cannot function,” she explains.
“I will nosedive into a very poor mental health state. I can barely put together sentences sometimes, and can sleep up to 13 hours in one go. It’s like clockwork; on time, every time. Then, as soon as I bleed, the symptoms disappear completely.”
Bercys is one of an estimated up to 20 per cent of women of reproductive age who experience premenstrual dysphoric disorder (PMDD). It is a severe form of the more commonly-known premenstrual syndrome (PMS) which can have life-threatening effects on sufferers, but it is believed to be underdiagnosed.
In the worst cases the emotional rollercoaster can prompt feelings of hopelessness and thoughts of suicide.
There is usually a rapid onset of symptoms in the seven to 10 days of a woman’s menstrual cycle leading up to her period, as levels of hormones including oestrogen fall.
The exact cause of PMDD isn’t settled but it is understood to affect women who are more sensitive to these hormonal changes in the brain. That sensitivity can be something they struggle with from their very first period, or it can be triggered by a stressful event, trauma or even pregnancy and childbirth.
While PMDD isn’t as well-known or common as PMS it has some high-profile connections.
Love Island Australia host Sophie Monk, TikTok star and singer Dixie D’Amelio, US-based Grey’s Anatomy actress Camilla Luddington and UK reality TV celebrities Vicky Pattison (I’m a Celebrity UK) and Kristina Goodsell(Married At First Sight UK) have all spoken publicly about living with the condition.
Australian Married At First Sight celeb, and now co-host of Kidspot podcast The Juggling Act, Jules Robinson says that her symptoms really became obvious after the birth of her first child, Oliver, in 2020.
“I am next-level, totally different to who I am on a normal basis,” she says. “It’s not a nice feeling. I naturally am a very happy, upbeat person and then to literally go, from one day to the next, you can’t get yourself out of that hole.”
On another podcast, Call It What It Is, Luddington also shared how she noticed an escalation in symptoms after the birth of her son in 2020. “It basically is PMS on crack,” she told co-host and fellow actress Jessica Capshaw.
“I can feel myself slipping into a depression and I didn’t understand what was happening. So every single month … I’ll be like something’s really wrong and I’m really sad.
“And then I would come out of it. It’s kind of helpful to know that I’m going to come out of that, now that it’s been named for me, but it is still hard every month.”
So what do you do if you think you, or someoneyou love, may be grappling with PMDD? Diagnosis is based on evidence of at least five symptoms consistent over multiple menstrual cycles.
There must be a clear onset of at least one core symptom in the week or two leading up to menstruation, such as irritability or anger, anxiety, depressed mood and feeling suddenly tearful or increasingly sensitive to rejection.
There must also be evidence of at least one of a list of other symptoms including difficulty concentrating, lack of energy, trouble sleeping, overeating or specific food cravings, a sense of being overwhelmed or out of control, and physical symptoms such as breast tenderness, joint or muscle pain and bloating.
The onset time frame may vary for women who have longer or less predictable menstrual cycles so it can be helpful to track symptoms for a few months using an app or written log.
Symptoms must be severe enough to interfere with day to day living, such as study, work, socialising or relationships. And a health professional will need to establish that the symptoms are not more likely to be caused by another physical or mental health condition.
For Bercys, the PMDD symptoms began when she was about 17 but the Adelaide human resources professional only learned about the condition at 24.
“People are severely misinformed or blissfully ignorant about it,” she says. “(But) it’s not a joke. It’s real and it’s exhausting.
“People’s marriages can fall apart, child-parent relationships can be strained, people’s livelihoods can be at risk due to workplaces being unsupportive.
“People may end their life over this illness because of the long-term struggles.”
Abbey Spranaitis, also from Adelaide, has experienced those extreme lows.
“At my worst I had suicidal thoughts,” the 26-year-old says. “I couldn’t drive without considering whether it would be better to drive into oncoming traffic or into a tree.
“Ten days before my period I was depressed, very irritable, very intolerant, snappy and just downright an awful person to be around.
“The only relief from this was one week between my period ending and my luteal phase (of the menstrual cycle, before ovulation) beginning.”
Spranaitis realises now that she was affected by PMDD from her first period, but the veterinary nurse only discovered the condition while scrolling TikTok in 2020.
“It was a video that explained the symptoms and that it was more serious than ‘just PMS’,” she recalls.
She identified with common symptoms including “extreme irritability and anger, impatience, emotional sensitivity, rejection sensitivity, headaches, muscular pain, fatigue, excessive sleeping and binge eating”.
“The physical symptoms can leave me in bed sleeping for most of the day.
“The psychological symptoms can make me extremely emotionally sensitive to things that normally don’t, and it takes me a long time to come out of it.”
After speaking with her GP and tracking her symptoms for four months Spranaitis received the diagnosis. But this wasn’t a magic fix.
“Since then I’ve seen numerous specialists, therapists and my GP thousands of times,” she says. “I’ve tried a range of contraceptive pills, (antidepressant) SSRIs, contraceptive internal devices, vitamins and therapies.
“It’s something I’ve had medical professionals seem to not understand. It wasn’t until I mentioned how severe the suicidal ideation was that they took me seriously. I believe PMDD is more prevalent than we think, there’s just a lack of education surrounding it.”
A 2025 survey of more than 920 Australian women by The House of Wellness found 55 per cent had never heard of PMDD.
The condition was only recognised as a depressive disorder in the global Diagnostic and Statistical Manual of Mental Disorders in 2013.
In May 2019, the World Health Organisation (WHO) acknowledged it as a legitimate medical diagnosis, adding it to the International Statistical Classification of Diseases and Related Health Problems (11th revision).
