A pattern that kept repeating
A woman in her early 30s presented with severe and recurring episodes of irritability, intense anger outbursts, depression, negative spiralling thoughts and ruminations, and suicidal thoughts. During the symptomatic days before her period, her mood would change dramatically, leading to frequent arguments with her partner and family, withdrawal from loved ones, and difficulty managing everyday responsibilities.
The symptoms had a significant impact on her relationships. During these difficult days, she would experience intense anger and emotional reactions that she later regretted, leaving her feeling guilty and distressed. Her family struggled to understand the sudden changes in her behaviour, while she herself felt that she was losing control over her emotions.
A previous diagnosis of Bipolar Disorder
She had previously been diagnosed with Bipolar Disorder elsewhere and had received treatment based on that diagnosis. However, a detailed clinical assessment revealed a crucial pattern: her severe emotional symptoms consistently appeared during the premenstrual phase and improved substantially after menstruation began. Prospective tracking of symptoms across menstrual cycles helped clarify the cyclical nature of her difficulties — an important part of evaluating suspected PMDD.
The correct diagnosis: Premenstrual Dysphoric Disorder
The assessment led to a diagnosis of Premenstrual Dysphoric Disorder (PMDD) rather than Bipolar Disorder. PMDD can cause severe irritability, anger, depression, and significant impairment in personal and professional relationships.
What changed with the right treatment
With the correct diagnosis and an individualised treatment plan, her symptoms became significantly more manageable. As the severe premenstrual mood episodes reduced, she was able to rebuild communication with her family, improve her relationships, return to daily activities with greater confidence, and regain a sense of control over her life.
Why timing matters in women's mental health
This case highlights why timing matters in women's mental health. Severe mood symptoms that repeatedly emerge in the premenstrual phase and substantially improve after menstruation should prompt consideration of PMDD, and careful differentiation from other mood disorders. Prospective daily symptom tracking over at least two symptomatic cycles can help establish the characteristic pattern.
If your mood shifts dramatically in the days before your period and settles once it starts, it's worth having that pattern properly assessed. To read more about PMDD symptoms and treatment in general, see our blog post Premenstrual Dysphoric Disorder (PMDD): What You Should Know.
Dr. Swetha Reddy. S
MBBS · DNB (Psychiatry) · Consulting Psychiatrist, Co-founder & Director at Synapse Mind Clinics. Read full bio →
