Premenstrual dysphoric disorder (PMDD) is characterised as a severe, chronic form of premenstrual disorder resulting from an abnormal brain response to normal hormonal changes during the menstrual cycle. Individuals with PMDD experience heightened sensitivity to fluctuations in oestrogen and progesterone, which can trigger debilitating psychological and physical symptoms in the premenstrual (luteal) phase of the cycle.
The condition is characterised by a range of symptoms that recur each month before menstruation and significantly interfere with daily functioning. These may include severe mood disturbances such as irritability, anxiety, depression, and emotional instability, as well as physical symptoms like headaches, fatigue, and sleep disturbances. The symptoms typically improve once menstruation begins, distinguishing PMDD from other mental health disorders that are not linked to the menstrual cycle.
Diagnosis generally requires careful assessment of the cyclical pattern of symptoms, often involving prospective tracking of symptoms across several menstrual cycles to confirm their timing and severity. Because PMDD affects both mental and physical health, management typically requires a multidisciplinary approach involving general practitioners alongside specialist input from psychology or psychiatric and gynaecological services.
Treatment is tailored to symptom severity and may involve a combination of lifestyle measures, psychological support, and medical therapies. Pharmacological options may include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) to address mood symptoms, as well as hormonal treatments aimed at regulating or suppressing ovulation. In some cases, counselling or psychological therapies, such as cognitive behavioural therapies, can help individuals manage the emotional and behavioural effects of the disorder.
In Ireland, there are currently no dedicated national clinical guidelines specifically addressing the diagnosis and management of Premenstrual Dysphoric Disorder (PMDD). Medical practitioners refer to established international guidance when assessing and treating the condition. Clinicians commonly draw on recommendations from the Royal College of Obstetricians and Gynaecologists (RCOG)1 and the National Institute for Health and Care Excellence (NICE)2, as well as other guidance3, which provide evidence-based guidance on the diagnosis and management of premenstrual disorders, including PMDD.
These frameworks outline approaches to diagnosis, such as prospective symptom tracking across menstrual cycles and recommend a stepped, multidisciplinary model of care involving general practitioners, gynaecological specialists, and mental health professionals. Treatment options described in these guidelines include lifestyle and psychological interventions, selective serotonin reuptake inhibitors (SSRIs), and hormonal therapies where appropriate. Surgery may be considered for severe cases of PMDD.
In terms of psychology supports within the community, Cognitive Behavioural Therapy is available as part of a care package for patients with moderate to severe mental illness, with access determined by a treating psychiatrist. Medical card patients can access eight counselling sessions through Counselling in Primary Care.
Where onward referral is required for management, a GP can trigger a referral to an acute gynaecology service, where an appointment will be allocated in line with clinical prioritisation and national outpatient waiting list protocols.
In relation to healthcare professional awareness and training, the Irish College of GPs develops and delivers education on a range of community gynaecology topics including PMDD. Education is delivered in a range of formats from the large-scale webinar to the in-depth skills-based education in blended, modular format. This is CPD education, which is also available to GPs in training. PMDD is included as a mandatory topic in this course. The Community Gynaecology Course promotes effective communication skills in relation to a range of Gynaecological conditions and procedures
The Royal College of Obstetrics & Gynaecology’s published clinical guidelines on ‘Management of Premenstrual Syndrome’, provides clinicians with a comprehensive tool to diagnose and treat severe PMS.
In relation to awareness more generally, I have recently approved funding for the development of a menstrual health awareness campaign which is currently being developed by the HSE's National Women and Infants Health Programme.
The HSE is currently undertaking baseline research to establish the current knowledge and awareness levels in relation to menstrual health. The results of this research will directly inform focus areas for the roll out of this National Menstrual Health Awareness Campaign. Knowledge and awareness of PMDD are included within the scope of this piece of work. It is hoped that broader awareness will encourage girls and women who need advice or guidance in relation to possible signs or symptoms of a (pre)menstrual disorder to seek help early, allowing care to commence in line with clinical guidelines and best practice and in turn improve outcomes and quality of life
I have also approved funding for the HRB Applied Partnerships Award Scheme specifically for Women’s Health. Up to €1 million from the Department of Health’s Women's Health Fund will be made available for the Women’s Health Applied Partnership Scheme for both 2026 and 2027.
Research themes have been determined and are informed by Ministerial priorities, outcomes of various listening exercises with women, the work of the Women’s Health Taskforce and the HRB’s Women’s health outcomes: An evidence and gap map review commissioned by the Department and published in 2025. Menstrual health is one of the priority themes identified and applications are welcomed on all aspects of this area of women's health, including PMDD.
As the first research programme of this kind in the area of women's health, alongside specific themes focused on areas of unmet need, we are also including a general women's health theme. It is hoped that this dual approach will stimulate interest from a wide range of disciplines and open the door towards filling this longstanding gap in women's health research.
The research call went out to the research community in January 2026 with a deadline submission date was the end of March 2026. The HRB received a strong response and assessments are ongoing. We are confident that multiple awards will be recommended later this year.