Both Bercys and Spranaitis say they had to research the condition themselves and raise it with their doctor before getting any clear answers. They want PMS and PMDD included in sexual health education for all children in schools.
Australian Professor Jayashri Kulkarni, an expert on women’s hormones and mental health, is leading work to raise awareness among health professionals.
The director of Melbourne’s Multidisciplinary Alfred Psychiatry Research Centre (MAPrc) is pioneering investigations to better understand how to diagnose and treat PMDD. In 2024 MAPrc and HER Centre Australia (which stands for Health, Education and Research, and is also headed by Kulkarni) announced work on “hormone treatments and new brain stimulation approaches” for the condition. Kulkarni stresses that while PMDD might be triggered by so-called sex hormones like oestrogen, progesterone and testosterone it must be treated as “a brain disorder” because it is in the brain that changes in levels of these hormones can affect our mood.
PMDD is widely reported in medical journals as affecting between about three and nine per cent of women of reproductive age. However Kulkarni is quoted as saying it is more likely to be up to 20 per cent.
Writing in a guide for doctors in 2020, she stated: “There is no single clear theory that explains exactly which hormones trigger specific neurochemicals – or why only some women experience PMDD.”
While lifestyle changes such as diet, exercise and improving sleep can help with PMS symptoms Kulkarni stresses that these are not enough to address the severity of PMDD on their own. The most common treatment options currently are the oral contraceptive pill (although some have been found more effective, while others have been shown to exacerbate symptoms), antidepressant medications and hormone replacement therapy.
For those living with PMDD, the symptoms areonly part of the problem; there is also the hangover effect.
In the weeks when sufferers are most affected they may do or say things they regret, in the grip of mood swings that feel impossible to control. There is fighting with partners and shouting at the kids. They may spend days in an unproductive slump and fall behind on paid work and housework, ignore social invitations and withdraw from friends and family.
One woman described it as like “sinking down a black hole and then the subsequent scrambling to try to recover”.
Another said it felt like having to “start over each month after a lost week”.
When sufferers come out the other side there can be lasting effects, especially if the people around them don’t understand the condition. “Unfortunately I’ve lost friendships over PMDD symptoms and misunderstandings,” Spranaitis says. “I find I tend to push people away then things feel bad and I eventually end up exploding with emotion. I’m lucky to have an extremely understanding and wonderful partner.”
Bercys says one of the hardest parts of managing PMDD is “the self-loathing, shame and guilt over not being able to function”. “It’s frustrating and upsetting to know it’s coming again and you can’t do anything about it. When someone has PMDD the worst thing for them is feeling guilt for not being ‘normal’, for having irrational outbursts or disassociating.
“We shouldn’t be shamed for having a period, for having hormone-related effects on our mood and bodies. We aren’t making it up or trying to get out of doing our day-to-day responsibilities. We’re just trying to do the best we can with our circumstances.”
“It is very much not ‘just’ PMS.”
Cassandra Ellis loses a handful of days each month. Life stops because she is down a deep, dark hole. For the Darwin-based 46-year-old PMDD steals these days with relentless regularity.
“I almost always need one to four days off work each month,” she says. “I generally spend a couple of days in bed, basically non-functional. The deep hopelessness is real and it does feel permanent and like there’s no way out.
“I spent most of my life not knowing that this was (menstrual) cycle-related so I thought it was just random and unpredictable.
“Now I know (that it is PMDD) one of the most helpful things to get through it is that I can remind myself it’s chemical … and it will pass.”
Ellis was diagnosed about three years ago but remembers struggling from the time of her first period, which arrived at age 12. On reflection, she thinks some of the symptoms may have been worse in her teens, before starting hormonal contraception.
These days, PMDD brings crippling fatigue, body aches, bloating, nausea, tears and paranoia. Then there are the intrusive thoughts: No one likes me. My life is pointless. And the rage: “I am so wildly angry. Embarrassingly, I do sometimes lose my temper in stupid, irrational ways during this time.”
Like the day the long-time lawyer threw and smashed a jar of protein powder in her office. Or the time she yelled at a man driving through Darwin’s CBD because he was about to run over a stunned kingfisher bird on the road. “He somehow didn’t see me running and yelling and he ran over it and killed it in slow motion,” Ellis recalls.
“I completely lost it and screamed and swore at the top of my lungs … at a main street intersection. Not a good look.”
Before being diagnosed with PMDD, Ellis experienced these periods of intense emotions as “valid” at the time, but in hindsight was “often unable to comprehend why I felt so strongly or responded in such an extreme way”.
“It took me a long time to put together a pattern where I’d get my period and then suddenly be like ‘Oh, now I’m happy and calm and life feels fine again.’”
These days Ellis, who also has the gynaecological condition endometriosis, has made herself a “very comprehensive care plan” for managing the descent into PMDD. It includes exercise like walking and yoga, meditation, certain supplements, “heaps of water” and – most importantly – cutting herself some slack.
“Maintaining work is extremely hard on me during the bad times so all I can do is kind of barely scrape through … then come home, go to sleep and repeat,” she says.
“My brain and body just feel heavy and slow. Everything is a massive effort. I have a few friends who suffer similarly and it is helpful to have the experience (of PMDD) validated by those who understand.”
Ellis wants others to know that PMDD is “very much not just PMS … in the way that people joke about ‘that time of the month’. I wish it was more widely known and accepted that this is a real condition, and it’s horrifically debilitating,” she says.
“Very few workplaces offer reproductive leave or any kind of accommodation for the 50 per cent of their workforce who may need it. There is very little awareness (of PMDD) even among the medical fraternity.
“I am sure it probably affects so many more people than is known.”
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Originally published as Premenstrual dysphoric disorder severely affecting up to one in five Australian women
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